Re: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps.

[Marilyn Kleidon]

Hi: I am not yet a lactation consultant but I am a midwife who lived in the USA until 2002. There are a number of factors involved here re the vitamin D drops. I am assuming this is in response to an increase in the prevalence of rickets in babies and young children. I will list them below. Yes it does seem like an overreaction but I think it fits into the public health mantra of treating all rather than missing some. Coming from Norwegian heritage  I remember a childhood of drinking my daily dose of cod liver oil in sunny far north qld, yes I do have strong bones and teeth. Anyway these are some of the possible reasons for this response that I can think of:   1. Increasing numbers of americans covering up completely to avoid sun exposure a strong belief that there is no "good" exposure. 2. a significant group of americans who cover up for religious and social reasons. 3. the sun IS a lot weaker, trust me. 4. yes different skin pigmentations do let is more or less light: the fairer you are the less sun you need to make vit D (or get sun burned)and unless you are eating a diet rich in fatty deep ocean fish or ocean dwelling sea mammals (whales, sea lions, etc..) you will be deficient hence the scandanavian use of cod liver oil: an oldy but a goody. Eskimoes in Alaska would prolly be those least likely to need supplements unless of course they are living on Mc Donalds. 5. When it gets cold many people are reluctant to give baby a sun bath in direct sun and that far from the equator indirect sun is not that efficient...it can be cold 9 mnths of the year...the reverse of here!   Because of this normal supermaket milk has been supplemented with vit D for decades as has baby formula. If a mother is confident of her diet and her sun exposure and her babies then no supplement would be necessary of course.  I don't think there are supplement police...yet.   marilyn ----- Original Message ----- From: [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, April 29, 2005 10:44 AM Subject: [ozmidwifery] Antenatal Screening/Informed Choice Agreement. Vitamin D supps. Hi All,         Just hoping some of you wonderful Homebirth midwives out there can enlighten my ignorance regarding what "routine" antenatal investigations you order for or recommend to your clients, as part of your initial consultation. Is there a standard guideline that you must adhere to?(Apart from the "National Midwifery Guidelines for Consultation and Referral", that is). Or is it only up to the individual practitioner and his/her client to discuss and come to an agreement about what tests she will have and when she must go to hospital?         My reason for asking is the vague responses to our enquiries  we recently encountered when a planned homebirth client presented to hospital for delivery. There was no accompanying antenatal record so we thought it feasible to ask basic questions of the client and her midwife such as blood group, last Hb, etc because it was no longer a normal situation. Is it probable these tests weren't done, because she was hitherto a normal, healthy woman with the right to choose what invasive procedures she had? Sorry to sound stupid but I'm used to the Obstetrician/G.P. who orders every test the lab has ever done and then some, you know - like the questionable Hep C and HIV without prior counselling, but I won't go there!        I've done a couple of Web searches re the evidence (and lack of), and cost-effectiveness of the regular antenatal screen blood tests (I think I read it cost Medicare some $48 million dollars back in 1997), but wanted to know what you guys are practicing out there.        On another tack, I just read this gem in an excerpt from a policy statement by The American Academy of Paediatricians: "Vitamin D drops containing 200iu should be given to all breastfed infants starting in the first two months of life"  Gartner LM et al "Breastfeeding and the use of Human Milk" Pediatrics 2005 Feb; 115: 496-506.    Alaskans born in the middle of winter perhaps? I think our NICU give daily Pentavite from about Day 5, but surely, if there is some sun exposure this routine administration shouldn't be necessary? Do different skin colours absorb it from sunlight at different rates, such as black skin slower, perhaps? Any Lactation Consultants able to comment here please?        Cheers,  Gaye :)