“Attachment Parenting Medicine”, part I

I’ve recently come across a pediatrician on the Web who calls herself the Attachment Parenting Doctor, one Dr. Susan Markel. Dr. Markel is board-certified in pediatrics and has an M.D. from Tufts University, and is the medical associate for Attachment Parenting International. She also blogs on a group blog at Babycenter called Momformation. Looking over her entries on vaccines, one gets the impression that while she may not be anti-vaccines in general, she has an inordinate amount of sympathy towards parents who choose to opt out of vaccinating their children. Sometimes this is very subtle – for example, on a recent entry that discusses whether nonvaccinating parents should falsely claim religious exemptions for their children, a picture of a book dealing with legal vaccine exemptions is shown. Similarly, her comment on a study which demonstrated that parents who do not vaccinate are more likely to utilize woo*, have more distrust of the government’s motives, and display a good deal of ignorance and denial about vaccines and immunity, is:”Asking questions about the safety and effectiveness of your child’s health care and medical treatments is a positive parenting trait. It is important to get all the facts before making a major decision like forgoing childhood vaccinations.” …um, Doc? A few pointers about how not all sources of “facts” are equal might be in order, dontcha think?

Unfortunately, Dr. Markel doesn’t seem to vet her sources very carefully, either, that is when she chooses to reveal them. She seems to think a book by the late medical maverick, Robert Mendelsohn, M.D. , is a good source to quote. Never mind that the information being supported (feverphobia and the proper treatment of fever in children) is nothing original and is available from much more reliable sources.

Sometimes, all this flirting with woo and nature-worship causes Dr. Markel to cross over the line into outright misinformation. Let’s look at one of the more egregious examples I’ve found.

The Vitamin K birth dose “dilemma”

Markel states :

“If newborns are allowed to breastfeed soon after birth, the injection of Vitamin K is less necessary, since the colostrum that comes immediately from the mother’s breast before her milk lets down is usually rich in Vitamin K.”

Unfortunately, the amount of vitamin K obtained from colostrum is neither very large, nor is colostrum all that much richer in vitamin K than breastmilk. Either way, one must contend with the reality that exclusive breastfeeding (as opposed to formula feeding) is a risk factor for hemorrhagic disease of the newborn, which the vitamin K (given by injection or in several oral doses) is meant to prevent.

Dr. Markel muses:

It might be said that the standardization of the Vitamin K injection and indeed all the routine procedures performed on the newborn baby reinforce the messages to both baby and mother that nature is inadequate, that they are now dependent on the medical profession for their health.

Um, doc? Nature is inadequate. Nature is “looking” (assuming we accept the personification of this entity, of course) to keep the species going, but that doesn’t mean every human baby is guaranteed to survive under natural circumstances. To remind you, some 25% of fetuses are spontaneously aborted in the early weeks for pregnancy, most often because nature got it wrong and conceived a fetus with severe chromosomal abnormalities. There’s also that small issue of the 4% or so of babies born preterm. Nothing says “nature goofed up” better than a 24-weeker saved by the NICU staff.

Most babies will eventually overcome their vitamin K deficiency by acquiring vitamin K-producing gut bacteria in time (and one can argue that under more “natural”, less sanitary conditions, this happened sooner rather than later), but a minorty won’t. To most mothers, however, having one’s own baby die of an easily preventable cause is inexcusable. Therefore, we improve upon nature by this very simple intervention. Most mothers should be able to deal with the ‘unnaturalness’ of it.

Oh well. I suppose one should be thankful that Markel didn’t dredge up that old, long discredited canard about how vitamin K causes childhood cancer.

Next post, we’ll be dealing with another manifestation of Dr. Markel’s wishful thinking vs. the real facts of breastfeeding and vaccinations.

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*For the definition of woo, see here.

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9 Responses

  1. OMG I just can’t stand it! Folks come into L&D all the time and want to refuse erythromycin and vitamin K because they are not natural. Like the death of your newborn or permanent blindness is a great natural occurance. I personally would try to avoid the natual consequences of birth. But thats just me.

  2. Just curious, and not that I would not give my own kid vitamin K, but if the mother took additional supplements of K or a diet rich in it would it be expressed in the breast milk/colostrum, and would that be sufficient? If it would be, perhaps that would be a good compromise for many mothers.

  3. I have also read that mothers can supplement with alfalfa or Vitamin K supplements before birth and they will have greater concentrations in their breastmilk.

    Even AP advocates often choose the vitamin K shot if they are going to circumcise or if there was trauma in birth (such as the use of forceps) that could cause internal bleeding.

  4. There have been studies that show maternal oral vitamin K raises the baby’s vit K blood levels, and some that show the opposite. They were all done after all the babies got their birth shots, as far as I can determine.

    Either way, that’d be a lot of alfalfa (which I personally can’t stand 🙂 ).

  5. Colostrum is a miracle of nature. Which nature gives us it´s usually better than chemical additives.

  6. Dani – your evidence of this is…what exactly?

    Exclusive breastfeeding w/o vitamin K supplementation is a risk factor for hemorrhagic disease of the newborn, whether or not you, or Dr. Markel, like this fact.

  7. I must appreciate your work. from last couple of days i was searching for something interesting and this post is really nice.

    Thanks for this nice post.

  8. Thank you so much for exploring these subjects and your rational interpretation of the available science! There is a heinous amount of “magical thinking” being put forth as science and very few who have taken the time to address this.

  9. You’re welcome, KEC 🙂 .

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