Vitamin K Deficiency Bleeding (VKDB) is a complication that is nearly 100% preventable when babies receive the injectable vitamin K within the first hours of birth. Virginia law requires all maternity care providers to administer the injectable vitamin K, but Virginia law also prohibits Licensed Midwives from legally administering this life-saving medication.
This rural Virginia mother shares her story of how her baby suffered VKDB and how quick action from her midwife saved his life and perhaps has prevented long-term consequences. However, this is a complication that should never have happened in the first place. If her midwife had been legally allowed to administer the injectable vitamin K soon after her baby was born, all of the medical interventions he received would not have been needed.
I live in rural Virginia, about an hour and a half from the nearest hospital. My first baby was born in 2020 and about halfway through that pregnancy, I switched from a planned hospital birth to a birth center because of my desire to have a natural birth with limited interventions and to have the increased personal care and connection certified professional midwives provide. As a first time mom, the security of the birth center’s location - in close proximity to a hospital - was important to me. However, my first labor was surprisingly fast - only 3.5 hours - and we didn’t make it to the center. My baby was born about 15 minutes before the city, born with my husband still driving behind the wheel. When I became pregnant a second time, I knew labor would likely be even faster. I wanted to give birth naturally and didn’t want to be induced. Both logistically and financially, we couldn’t afford to move closer to a birth center or hospital in the last weeks of my pregnancy. So, I found two midwives within 45 minutes of my house and under their care started planning for a home birth. In 2022, I had my second baby after an intense 2 hour labor. He was slightly malpositioned, and the next day, a giant, puffy bruise - a cephalohematoma - appeared on his head. Because of the birth injury, my midwife suggested my baby be evaluated by his pediatrician and to ask about giving him an injection of Vitamin K, an essential vitamin related to blood clotting. Upon examination, the pediatrician said the slightly less effective oral Vitamin K we were giving was sufficient. At four weeks old, his cephalohematoma began going down, and a few days later, we noticed three unexplained bruises on him. Knowing bruises on an infant are not normal, I took him back to the pediatrician, who was initially concerned and ordered basic blood work and x-rays. Despite the bruising, the doctor did not order any blood work related to coagulation. When all ordered labs came back normal, the doctor suggested the bruises were from his toddler sister. Not satisfied with this as an answer, I reached out to my midwives. One of them immediately wrote that the bruising could point to a Vitamin K deficiency, a rare condition that can cause deadly bleeding, often in the brain of young babies and recommended an injection of Vitamin K. When I saw that email at 4 am, I had a pit in my stomach that this was what was happening and started making plans with her to administer the shot that day. When the doctor's office opened, I called the pediatrician one more time around 8:30 am to ask if the bruising could be related to Vitamin K and if he recommended the more effective injectable Vitamin K. He said no. Around noon that same day, my baby became increasingly unsettled and by 1:15 pm, my normally mellow baby was inconsolable. I was terrified a bleed had occurred and asked my midwife to immediately administer the Vitamin K shot - which would halt a potential bleed - upon her arrival at 2 pm. When the crying did not resolve 30 minutes later even after the shot, she suggested he be taken to the emergency room an hour away. Upon arrival at the ER, he had developed a fever and underwent a series of tests, including a head scan, that showed my worst nightmare had occurred. He had sustained a brain bleed. With no room at the nearest Pediatric ICU, he was taken by helicopter to Richmond, 3.5 hours from our home for further care. After 8 days of testing and monitoring - including an MRI which he had to be intubated for, a nuclear medicine scan of liver function, and investigation by CPS due to the bruising - he was discharged from PICU with the diagnosis of a brain hemorrhage caused by a Vitamin K deficiency, likely due to a failure of the oral dosage. At this point, we are hopeful in the resiliency of infants, that - as one neurosurgeon put it - one day, all this will just be a bad memory. Moving forward, he will receive follow-up care, including a new pediatrician visit, follow-up blood work, appointments with specialists, PT to monitor for developmental delays, and a head MRI to ensure things are improving. I can’t allow myself to think what would have happened if my midwife had not caught the warning signs my pediatrician missed, prioritized meeting me that day for the vitamin K injection, and helped my son get his shot. If she hadn’t - especially with our rural location - I know that my baby could have been permanently brain damaged or died. The ability for midwives to carry and administer Vitamin K should absolutely be legal in the state or Virginia. By helping my baby get Vitamin K, my midwife saved my baby’s life.
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