Dear Julie,

I totally agree with promoting thinking about interventions and deciding
whether they are needed or not.  Beeing a home birth mom myself (just 3
weeks ago) I have gone the same route to eliminate all unnecessary
interventions for my baby and me.  My midwives were very helpful at
keeping me honest!!!  I have therefore reviewed the vitamin K issue
because there was great debate in our classes about the necessity and
efficacy of the vitamink.  I found several articles one of which I think
will be helpful
Reference:  Lancet 345, january 24 1995 by shearer pp229-234

Vitamin K as you know serves at forming the clotting factors in the
blood.  In Adults and older kids deficiency usually not a life threat.
However in babies deficiency can be accompanied by spontaneous bleeding
in particular intracranial bleeding.  Prophyllaxis was introduced in the
50's and pretty much wihtout questions.  lately, concerns raised about
cancer and IM vit K.

Vitamin K comes from the food we eat such as green veggies, legumes, some
oils,.....  also comes from bacteria in colon which synthetises it
(problem for babies without established flora)

Risk and benefits of prophyllaxis:  as you pointed out hemorrhagic events
are very rares.  (I shiver when you say that no vitamin makes drawing PKU
easier... I hear clots slower!!!!).  There are 3 times of occurences of
the bleeding:
1. Early 0-24 hours, frequently related to maternal drugs affecting vit k
in baby (ie warfarin)

2.  Classic 1-7 days:  usually GI, skin and circ

3.  Late  2-12 weeks:  usually intracranial and gi bleeding.  sometimes
related to other diseases such as liver problem.

The problem with hemorragic disease is not its frequency (between 4.4 and
72 per 100,000 live births) but its
severity!.  If bleeding occurs it is likely to be Intracranial (50%) and
cause severe brain damage or death!  Breastfeding exclusively is viewed
as a risk for increased incidence because af low concentrations of vit k
in hm.

Oral versus IM:  recommendations in this country is IM because the levels
stay higher longer compared to oral.  If oral route is chosen, you must
use repeated doses,(I believe one at birth, one at one week and one at
4-6 weeks) especially for exclusively BF children.  Reasons to
chose oral is because of the possible higher risk of cancer in kids who
got the IM dose.

So in conclusion,  I think that in the experience of the home birth
community it is true that the disease is infrequent,  however there is no
way to determine who is more at risk (except for BF) and if it happens, a
hemorrage can have devastating consequences for the baby.  So I chose to
give it to my children.  Mine got 3 oral doses but the jury is still out
on IM and cancer since for every article saying yes another says no!!.

I hope this makes sense to all of you and I would urge you to review the
reference I gave you and possibly review your recommendations on vit k.

Sorry for this long post!
Maryelle