Vitamin K administration legal/ethical nightmare!

cherokeesummer · May 14, 2008

OK. I didn't read the link yet.
This is sounding like a case of heavy-handed legislation written and passed by people with no medical knowledge or consideration of scientific evidence. (Huge surprise there, right?)
There is absolutely no medical or scientific reason to mandate that vitamin K be given within the first hour of life. And anyone with experience in L&D or a birthing center can attest that this is the very time frame during which its administration(and erythromycin ointment, for that matter) is likely to interfere with bonding.
What boneheaded legislation.
I'm beginning to see the parents' point!

Yeah I agree...ours is never given in the one hour frame, usually they don't come to admit nursery til 45 mins to 1 hour of life anyway,then we get them assessed and first bath and then comes the meds, so they are usually 2.5 hours old by that point.

OzMW · May 14, 2008

Yeah I agree...ours is never given in the one hour frame, usually they don't come to admit nursery til 45 mins to 1 hour of life anyway,then we get them assessed and first bath and then comes the meds, so they are usually 2.5 hours old by that point.

How come this isn't done in the delivery suite in front of the parents? So do the parents not get to see the first bath? The parents and the baby are actually separated so admission procedures can be done??

danissa, LPN, LVN · May 14, 2008

We give Vitamin K within 6 hours post delivery, as per protocal, and if consented as I said before. Don't see the hurry for giving it in the first hour.

Elvish, BSN, DNP, RN, NP · May 15, 2008

How come this isn't done in the delivery suite in front of the parents? So do the parents not get to see the first bath? The parents and the baby are actually separated so admission procedures can be done??

Oz - this depends on the facility. Some facilities are strictly rooming-in, which as I'm sure you know means mom & babe don't get separated at all and there is no nursery except for sick babies. So in this case all is done at bedside.

Other places it can be done in LDRP room or in nursery. Depends on parents' choice. Most of the time parents choose to send baby to nursery for bath, shots/drops (I don't know why).

The place where I delivered my son (would NOT go back knowing what I know now) would not allow baby to be bathed in room c mom, and would not allow baby to go to mom's PP room unless he'd been bathed already. He's considered biohazard. :madface: (And this stuff coming out of my lady parts is.....what?) I didn't know any better then, but hoo boy. When I found that out it twerked me and I won't be delivering any future babies there.

I really have a problem when hospitals treat families as if they baby is not theirs but the hospital's. In any case, we have 2 hours to do the Emycin drops and 6hrs for the VitK per our p&ps.

IndigoCarmine · May 15, 2008

How come this isn't done in the delivery suite in front of the parents? So do the parents not get to see the first bath? The parents and the baby are actually separated so admission procedures can be done??

Where I work now it is done in the delivery room, although that's not the NY state norm.

At my last job all the babies were admitted via the nursery and not L&D. The VitK/erythro mandate forced us to transfer the babies before one hour had expired (we usually hit the 55 minute mark). They were reunited with Mom after she followed to postpartum, anywhere from one to two hours later if she was an NSD. We held c-sectioned pts for anywhere from 6 to 8 hours, so babies would then be brought back to L&D for bonding.

IndigoCarmine · May 15, 2008

We give Vitamin K within 6 hours post delivery, as per protocal, and if consented as I said before. Don't see the hurry for giving it in the first hour.

Our only hurry is the mandate.

OzMW · May 15, 2008

Where I work now it is done in the delivery room, although that's not the NY state norm.
At my last job all the babies were admitted via the nursery and not L&D. The VitK/erythro mandate forced us to transfer the babies before one hour had expired (we usually hit the 55 minute mark). They were reunited with Mom after she followed to postpartum, anywhere from one to two hours later if she was an NSD. We held c-sectioned pts for anywhere from 6 to 8 hours, so babies would then be brought back to L&D for bonding.

Even more reasons for parents to get ansty!

cherokeesummer · May 15, 2008

How come this isn't done in the delivery suite in front of the parents? So do the parents not get to see the first bath? The parents and the baby are actually separated so admission procedures can be done??

Yes where we are, it is done this way - babies are delivered and then they bond with mom but usually L and D is rushing to get baby over to us, mom doesn't get to keep baby there very long though sometimes they do let them bf longer, I think really they should be allowed to stay longer but I think its in the works...I'm new to the field, new to nursing and am hoping to see that be one of the things that change. But for now, baby comes to admissions usually 45 mins of age, sometimes one hour. They are assessed and ballard done, measurements taken. The person designated by mom as the support person is allowed to be present for all of this, if they want to be, suprisingly there are several that don't but several that do, about half and half. They can bring one other person with them (i.e. gramma, sibling, etc.). The first bath is done at one hour old AND when vitals/assessment are stable. support person is able to be there for the whole thing. Then they go under the warmer for another hour after bath before going out to mom.

cherokeesummer · May 15, 2008

Oz - this depends on the facility. Some facilities are strictly rooming-in, which as I'm sure you know means mom & babe don't get separated at all and there is no nursery except for sick babies. So in this case all is done at bedside.
Other places it can be done in LDRP room or in nursery. Depends on parents' choice. Most of the time parents choose to send baby to nursery for bath, shots/drops (I don't know why).
The place where I delivered my son (would NOT go back knowing what I know now) would not allow baby to be bathed in room c mom, and would not allow baby to go to mom's PP room unless he'd been bathed already. He's considered biohazard. (And this stuff coming out of my lady parts is.....what?) I didn't know any better then, but hoo boy. When I found that out it twerked me and I won't be delivering any future babies there.
I really have a problem when hospitals treat families as if they baby is not theirs but the hospital's. In any case, we have 2 hours to do the Emycin drops and 6hrs for the VitK per our p&ps.

I'm wondering if our hospital has the same thoughts b/c the babies are bathed first before going out. And we handle with gloves until the first bath. (my guess is for biohazard reasons ). But yeah it would be nice if it could be done in the L&D rooms. That would be nice for some moms but like you said there are many that don't want fully room in. We have been told that its the future hope for our hospital but seriously, it will take a lot of trianing in the ob offices and in tours and what not b/c the majority of our patients do not want to room in and will bring baby to us all the time for smoking or for rest or whichever. Now I'm one to say I do tell a really tired mom if she is feeling super tired and would like rest but is holding off b/c she feels guilty, I have been known to say its ok, don't feel guilty, if you want to take the time to rest for a bit its ok. But most of the time its 70/30, seems 70 percent want baby in nursery and 30 percent want baby with them in room.

I'd be interested to see the rooming in come though.

crissrn27, RN · May 23, 2008

Wow! Can't believe this is a law in NYS. And the heavy handed way it was written was unbelievable. I'm glad I won't be having any kids there. What is the "policy" for babies born at home, I wonder?

I don't blame those parents for bringing in legal docs. I would have too. Some nurses I know have tried to use the "state mandated" thing to force anything from PKU's to Vit K, to Hep B on babies when parents didn't want it, and some have actually gave it with the parents not consenting! Not me, sister!

cmonkey · May 26, 2008

Aren't there a couple of studies out that render this issue moot if delayed clamping is implemented? Maybe I heard it on the radio, but I know I read/heard of a study that is suggesting delayed clamping reduces the incidence of neonatal hemorrhage... I'll see if I can't find it.

FWIW, my son didn't have any K (homebirth) or EES and he clots and sees just fine. Didn't have to sign a waiver, didn't have to argue or see a lawyer. I thought that all states allow personal or religious refusal for these things. Sad if they don't.

Well, maybe I was partly right: http://www.ncbi.nlm.nih.gov/pubmed/16585320?dopt=Abstract

"Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial."

RNmommy · May 27, 2008

I would tell you to **** right off if you told me you were going to interrupt my breastfeeding and bonding to administer a medication to my child in another room. FTR, I fully support the parents right to refuse vit K after being given the risks and benefits.

I can't believe that so many facilities still get away with mother-baby separation purely for staffing convenience. Those of you working in those facilities should be advocating for change in procedure. The benefits are so well documented.