Vitamin K injection and Antibiotic eye ointment are given routinely to all babies born in US hospitals without considering individual situations. In some states you can refuse, in others it’s the law and they can report you to Child Protective Services - but these organizations have bigger problems to deal with and often the case is dropped after some unnecessary stress and aggravation. We don’t have these laws in most homebirth settings.
The antibiotic eye ointment is to prevent sexually transmitted infections gonorrhea and chlamydia that could cause blindness in newborns after exposure in birth. It is given within the first hour of life during the most alert time of baby after birth, interfering with vision at such a sacred crucial time when initial bonding and breastfeeding take place. It is irritating to baby and disrupts the delicate balance of flora in their eyes which can lead to other infections. Needing to give antibiotics is not relevant to babies born to mutually monogamous parents who do not have these infections. Taking into consideration that one may not know for sure there is another secret partner, these infections can be tested for in a pregnant mama at term, and if negative, the antibiotics can be refused in good faith. If you do test positive for one of these sexually transmitted infections, you and partner can be treated and retested to see if cured, but it may be wise to consider the antibiotics for baby’s eyes, since exposure can happen again. Then you can delay the medication until after you and baby look into each other’s eyes, have some time for bonding and breastfeeding.
To give vitamin K to the newborn within the first hour of birth is to prevent a rare but serious blood clotting disorder called vitamin K deficiency bleeding (VKDB). There is an early onset VKDB that happens within the first 24 hours, classical expression in 2-7 days, and late onset that usually occurs in 3-8 weeks of life. Our bodies need vitamin K to help the blood to clot when needed. Giving it to babies at the recommended dose via injection is currently evidenced based care, but still not a simple matter.
The American Academy of Pediatrics opines strongly in favor of it. The current evidence does support the injection, saying there is little risk other than rare potential allergic reaction, and that the benefits far outweigh the potential risks. The injection is mega dosed, with 20,000 times the amount new baby has at birth, 5000 times the recommended daily allowance. It is injected into the muscle, which is a more rapid route than oral. In its synthetic form, it is considered a class C drug which means its safety is unknown in pregnancy, risk cannot be ruled out, there are no satisfactory studies in pregnant women, but animal studies demonstrated a risk to the fetus or potential benefits of the drug may outweigh the risks. The package insert itself warns that it can cause sometimes fatal allergic reactions when injected into a muscle or vein, and is ideally take by mouth or injected under the skin. The synthetic medication contains concerning chemical preservatives. It is available, but not accessible in most hospitals without the preservatives, but the preservative free vitamin K still does have some chemicals to increase absorption. It is also concerning to ponder the impact of overdosing on a fat soluble vitamin that stays in the system, as opposed to water soluble vitamins in which excess is excreted out in the urine.
In formula fed babies, the risk of VKDB is negligible as the formula contains synthetic vitamin K. For babies who breastfeed, an alternative is the oral form of vitamin K, in which some protocols have not been as effective as the injection in preventing VKDB - although some of the increased risk was related to parents not administrating of all the doses. Vitamin K using the Danish protocol is just as effective at preventing VKDB, though not accepted by modern medicine and hospital practice in the USA. Several European countries have a licensed oral vitamin K available with varied protocols, for those who wish to decline the injection, which is most effective according to the research to prevent vitamin K deficiency bleeding in babies. Except the Danish protocol. The Danish protocol is preferred as it seems to be just as effective as the injection according to the studies. It is vitamin K1 - phytonadione: 2 mg orally at birth, the 1 mg once weekly for 6 months as long as breastfeeding is greater than 50% of the baby’s diet. As it is a supplement in the USA, it is not regulated, FDA approved or certified like the injection made from pharmaceutical companies, for preventing VKDB in new babies. That does not mean it is not effective or unsafe. Still many who decline the injection prefer it as a viable alternative. Finding it in the states can be a challenge, but some homebirth supply companies and midwives carry it. If doing this protocol, best to do with a feeding as vitamin K is fat soluble, to increase absorption.
Little research is available on the alternatives, such as breastfeeding mamas eating more vitamin K or supplementing (like with 5 mg daily) to boost levels in breastmilk and prevent the rare vitamin K deficiency in newborns.
But as with all other routine interventions in the entire healthy normal physiological process of having a baby, the more we study, the more we find their lack of benefit and increased risk, and that mother nature or the Divine intelligence that created it all did not get it wrong. Maybe there is a reason we do not know yet why newborns are born with low vitamin K that does not reach optimal levels until the eighth day of life, from the gut flora. Is it a deficiency if they are all born that way? I defer to Dr. Sara Wickham who has analyzed the research for over 20 years and even wrote a book on this subject alone. “Several thousand babies need to be given vitamin K in order to prevent each case of vitamin K deficiency bleeding (VKDB), a disorder formally known as hemorrhagic disease of the newborn. Unfortunately there is little research interest (as is so often the case) in questions such as 1- how we might be able to pick out the babies who are truly at risk rather than giving the universal prophylaxis and 2- whether and why it might benefit babies to have a relatively low level of vitamin K compared to adults.”