baby - Stockport Birth Services

Vitamin K & The Newborn

V I T A M I N K A N D T H E N E W B O R N

Babies are born with proportionally low vitamin K. We don’t know why yet, although there’s a few theories that it could be due to babies being born without all their systems fully functioning, or some kind of residual consequence of some other mother-baby mechanism. As mothers need to be intaking high doses of vitamin K for it to pass through breastmilk in sufficient quantities to protect their baby it seems unlikely to be an evolutionary response although my anthropological days were left behind at uni so, I may well be wrong.

Vitamin K helps blood to clot and prevent uncontrolled bleeding. Due to low vitamin K in babies, they’re at risk of something called ‘Vitamin K Deficiency Bleeding’ or VKDB. Some of these at risk babies have known risk factor but about a third don’t. This includes what type of birth the baby experienced, as it had been mooted at one point that assisted deliveries and caesareans increased the risk.

We started giving babies vitamin K after a Swedish study in 1944 was released which showed a 5 times reduction in newborn deaths of 2-8 day old babies due to uncontrolled bleeding. Manufacturing and commerciality interests pushed the dose given higher which triggered their own problems in the baby, so the dose was reduced back down and remains at 1mg although this is still twice as much as was given in the original study. At this time it was only being given to babies with suspected risk factors of bleeding, however in 1978 a study was released which discovered that late onset VKDB was a problem for exclusively breastfed babies and very quickly it became policy to universally offer to administer vitamin K. A small study did indicate that parents who refused to give their babies a vitamin K dose could raise the levels of vitamin K sufficiently to pass through breastmilk at protective quantities by the mother taking a supplement of at least 5mg daily.

Vitamin K is usually given via one injection within 24 hours of birth, although parents have the option to have oral doses given instead. If given orally this is done over the course of 3 doses, 2 of which are normally given to the parents to give at home. Side effects of the injection are a potential allergic reaction to the ingredients, or a small reaction at the site of the injection, plus of course a small amount of pain when carrying out the injection itself. The oral dose isn’t quite as effective at minimising the risk of VKDB and there’s the potential for further doses to be forgotten to be given in the sometimes chaotic environment of a newborn household.

One of the concerns some parents have about vitamin K doses is that a 1992 study was released that indicated an increased risk of cancer in children. Helpfully most UK health authorities and authoritative bodies made no official statements to help families make their decisions but instead fence-sat and passed the buck spectacularly to parents. Further studies showed that the risk of tumours remained the same whether children received vitamin K or not, however remained unclear about the increased risk of developing leukaemia. However, the most recent studies and reviews have concluded categorically that there are no links between vitamin K and an increase of cancer of any types.

So what are the actual statistical risks we’re looking at? The most recent studies show the numbers as follows:

Untreated babies risk of developing VKDB: 4.4-10.5 per 100,000
Oral treatment: 1.4-6.4 per 100,000
Intramuscular treatment: 0-0.62 per 100,000

Although small risks anyway, by choosing vitamin K to be given by injection the risks are all but eliminated.

If you choose to decline vitamin K there are things that you should watch out for in your baby. These are:

Active bleeding from the nose, mouth, gums, umbilical stump or any treatment site (heel prick test for example)
Blood present in urine, faeces, or vomit
Unexplained bruising or bigger than expected bruising (at a vaccination site for example)
– The fontanelle (soft spot of the head) appearing different to normal (which could indicate bleeding on the brain)
If baby starts acting differently; although this is a particularly difficult one as baby’s not been around long enough to have a ‘norm’.

As an aside, some trusts will refuse to divide a tongue tie if your baby hasn’t received vitamin K, so something to bear in mind.

As ever, this is my interpretation of what I’ve read and understood, and so any mistakes are my own only. My resources for this topic are below.

NICE Guidelines

Evidence Based Birth

Article with paediatrician E Hey in BMJ

You and Your NICU Baby

Having a baby in nicu is a strange old time in ways that many people don’t get.

You become fiercely protective of them but you have to put your trust in others to look after them.

You often have to inhibit your natural instincts to hold and comfort them because they need more treatment than you can give. You’re often told when to cuddle, when to feed, when to visit…but they’re YOUR baby and they need you there more than ever.

You need to be looked after because you’ve just given birth but you don’t want to spend time thinking about yourself, only your baby.

Life moves on outside the artificial environment of nicu and you don’t feel quite like you belong with all the bright lights, noises and people…but you don’t feel quite like you belong among the doctors, nurses and equipment either.

We were lucky. Our time in nicu was short and either through family-friendly practice or our own sheer bloody mindedness we didn’t leave the unit. Other people aren’t in the same position and the impact on their lives, minds, attachment is immeasurable.

What On Earth Is The Fourth Trimester?

I wrote this blog post for The Daisy Foundation all about what the fourth trimester is and how you can help yourself in that time.

The chances are that if you’re a new parent you’ll have uttered one or more of the following phrases; “my baby will only sleep on me!”, “my baby hates their cot!”, “my baby will never be put down!”, often alongside an existential crisis and the idea that you don’t know what you’re doing, you can’t do this, you’ve broken your baby and that you’re a rubbish parent. You ask and search around for help and the nagging doubts you have of yourself – that you’re not parenting in the right way – are cemented because so frequently these questions are packaged as a problem to be overcome, to be worked on, to fit in to the “good baby” narrative that is so frequently forced on new parents (and yes, from which many so-called ‘experts’ exploit new parents into shelling out many, many pounds).

Yet picture, if you will, the life your baby has had while growing inside the womb. Dark within the confines of your uterus, warm and protected by your body, comfortably hammocked, rocked by your movements, the swoosh of amniotic fluid in their ears. Their every primal need met instantly by your body that they’re connected to. Then they are born. The world is a vastly different place to everything they have known to this point. Temperature changes, the feel of nappies and clothes on their skin, sights, smells, feelings of hunger and thirst, all these wonderful things we take for granted in this world are brand new sensations for babies. When you appreciate this, you suddenly take in the enormity of life as a newborn and understand why babies cry to be held close by you, to be nestled in your warm embrace, able to smell you and hear your familiar heartbeat. Wanting to be with you is not a problem to be fixed; what baby is biologically designed to need is often not what our environment and culture encourages.

If we look at and treat the first three months of a baby’s life as a transitionary period, the so-called fourth trimester of pregnancy, a lot of the heartache and pressure we place upon ourselves as parents can be reduced. If we understand antenatally that when baby appears we must treat them as though they’re still in utero, that terrific pressure of wondering why our baby won’t be put down, why won’t he sleep in his cot, what am I doing wrong will disappear. You are not doing anything wrong. Your baby is behaving exactly as he should. You’re doing a great job. Let’s repeat that, because it’s so very important. You are doing a great job by tending to your baby’s needs.

There are some great ways of replicating that womb-like environment for a baby, many of which help to soothe him, reducing crying, and reducing the effect of their crying on you. Because let’s not forget how important you are in this picture. A phrase which is uttered almost as often as “my baby won’t be put down” is “a happy baby is a happy mom” and it’s certainly true that if a baby is crying your own stress levels will rise, making it more difficult to understand and react to what your baby is trying to communicate with you. But remember, none of these are guaranteed to work all the time for all babies because every baby is different and will react in different ways at different times.

Movement: Your baby is used to moving when you move. Which is why so many will be soothed to sleep by the gentle rocking motion of a car or pram, and why so many parents have developed their own baby-sway which is often so well-used that you can see it in practice when baby isn’t even with them!

Noise: Forget the lullabies and soft music: anything that mimics the swoosh of amniotic fluid will help soothe your baby best. So some serious SHHHHHHing, the hoover, Ewan the Dream Sheep or one of the multitude of YouTube videos.

Water: A nice deep bath mimics the feeling of the amniotic fluid around your baby while they were inside you, and can soothe (or at least distract!) from a troubled soul. Even better if you or dad can get in the bath with them as the skin-to-skin contact will do wonders for both of you.

Sucking: Sometimes a baby is cross because they’re hungry, so it’s important to be led by their feeding cues rather than a schedule, whichever way you choose to feed them. But sometimes babies crave non-nutritive sucking, similar to when they suck on their own fingers in utero. If you’re breastfeeding offer the breast even if you don’t think baby is hungry, and if you’re bottle feeding try a dummy or a clean finger.

Babywearing: Slings and carriers aren’t just a good way of not getting the pram muddy when you go for a walk! They’re a really useful tool to enable you to keep your baby close-by while you go about your day. Research has shown that babies who are carried in slings cry less than their non-slinged counterparts, not just while they’re being carried but throughout the day. That’s a pretty compelling reason to babywear, right?

Skin-to-skin: Not just for the golden hour after birth, but helpful at any age. Skin-to-skin contact can help regulate your baby’s temperature, regulate their breathing and heart rate, reduce stress hormones (in both of you!), and can boost oxytocin (the love hormone) production in you both.

Co-sleep: 50% of babies in the UK bed-share at some point before they are 3 months old. Many because their parents recognise that they will both get better sleep when they’re close to each other. Make sure that this is planned, and safe.

Many of these methods of recreating the womb-like environment for baby can be used in conjunction with another. Sometimes one will work where it didn’t yesterday. Dad may find one works best for him while you find another works best for you. All of this is ok. These are tools to add to your growing parenting toolkit and nothing will unilaterally work for all babies and all parents in all situations. And that’s ok. Enjoy your fourth trimester <3

All About The Postpartum: Your Postnatal Recovery

I wrote this blog post for The Daisy Foundation all about what the postnatal period is, and you can help yourself feel better during it.

What is the postnatal period?

The postnatal period is roughly those first 6 weeks following the birth of your baby during which you start to recover physically and emotionally from giving birth. And I say start because although, as we’ll see, there’s an expectation that women heal quickly if not immediately, research has been conducted which shows that women aren’t healed for up to a year – even with a straightforward, low-intervention birth.

What happens during the postnatal period?

If you’ve discussed your postnatal period with your midwives, it’s likely that you’ll have focussed on those first few days following the birth of your baby.

This conversation will probably focus on the care you’ll receive in those first couple of weeks. In the immediate days following birth you will be monitored for bleeding, bowel and bladder function, that feeding is established and that you know how to care for your baby. If you give birth in a hospital the average stay for a vaginal birth is 1-2 days, and for a caesarean section 3-4 days, although if you’re well and choose to leave you could leave hospital within a couple of hours if everything is as it should be. Therefore a lot of that initial monitoring will be carried out in hospital. Midwives will then visit you at home following an individualised care plan and then your care will be transferred over to the Health Visiting team. This will be at around day 10 but might be later if there’s a need for you to stay under the midwifery team.

As your baby gets a little older you will start to see your health care professionals less frequently – this doesn’t mean that they aren’t still there for you though, you can contact them at any time if you have concerns.

Mentally the postnatal period is important too. There’s a transition time between not being a mother and being a mother. Your body is physically transitioning and your mind is transforming too – it can be such a big event that there’s even a psychological label that can be applied ‘Adjustment Disorder’.

Why is it so important? All that matters is a healthy baby.

So what’s so important about this time? Well, it takes this long for your body to start to heal. Even with a straightforward delivery your body has been through some really big changes; growing in size, making new organs, increasing blood volume then releasing baby during delivery, getting rid of the placenta, the extra fluid, lactating…it takes a lot of hard work from your body. And that’s not to mention any other related discomforts such as Pelvic Girdle Pain or gestational diabetes! But a healing body isn’t the only thing.

You will have heard many people say ‘all that matters is a healthy baby’ when talking about birth but is this true? Does this diminish what a mother goes through in having a baby, and all that comes afterwards? Mothers matter too. The postnatal period – that first month and a half – is the time when a woman is particularly vulnerable for developing post-natal depression. So it’s especially important that a woman is supported both by healthcare professionals and other people in her life, to ensure that if she starts developing signs and symptoms of it, she’s well looked after in the most appropriate way. Around 10% of mothers (and 4% of fathers) will develop PND and it’s thought to be a number of factors coming together rather than there being just one cause. These include having previous mental health issues, feeling unsupported by partner, family and friends, having a birth they feel was traumatic, struggling to breastfeed and being exhausted. If you think that 25% of women suffer mental health issues in their lifetime, 40% would describe their birth as traumatic, and 59% don’t breastfeed for as long as they would initially hope to – highlighting a lack of support to help them breastfeed successfully – you can see that the postnatal period is a really important time to be supporting a mother.

What do women do in this time?

Having seen the importance of the postnatal period to ensure that moms are physically and mentally looked after and healing, what do we as a society think or expect mothers to be doing in the postnatal period?

When baby’s born, how quickly are you asked if people can come and have a cuddle? Pretty quickly, right? And how comfortable do you feel if someone walks into your house asking them to make a brew, or push a hoover round? You don’t, do you? I certainly don’t! So you end up making tea, and pottering about when you should be resting. And I know some of you are thinking that you’re not the type to be lazing on the sofa while people work around you but factor in soreness, tiredness, blood loss increasing if you’re too active…

And you’ve been in hospital for a few days, and not seen the outside of those walls, and you need to get something from Tesco (and admit it, you want to show off your tiny baby!) so you pop to the shops which always takes longer than you think it will. And maybe you have other children who need taking to school… Or your grandma can’t drive so you offer to travel the hour it takes to go and see her…And your workplace want to meet the new baby… It all starts adding up, doesn’t it? And very quickly instead of resting and allowing your body to heal, you’re trying to carry on at exactly the same speed as you were before you got pregnant!

And that’s not to mention the physical things that you need to learn as well! How to care for baby when they’re here; how to recognise their feeding cues, sleeping cues, if they’re over-stimulated, if they need their nappy changing… parenthood is a learning curve and a steep one for you, dad and baby! It’s like walking into a CEO job of a Fortune 500 company knowing you’ve lied on your CV about your A levels – you know you can do it but you’re scared of being found out anyway!

You can see, then, that when a mother is in a vulnerable state anyway any anxiety she has over how she’s parenting (the so-called mommy wars!) could overwhelm her and link into her emotional state and possibly contribute to her PND. Part of this comes from the expectations she has of how life with a newborn is. Perhaps she’ll feel like she’ll ‘bounce back’ like magazines insist on celebrity mothers doing, or carry on her life exactly as before because it looks to her like everyone else is. Perhaps she doesn’t expect the constant feeding, or short bursts of sleep to continue for more than a week or so. Perhaps she doesn’t fully understand the sheer relentlessness of looking after another person who relies on you for everything. It’s easy to look at a snapshot of other peoples lives and think they’ve got it together while you’re in 2 day old clothes and haven’t washed your hair for a week and feel like you’re failing. That your baby is broken. But if we can change your expectation that you have of a newborn and the way your new life is going to be, then it’s a great way to help stop that feeling of helplessness that you’re not doing things ‘right’. One of the overwhelming things we hear from new mothers is ‘I didn’t know it would be like this’ and this is what we’re here to help you with.

What did women used to do?

It’s interesting that as life generally has got faster-paced and more demands placed on us, that the demands placed on a new mother have increased, with a shift in what she would be expected to do and how others would support her.

In a practice called ‘churching’ a woman in the UK would be set apart from their community for 5-6 weeks (or 40 days) while they tended to their new baby and healed, with help from other close women – usually family or neighbours. The timings differ slightly depending on which variant of Christianity they were but at the 40 day or 6 week point they would be reintroduced to their community with a blessing at their church. Although this was primarily a religious ceremony, the 40 day timing linked closely with the time it takes for a mother’s body to have that healing process, and this time frame is seen over and over across different cultures.

This tradition has fallen by the wayside in the UK due to a number of factors; the decline of Christianity, the medicalisation and masculinisation of birth and the birth world, migration of labour creating more fragmented communities, changes to the working patterns of women…many things, but increasingly women are trying to carve back this time for themselves to be looked after.

What happens around the world?

I’m willing to bet that you’ve either said or heard about a woman in a different culture giving birth in a field then getting right back to the work they were doing, right? It’s a trope trotted out frequently but actually it doesn’t have much basis in truth. Most pre-industrial or traditional cultures all honour the 40 day period after a woman has given birth, with additional support being given to her and her family. Nobody is compelled to feel like they have to get right back into the swing of things, and they’re honoured and celebrated for bringing new life into the world.

China – zuo yuezi – sitting the month – a big focus on the warm, nourishing food for the new mother to eat and replenish herself with, as well as practical support

Korea – no cold or hard foods, and no going out into cold weather. New moms are looked after for 21 days but sometimes this increases all the way up to 100!

Latin America – la cuarentena (quarantine) – Approved food, no sex, no hair washing, lots of rest!

Now it’s clear that times have moved on and there’s very few women who would consent to following the full confinement to the full extreme – I definitely couldn’t go without washing my hair for more than a couple of days! But it’s interesting that universally there is an acceptance that time cherishing the mother after a baby is born is really, really important for so many reasons. The way in which we look after the mother and allow her the space she needs to recuperate and to learn how to be a mother shows how we understand and appreciate the newborn baby. And in some respects having that protected time without having to worry about too much of the outside world can make the intensity of life with a newborn seem easier as your focus is on them and not a hundred other things.

Make a plan

When you’re pregnant and planning for life with a baby, think about creating a postpartum plan. After all, we spend time planning our births, planning what car seat and pram we’ll use, what nursery they’ll attend – isn’t planning to protect your wellbeing equally as important? Think about who can help you in the early days, and what they can do that’s practical and will mother the mother; think about what external support you might need and where you could go for that; think about if things aren’t going so well and you need help urgently – what might that look like and have you got people who know what to look for?

Most of all – take care of yourself, and enjoy that lovely new baby.

What Is The LOA, The OFP, And Other Acronyms.

The presentation of baby in labour is extremely important for how that labour progresses. Most women know, or come to know, through their pregnancy that their baby should be head down in preparation for birth: but even a head-down baby can be in an optimal or suboptimal position depending on where their spine aligns. The baby’s position is important as it affects their ease of rotation and descent as they travel through the birth canal.

The occiput anterior position is the most effective way for the baby to travel down through the pelvis and make its way into the world. The baby is head down, facing the maternal spine which gives space for the chin to be easily tucked in onto their chest allowing the smallest part of their head to fit through the cervix first. The soft bones at the fontanelle fold to make their head smaller still. This position allows the baby to travel through the pelvis as easily as possible. There is less likelihood of a baby in an occiput anterior position needing medical assistance in being born.

The occiput posterior position, while head down, is not so effective at helping the baby on its way through the pelvis. The baby’s spine is aligned with the mother’s such that the baby is facing towards the mother’s naval. As the baby descends they have to rotate all the way around so they’re facing the back, often making the labour longer and more painful, with the pain being felt at the woman’s back caused by the hard surface of the baby’s skull pressing on the mother’s back. It is more difficult for the baby to tuck their chin down, meaning that the diameter of the presenting part of the head is bigger (approximately 11.5cm) than if presenting in an anterior position (approximately 9.5cm).

There needs to be a good connection between the baby’s presenting part and the cervix in labour in order for oxytocin to be released – oxytocin being the stimulus to the uterus contracting. An occiput anterior position allows the best fit of the baby’s head into the cervix, resulting in good contact and hence causing a good flow of oxytocin to be released. When in labour, kneeling positions can encourage this contact by allowing gravity to assist in putting pressure between the baby’s head and cervix. If the baby is in an occiput posterior position, these movements will not be working as effectively for the baby or mother. This can result in a long latent phase of labour for the mother or having a stop-start pattern to contractions.

It was Jean Sutton and Pauline Scott in 1996 who coined the phrase ‘optimal foetal positioning’[1]. Through their work they showed the importance of the mother’s posture and position in pregnancy and labour. They showed that babies who start labour from a left occiput anterior position seem to birth easier. Babies in that position tend to curl the crown of their head into the mother’s pelvis better, allowing a flexed vertex presentation of the skull with a diameter of approximately 9.5cm.

Sutton and Scott noted that the number of left occiput anterior presenting babies are decreasing in recent decades, and attributed this to the change in lifestyle of women. Women are less likely to spend substantial time in active physical housework (often leaning forwards or on all fours) and more likely to spend their time relaxing on laid back sofas. Gravity does the rest in pulling the heaviest part of the baby – its spine – down towards the mother’s spine. By paying particular attention to the encouragement of a left occiput anterior position during the stage of pregnancy where the baby is beginning to start engaging (around 36 weeks for a first time mother and slightly later for biparous or multiparous women) women can help themselves have the most efficient labour possible.

There are ways for women to help position their baby optimally by building in things to their everyday lives. These include: changing their sitting style to ensure their knees are lower than their hips; not crossing their legs; kneel over a birthing ball while watching television; not putting their feet up; sitting on a birth ball not a sofa and swimming using breaststroke or front crawl.

Babies who are right occiput anterior may rotate away from that position as they travel through the pelvis and become posterior during labour. Indeed, Gardberg (1998) states that the majority of occiput posterior babies in labour start off as occiput anterior[2] – likewise the majority of posterior babies will turn in labour too. This, then, would lead to the conclusion that while there is an optimal position to begin labour in, it really isn’t a defining moment for the mother if baby turns away from this position.

[1] Sutton, J. and Scott, P. (1996) Understanding and teaching optimal foetal positioning. 2nd edn. Tauranga, New Zealand: Birth Concepts.

[2] Gardberg, M. (1998) Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries.