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