The v-word (vaccinations)

I recognize that many homebirthers choose not to vaccinate their children. But many of us do. For those of us who choose to immunize, what do we need to know?

First, allow me to get on my soapbox for a bit about why I vaccinated my son and why I think it's a good idea.

A large population of immunized individuals provides what's called "herd immunity," which dramatically reduces the chance of a disease outbreak - that's good news for everyone, especially since vaccines aren't 100% effective at an individual level.

In the last couple of years, as the rate of unvaccinated children has increased to as high as 12% in some communities, we've seen outbreaks of diseases that were once largely eradicated in the U.S., including measles outbreaks in California and Minnesota and a whooping cough resurgence in California in which many children got sick and some died. Personally, I can't stand to watch my child in pain or discomfort even from a run-of-the-mill flu, so the thought of my kid getting measles or whooping cough is too much for me to bear.

I know a lot of parents worry about the harmful effects of vaccines. I do, too. But so many studies have discredited the link between vaccines and autism (in fact, the original study that started it all was not only a bad study - it was an outright fraud and the doctor has subsequently had his license revoked). Bottom line is, the risk of not vaccinating is far worse than the risk of doing it. At minimum, I'd encourage you to vaccinate on a non-traditional schedule at least for the most harmful diseases (for example, get MMR but skip chicken pox or spread the shots over a longer period).

I know my pro-vaccine stance is controversial, especially among homebirthers, but as our ranks become increasingly diverse, the homebirth community will need to be inclusive of those who want to immunize their children. We homebirthers love to do our research, and we're good at being skeptical - please, please, please scrutinize the claims on both sides of the vaccination debate and come to your own decision about what's best for your child and our society.

If you're birthing at home, keep these tips in mind:

1. Tell your midwife your plans.
If you plan to vaccinate your child, it's a good idea to give your midwife a heads up. She may not agree with you. That's okay. But she shouldn't make you feel bad about your decision or try to dissuade you in any way. It's your decision.

2. Plan ahead on the Vitamin K shot.
Most states require newborns to get a Vitamin K injection within a few hours after birth. Although I don't consider this shot a vaccine, Vitamin K prevents a rare but serious bleeding problem called hemorrhagic disease of the newborn (HDN), which stems from a baby's naturally low levels of Vitamin K at birth. You can choose to have Vitamin K administered as an injection, orally, or not at all. If you don't want the shot, you'll likely need to fill out an exemption form, which your midwife can provide. Think about what you want to do well in advance of the birth and include your decision in your birth plan.

3. Don't fret about Hep B.
The first dose of the three-dose series of the Hepatitis B vaccine is usually given to newborns in the hospital. Obviously, if you birth at home, your baby will miss it. Not a big deal. Hep B is spread through bodily fluids - blood, semen, saliva - so your baby isn't likely to be exposed so early in life. Your pediatrician can administer the first dose at your first immunization visit and get you back on track fairly quickly.

4. Find a like-minded pediatrician in advance.
Before you even give birth, you should have your baby's pediatrician lined up. Talk to the doctor about vaccines. If you want a non-traditional schedule, find out what your pediatrician would recommend. Most doctors today are willing to work with parents who want less traditional immunization schedules, but you'd be hard-pressed to find a pediatrician unsupportive of vaccines entirely. The Centers for Disease Control has information about the "traditional" schedule. Go over it with your doctor. What can you put off? Which ones can you spread out?

If you're interested in exempting your child from immunizations all together, you'll probably need to file paperwork with the state. Talk to your midwife or pediatrician about the details.