Vitamin K, persuasion tactics, and tips

Vitamin K is a very divisive topic. Most parents decide to give this to their baby, just after birth, but a few decide to decline.

I became interested in the evidence relating to vitamin K many years ago, when working with women who declined. After researching it for myself and the women I was looking after, I wrote a book.

Vitamin K and the Newborn is now in its second edition. It has helped tens of thousands of women and families to make decisions about vitamin K.

The problem of persuasion tactics

I have long been aware of a problem that a few women encounter.

Parents who decide to decline vitamin K sometimes find themselves subject to heavy-handed persuasion tactics in person. That is especially the case if they give birth in hospital. The idea is to get them to change their minds and allow professionals to give vitamin K to their newborn.

These persuasion tactics, as I wrote in Vitamin K and the Newborn, are both inappropriate and potentially harmful.

“Heavy-handed persuasion tactics and the aggressive language of some medically-focused papers and websites on the subject of vitamin K are not only inappropriate, but they harm relationships and make it less likely that parents will reach out for help if a problem does occur.” (Wickham 2017).

But as counter-productive as these persuasion tactics are (because they really do harm trust), I can’t stop them from happening.

What I can do, and what I will do in this blog post, is to explain how they come about, and give you a few tips to help you to deal with this situation if it arises.

Getting informed about vitamin K

What I’m not going to do in this blog post is explain vitamin K or share a load of information about making the decision.

I have an information hub for that, and a popular book which will help you fully understand the evidence and the issues so you can make the decision that is right for you.

This post is going to cover what happens once you’ve made your decision and then need to communicate that to your health care provider.

A range of possible responses

As I explain in my book, if you decide to give your baby vitamin K, you aren’t likely to experience any problems with this. Your health care provider will likely be pleased, because you are making a decision that most health professionals agree with.

If you are seeking something that deviates slightly from the norm, you might encounter raised eyebrows, or a bit of resistance. These variations include, for example, asking for oral vitamin K, or asking care providers to delay giving a vitamin K injection until you have spent time with your baby. Most parents don’t find it too difficult to get what they need, though, especially if they use some of the strategies I discuss below.

Some women and families who decline vitamin K report that, if they tell a midwife that they don’t want their baby to have vitamin K, a senior midwife or junior paediatrician is brought in to talk to them. Scare tactics are often used. For instance, they may be told that their baby is at high risk if they don’t give vitamin K. Some of the things that have been said to parents are so scary (and untrue) that I don’t want to repeat them here.

If parents continue to decline vitamin K, then a more senior paediatrician may try to persuade them.

As one woman wrote to me:

“What he [the neonatal consultant] did was go on about how, if we had watched babies bleed to death, we wouldn’t say no. You see that on social media too. It’s inappropriate. Of course they see the one in ten thousand events. That’s literally their job. But what about the other side of the picture? And it’s our decision anyway, not theirs.”

Time to smash the patriarchy

I’m not here to tell you what decision is right for you and your baby.

For example, in one book which purports to help women make decisions about pregnancy and birth, the author takes the stance that, while it’s worth questioning other decisions, she doesn’t think you need to question vitamin K. She quotes some data that I showed to be inaccurate and recommends that all parents go along with this.

This is also patronising and patriarchal, and we all deserve better.

Parents are more than capable of deciding

And I am not, by the way, saying that you should decline vitamin K.

That’s not my decision, or job.

I write about evidence and the wider picture around pregnancy and birth decisions so that you can make the decisions that are right for you.

The vast majority of parents, including many of those who read my book, decide to consent to vitamin K being given to their baby.

Again, I’ll quote from Vitamin K and the Newborn:

“I want parents to make the decision that is right for them and their baby, and I want professionals (and those who write on such topics) to treat parents in a respectful manner that acknowledges their intelligence, beliefs and viewpoint and engenders rather than endangers trust.”

“Most parents are entirely capable of making up their own minds about whether or not they want an intervention for their baby and, in fact, many will have decided long before they meet a health care provider.”

Persuasion tactics and care providers

But herein lies the problem.

When it comes to vitamin K, some care providers believe so strongly that babies need this substance given to them after birth that they think it’s appropriate to try and persuade new parents – who are often tired and emotional after labour and birth – to change their minds.

When I was writing Vitamin K and the Newborn,, I talked to many women, families, midwives, birth workers and so on.

Many had encountered or seen these kind of persuasion tactics.

Some described disempowering language and sometimes nasty attitudes when trying to make the decisions that are right for them.

A few parents said that their love for their baby was questioned, which I know happens in relation to induction coercion as well, and is an appalling tactic to use.

So what can you do to help in this situation?

Choose midwives and low tech where possible

But I recognise that these aren’t available to or appropriate for everyone.

Do your research, and make notes

Write your wishes in a birth plan.

Where possible, communicate your decision to your care provider ahead of time.

Remember that you may encounter attempts at persuasion at a time when you’re tired. So make some notes of anything you think you might want to remember or say in this situation. Put a copy in your birth bag, and share it with your partner or birth companion.

This might include an explanation of why you are declining vitamin K (although you do not have to explain your decision) and any information you have to hand about what your rights are in your country.

Understand the professional’s obligations

Remember that midwives and doctors often have a professional obligation to offer something, and to ensure that you have appropriate information. It’s really important to bear that in mind, and an important tip is to assume positive intent, and let professionals do their job respectfully.

I realise that this may sound counterintuitive. I’ve told you that some parents experience coercion, but now I’m asking you to listen to what they say?!

I can explain this by adding that (a) the majority of care providers don’t use these tactics, (b) most care providers are lovely people who genuinely want to ensure that you and your baby are well and happy, and (c) they all have a professional and sometimes legal obligation to make sure that you have been offered appropriate information.

Consider things from their perspective for a moment.

Unless you already know your care provider well, they cannot know whether you have spent hours researching this topic, or have been given inaccurate information by someone who has attended exactly one weekend of birth worker training but now considers themselves an expert.

The latter happens a lot when it comes to vitamin K. I don’t know why, but some people online seem to think it’s the worst substance ever. Some mistakenly think it’s a vaccine, which isn’t true. In fact, I have seen more conspiracy theory-type conversations about vitamin K than about any other pregnancy or birth intervention.

Parents deserve to have relevant, accurate information before making decisions, and care providers are obliged to offer certain information. So let them tell you once, listen to what they have to say (because they might have something to tell you about your baby’s situation that you may want to consider), and then communicate your decision, so that they can record this in your and your baby’s notes.

The care provider’s perspective

Care providers who come to my workshops sometimes report frustration about this situation, too.

Many midwives have told me that they totally respect parents’ right to say no, and in fact some say that they didn’t give their own baby vitamin K. But they know that they have to tell you ‘the spiel’ so that they can document it.

As one midwife explains:

“Even bringing it up can raise some parents’ hackles, which is so frustrating. I want to say to them, look, just give me two minutes to tell you what I have to, I’ll document your decision and then we can go on. When people come in expecting a fight, and get angry when you even just say the words. It’s not conducive to a good relationship. I want to tell them, most of us are on your side. Really. We are. It’s the bureaucracy and the system and the medical crap that’s the problem, not the individual midwives.”

Stay flexible

It’s a bit like the difference between deciding to take your seatbelt off when the plane is flying steadily at 30,000 feet (where there’s always a small chance of unexpected turbulence, but it’s low, and people need to nip to the bathroom and stretch their legs), and taking your seatbelt off during a bumpy flight in a storm after the captain has issued a warning, stopped cabin service, and asked the flight attendants to take their seats as well.

Be a broken record

If you’ve done all of the above and your decision isn’t being respected, try the ‘broken record’ tactic. This is where the notes you made in pregnancy can come in handy.

Pick one line, and repeat it, in a calm voice, as often as necessary.

“Thank you for the information. I/we have done research into this area and have decided not to give vitamin K to my/our baby. I/we would appreciate it if you would respect my/our informed decision.”

One reason that this can work is because, if you start replying to questions, or engaging in a back and forth conversation about the pros and cons of something, it can quickly become an argument.

That doesn’t help anyone.

You’re certainly not going to persuade a consultant paediatrician who believes that every baby should have vitamin K that they are wrong. And they’ve had years of practice at the arguments.

Just continue to decline, quietly and politely (because then you can’t be accused of being aggressive, which we’ll come back to in a moment) and, if you can manage it, with a friendly expression, or smile.

This isn’t because I am trying to get you to fawn. It’s about being assertive, without being aggressive, and trying to get your individual needs met in a system that is designed around a ‘one size fits all’ approach.

Things your partner needs to know

Two last important tips relate to your partner, husband, or co-parent, if you have one.

One of these is a repetition of what is above. Let your partner know ahead of time that it is imperative that they stay calm during difficult conversations, especially where these occur in a hospital or medical setting.

Medical staff face increasing aggression, which is appalling, and there is – rightly – a low tolerance for behaviour which can be construed as aggressive.

Sometimes, people’s passion about their decisions can be interpreted as aggression, and the last thing you need in this situation is to have your partner asked to leave.

Am I telling you this because I think your partner is aggressive?

Absolutely not.

I’m telling you because, occasionally, coercive professionals who aren’t very woman-centred will latch on to the tiniest thing in order to try to get someone to leave. Ensure ahead of time that your partner or birth companion knows the importance of calmness.

The separation tactic

The second thing that your partner needs to know about is a tactic which is sometimes used when parents have declined vitamin K.

If vitamin K has been declined, your partner will sometimes be approached by a paediatrician or midwife when they are not with you. For instance, on their way back from the bathroom, while you are showering, or when they nip out to the car to get something.

At such times, staff may try to persuade your partner to agree to vitamin K, even though you have already said no. Scare tactics are sometimes used. But persuasion comes in many forms. One dad told me that a paediatrician slapped him on the shoulder and said:

“You only need to tick this form, mate. Men make better decisions at times like this, because we’re not so emotive…”

(Yes, he reported it. And yes, action was taken.)

It can also happen that, if you end up having a caesarean, your partner is asked to consent to things for your baby while you are still in surgery. They may be told that its routine, or time sensitive. Staff may try to make them feel as if they are holding things up if they don’t agree.

If you want to decline vitamin K (or any other intervention for your baby), get more information or request an alternative option, it is vital to ensure your partner knows that they might be approached to consent to something, even in your absence. I would recommend inviting them to read this post, so they can understand the issues for themselves.

This is because, in many countries, only one parent needs to consent, and it doesn’t need to be the mother. Remember that, while only you can consent to things that will be done to your body, or to your baby before it is born, your partner may be able to consent to things for your baby after it is born.

Again, we are talking about something that only happens occasionally. The majority of people will not encounter persuasion tactics in any form. I’m just suggesting that you ensure your partner is aware of this possibility, and prepared for such conversations.

A useful phrase is:

“My partner and I are making decisions about our baby together. Please don’t ask me to make decisions without her or behind her back.”

A final reminder

I want to add a final reminder that the vast majority of health care professionals are wonderful people, who want the best for you, your baby, and your family.

Some of them might well share your belief system. Some won’t. Some might have different values or priorities from you. They all have professional obligations, which they cannot directly influence.

In the vast majority of cases, your decisions will be respected and supported.

Occasionally, you might need the information in this blog post.

But just like vitamin K, it’s preventative, and most people won’t encounter any problems in making and exercising the decisions that are right for them.

I really hope you’re one of them.

If you’d like to know more about vitamin K and the wider issues around this, please see my book, Vitamin K and the Newborn, which has been written for both parents and professionals.

Vitamin K

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