Report Highlights
- A risky decision: When baby Gwen was born, her parents decided not to give her a vitamin K injection, even though it has been a common practice for decades, and instead gave her drops.
- Desperate efforts: The emergency room doctor who first treated Gwen tried seven methods to stop the bleeding from her belly button before the baby was transferred to the hospital.
- Processing Questions: The family filed a complaint against the emergency room doctor with the Texas Medical Board, alleging she failed to recognize that Gwen was suffering from bleeding due to a vitamin K deficiency.
These highlights were written by the reporters and editors who worked on this story.
The emergency room was a mile from their home in Texas. Stephanie and Eric Biesenbach were comforted by the fact that their newborn daughter, Gwen, kept bleeding from her belly button. They strapped Gwen into her car seat and drove away.
Medical records from that hot August evening in 2023 described his condition as a “generic problem” of a bleeding umbilical cord stump. The doctor on call, Nicole Malouf, had treated many of them as an emergency specialist. She covered Gwen’s oozing belly button with special gauze to stop the flow, and when it seemed to stop, she sent Stephanie, Eric, and Gwen away.
They made it to the parking lot before noticing that Gwen had bled through her pajamas on her feet. Eric slipped his arm under the car seat handle and pulled his 11-day-old daughter out of the car. They headed back toward the bright lights of the Lonestar 24HR ER, a free-standing emergency room in New Braunfels, next to a car wash, a McDonald’s and a deli.
Stephanie told Malouf that Gwen was bleeding a little after the scab that replaced her umbilical cord stump fell off. The amount of blood they saw that night worried them. She looked through Gwen’s story. No fever. No vomiting. Exclusively breastfed. She mentioned that she and Eric refused a vitamin K injection when Gwen was born and instead gave Gwen oral vitamin K drops, which they believed would protect her.
Malouf tried a different type of pretreated gauze. When that didn’t work, medical records show, she turned to silver nitrate, a chemical applied to the end of a long matchstick-like stick that cauterizes blood vessels. Malouf swirled one stick after another inside Gwen’s navel.
Since the 1960s, the vast majority of newborns in the United States have received a vitamin K injection. The injection has virtually eliminated bleeding due to vitamin K deficiency, a rare condition that can cause catastrophic bleeding and even death.
But a change in recent years has threatened to upend the steadfast protection many doctors and hospitals took for granted. Families – wary of medical interventions, misled by social media, and devoted to a birth experience they consider natural – have begun to avoid the vitamin K injection.
Two studies published last week, both involving millions of births, found that babies who did not receive vitamin K had an increased risk of bleeding. One of the studies found that between 2017 and 2025, the rate of bleeding related to vitamin K deficiency increased by 347%.
Without a single, inexpensive injection – which is not a vaccine – babies are dying. Autopsies reveal how babies’ systems shut down without warning and well-meaning parents who refused the vitamin K injection mourned the loss of their children.
Malouf continued to try to stop the bleeding. For nearly three hours, she used seven methods. At one point, she applied so much pressure to a bandage that, according to Stephanie, Gwen vomited. Remedies primarily treated the symptoms and not the cause, like putting a cover on a leaking faucet.
Malouf said she called her husband, who is also a doctor and nurse at a local hospital, to see if he was missing anything. They too were lost. The nurse’s only suggestions were ones Malouf had already tried.
Malouf decided to transfer Gwen to a small local hospital, which had at least pediatric specialists and a neonatal intensive care unit. But while she waited for a callback to confirm that the hospital would accept Gwen, Stephanie came out of the room to tell her that Gwen had bled to the last bandage. Malouf, records show, quickly checked how long it took his blood vessels to fill. It was slower than when he arrived.
Gwen’s condition was becoming more and more dire and Malouf had reached the limits of what she could do. What followed wouldn’t be enough either.
Stephanie had given birth to Gwen without complications in an inflatable bathtub in their living room. She was perfect, with doe eyes and abundant brown hair that, when the light hit it, hinted at the red of her father’s beard.
Her older siblings looked after her like a birthday present. Her aunts from California and Louisiana came to meet her. When the house grew quiet, Gwen fell asleep to the soothing rhythm of Stephanie’s chest rising and falling.
Stephanie marveled at the way Gwen seemed to study the faces of everyone who wore her. She wasn’t yet two weeks old, but the corners of her mouth were constantly turning up into what her parents claimed were smiles. Even when her siblings passed her around, she rarely cried in protest.
Stephanie and Eric met in 2010, while they were both working at Chili’s. Originally from Texas, they had just returned home after spending time in Florida, where Stephanie spent a semester interning at the Walt Disney World Resort.
“I was doing lawn care and restaurant maintenance,” Eric said before Stephanie interjected. “He moved there for a girl,” she said as the two burst into laughter.
He proposed to Stephanie on Christmas Eve. They got married at a vineyard on Halloween. The evening closed with fireworks.
Life then moved quickly. They had a daughter and two sons, then adopted the daughter of a relative who was too young to care for the child herself. Just when they thought their family was complete, Stephanie became pregnant with Gwen.
Overjoyed, they decided to name it after Stephanie’s grandmother, Gwendolyn, who passed down her floral blanket with “Gwen” embroidered in the corner.
There were no signs that anything was wrong with Gwen until one day her parents took her to the emergency room. Stephanie had first texted her midwife.
“I’m sorry to bother you,” she typed into her phone, writing that Gwen’s belly button had been bleeding most of the day and they couldn’t stop it.
“How much blood is too much blood,” she asked.
The midwife told her to send a photo. Stephanie sent two, one containing dried blood on Gwen’s stomach and the other containing a pile of bloody tissue. The midwife asked Stephanie to tape gauze to Gwen’s belly button. About 90 minutes later, just before bed, she checked on Gwen again. She took another photo, this one with bright red blood soaking through the gauze and diaper, and texted it to the midwife. “Are you sure everything is okay?” »
The midwife told her to go to the emergency room.
In many states, all emergency rooms are in hospitals, where patients can be transferred to other units to receive more care. This is not the case in Texas, where more than 200 emergency rooms are stand-alone, separate and distinct from a hospital. In the emergency room, Gwen became increasingly pale. His heart was beating at 177 beats per minute. Around 1:40 a.m., Stéphanie and Eric receive their first good news: Malouf is transferring Gwen. She had abandoned plans to send Gwen to the local hospital and would instead transfer her to North Central Baptist, a larger hospital near San Antonio with more specialists. North Central was only about a half hour drive away and the unit was sending a NICU transport team to pick Gwen up.
Eric’s eyes were fixed on the large clock hanging in the room. Ten minutes passed, then 20, then 30, then an hour. He didn’t understand why it was taking so long. He walked into the hallway and asked if he could just drive Gwen to the hospital.
But, he said, Malouf told him he couldn’t because it would be too dangerous. Malouf, however, said she told him that if he left, he would have to sign documents acknowledging that he was doing so against medical advice. The transport team, she told him, would have blood and IVs. Besides, she said, Gwen was stable. Malouf called to check on the ambulance; he was told they were on their way.
Stephanie and Eric said that was the last time they spoke to Malouf that evening.
When the ambulance arrived, it had been almost two hours since Malouf had requested it. One of the team’s first questions was whether Gwen had received a vitamin K injection.
The emergency room nurse told them they didn’t have the vaccine on hand.
It was the first time since arriving in the emergency room, Stephanie said, that someone suggested that vitamin K might be the culprit — and the cure.
At 3:45 a.m., minutes after the ambulance crew arrived, they gave Gwen a vitamin K injection in her left thigh. They spent the next two hours at her bedside, hooking her up to an IV, drawing blood for lab tests and giving her antibiotics — all things that records show had not yet been done. Malouf did not respond to questions about why.
Stephanie and Eric watched the ambulance crew work, joking, discussing another call that came in, and, as they were getting ready to leave, waiting for one of them to go to the bathroom. Between what they considered the team’s relaxed pace…
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