By Nina, Contributing Writer
My first two children were born out-of-home. They were immediately given hats, Hepatitis B injections and erythromycin eye ointment. I never thought to question it. Why would I?
However, as I learned more about birth and evidence-based practice, I began to wonder if all of those routine newborn procedures were really necessary.
While I could easily launch into a post about all three, I’ll focus on the last procedure – erythromycin eye ointment.
What is erythromycin eye ointment?
Erythromycin eye ointment is used to prevent the infection of ophthalmia neonatorum, also known as neonatal conjunctivitis. This inflammation of the conjunctiva is a type of pink eye that affects newborns.
In the late 1800s, 10% of babies born in European maternity hospitals contracted this infection. Of those newborns, 3% were left permanently blinded.
A physician realized that the infection was being spread from mom to baby during vaginal delivery, usually caused by gonhorrea (the main cause is sexually transmitted disease), and began treating newborn eyes with silver nitrate. The treatment was effective and within a few years, the incidence of infection went from 10% of babies to .3%.
Over time, different medicines were used (silver nitrate was painful and accused of causing chemical conjunctivitis) and now erythromycin, an antibiotic is commonly used today.
While it is obvious that not all newborns need this prophylactic treatment, in many states, law mandates that it be applied after birth.
Some countries, like Denmark, Sweden and the United Kingdom, do not use prophylactic erythromycin eye ointment. Instead, they monitor newborns and begin antibiotics if they contract neonatal conjunctivitis, which happens very rarely. In developing countries, where women have poor access to STD screening and treatment, prophylactic eye ointment is still necessary.
If you were not screened for chlamydia and gonorrhea and are infected, if screening came back with a false negative or if you have a partner who has it and is re-infecting you after treatment, this can protect your newborn from neonatal conjunctivitis.
This helps to protect newborns in areas where chlamydia and gonorrhea infections are high and/or access to adequate prenatal care that includes STD screening and treatment is limited or unavailable to mothers.
As with any widespread antibiotic use, there is a risk for resistance. According to this World Health Organization bulletin, recently, povidone-iodine has been shown to be effective in preventing neonatal conjunctivitis, which carries anti-viral properties as well and is cheap – a benefit to those unable to afford more expensive options.
Not every woman has a sexually transmitted disease, meaning not all babies need this prophylaxis.
Mothers can be screened and treated for STDs during pregnancy so that the ointment does not need to be used (so long as further screening indicates that they are no longer infected).
Erythromycin eye ointment may cause blurred vision and eye irritation, which can interfere with bonding.
According to this study, erythromycin does not prevent neonatal conjunctivitis 100% of the time, so applying the ointment does not guarantee a newborn will not be infected.
After switching to a midwife and educating myself about the risks and benefits of erythromycin ointment, I opted to decline it for my last two children.
Women who do not have sexually transmitted diseases (screening for chlamydia is routine in early prenatal care and screening for other diseases if done if the need is indicated) and are in a monogamous relationship can decline the ointment if they feel comfortable doing so. This can typically be done by signing a waiver.
Make an informed decision
The most important thing to remember is to do your research. Know why procedures are done, what the risks and benefits are and your options for proceeding or declining.
Whatever decision you make, make it an informed one.