Natural Child Birth

Many parents have concerns and questions about the numerous
requirements around giving birth in the hospital or at birthing centers. Here
are a few issues discussed in detail that my families ask about and you might be
wondering about too:

Hepatitis B Vaccine
This is currently the only vaccine offered to newborns, and the reason for its
inclusion dates back to when routine testing for Hepatitis B in the mother
was not widely available or utilized. The risk of contracting Hepatitis B is
minimal for newborns, unless the mother is positive for Hepatitis B, since
it is a virus that can only be transmitted through the blood. Major concerns
in the past were related to the ingredient Thimerosal (a Mercury-based
preservative), but this has been phased out since 2003. Most parents are
not excited to give their newborns vaccines, and wanting to avoid this
one is understandable, as the risk of catching it is close to zero. A needle
stick, sexual abuse or blood transfusion would be the only ways a newborn
could contract this virus. Besides, the Hepatitis B vaccine has one of the
highest rates of adverse events reported to the Vaccine Adverse Event
Reporting System, which is a national vaccine safety surveillance program
co-sponsored by the Centers for Disease Control and Prevention (CDC) and
the Food and Drug Administration (FDA). Some parents report to me that
they were never given a choice and their child was vaccinated without their
consent. Do not let this happen to you. This is your child, and depending
on which state you reside in, you have a say in whether your child gets this
vaccine.

Newborn Screening Test
This test is used to screen your child for congenital diseases that, if not
treated, could lead to brain damage or even death. I suggest this to all my
patients. The test is completely safe for the child and could save their life!

Newborn Hearing Test
Hearing in the newborn is well developed at birth, and so much language
development occurs in first 6 months; Infants can start saying “Mama/Dada”,
they can combine syllables, and jabber by this time. Therefore, in order to
give the best advantage to your child, it’s important to know if they have
normal hearing. The risk for congenital (newborn) hearing loss is about
1: 1000, and even higher in Hispanics & the poor (Mehra, 2009). This rate
is much higher than most of the diseases we check for on the Newborn
Screening test, which makes it just as important for your child. If you don’t
think that your child is at risk for newborn hearing loss because mom and
dad have perfect hearing, think again: 90% of children w/congenital hearing
loss have parents with normal hearing!

Vitamin K
This is given at birth, usually in the form of a shot, to prevent “Hemorrhagic
Disease of Newborn”. This means the baby can have serious bleeding
somewhere in the body. Some parents choose to use oral vitamin K drops,
because they don’t want to give their child a shot so early in their life. There
are some pros and cons to discuss here. Getting the oral vitamin K may not
be as protective as the shot, but does decrease baby’s risk of hemorrhage
nonetheless. Concerns with the shot came from some research in the past
that spoke of a possible connection between Leukemia and the vitamin K
shot. The connection may be related to phenol, a carcinogenic ingredient
found in vitamin K shots, which was reported in the journal “Gulf War &
Health” to be linked to cancer and leukemia. However, many physicians say
that the studies are inconclusive, and that the shot is safe. What needs to
be created is a Phenol-free vitamin K shot, which would alleviate concerns
of parents. New Zealand, Australia and Canada all have oral vitamin K
guidelines, which include at least 3 doses spread out over 4-6 weeks. Consult
with your physician on dosing for your child. The American Academy of
Pediatrics in 2003 stated:
“The rate of late Vitamin K Deficiency Bleeding (often 
manifesting as sudden central nervous system [CNS]
hemorrhage) ranges from 4.4-7.2 per 100,000 births
[.004-.007%], according to reports from Europe and Asia.
When a single dose of oral vitamin K has been used for
neonatal prophylaxis, the rate has decreased to 1.4-6.4
per 100,000 births.” [.001-.006%]

It is important to note that 30-50% who get CNS hemorrhage die
or have lasting brain damage, so this is not an issue to take lightly.

Here is the American Academy of Pediatrics statement in 2006: “Prevention
of early vitamin K deficiency bleeding (VKDB) of the newborn, with onset at
birth to 2 weeks of age (formerly known as classic hemorrhagic disease of
the newborn), by oral or parenteral administration of vitamin K is accepted
practice. In contrast, late VKDB, with onset from 2 to 12 weeks of age, is
most effectively prevented by parenteral administration of vitamin K.
Earlier concern regarding a possible causal association between parenteral
vitamin K and childhood cancer has not been substantiated. This revised
statement presents updated recommendations for the use of vitamin K in the
prevention of early and late VKDB.

For your own information, here are the studies implicating the vitamin K
shot and leukemia:

• Golding J, Paterson M, Kinlen LJ. Factors associated with childhood
cancer in a national cohort study. Br J Cancer.1990; 62 :304 –308

• Golding J, Greenwood R, Birmingham K, Mott M. Childhood cancer,
intramuscular vitamin K, and pethidine given during labour. BMJ.1992;
305 :341 –346

• This is used to protect the baby from contracting gonorrhea or chlamydia
from the mother if the child is born through the birth canal. Gonnorrhea
will almost always show symptoms in the mother, but chlamydia can
show no signs of infection. The original concern was that these diseases,
if untreated, can cause blindness in the baby. However, this occurred
at times when we did not have antibiotics developed and widely used 
if a child did contract this disease. However, we do have antibiotics
now for it. Mom should be tested for this and as long as the couple is
monogamous (and honest!), there should be no risk of these diseases in
the child as long as mother tests negative. Some parents have a concern
that there is a decrease in bonding with mother and father because they
have the ointment in their eyes and this would not allow the child to
catch the first glimpses of their parents. This is a reasonable concern that
should be respected. The bond in the first few hours of life is critical and 
important.

These are some of the big topics I come across in my practice and find myself
repeatedly answering. I hope they helped!