Belly Up

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Monday, July 8, 2013

It's The Law - Eye Ointment for All Babies

Texas State Rule 97.136 Prophylaxis against Ophthalmia Neonatorum 
(a) A physician, nurse or midwife or other person in attendance at a childbirth shall apply or cause to be applied, to the child's eyes a 0.5% ointment in each eye within two hours after birth.  If this ointment is not available due to the disruption in the distribution or manufacturing, a physician, nurse or midwife or other person subject to this section shall apply or cause to be applied to the child's eyes and alternative treatment included in guidance issued by the Department of State Health Services or the Center for Disease Control and Prevention.
(b) Failure to perform is a Class B misdemeanor under the Texas Health and Safety Code. 

Did you know that every baby in Texas is treated for an STD within hours of their birth?  Ophthalmia neonatorum (ON) is a conjunctivitis (ie type of pink eye) that can be contracted during vaginal birth. The two main causes of ON are chlamydia or gonorrhea. ON is NOT caused by Hep B, Step B or HIV.  If the mother does not have chlamydia or gonorrhea, then the newborn cannot contract it.   While ON can potentially lead to blindness (and that was a common problem before the advent of antibiotics), ON is treatable and blindness would only occur if an infected newborn did not receive antibiotics.  In most states though, antibiotics in the form of eye ointment or drops are administered prophylactically to avoid an initial infection on every single baby that is born regardless of the mother’s chlamydia or gonorrhea status. 

It's the Law
The Texas state law as seen above requires that every baby have the antibiotic erythromycin within 2 hours of birth and the law is written so that it is a misdemeanor for the care provider to not to so (though there are provisions for midwives that I have not listed).  In practice, many hospitals provide a waiver for parents to opt out as patients should always have the right to decline any medical care that they choose.  However, a number of big hospitals do not have any opt out and those hospitals typically call CPS if mom and dad decline and often will administer the ointment against a parent's wishes. 
Why would a parent even want to decline the treatment?  There could be any of a number of reasons.  The ointment is irritating to some babies eyes, most babies are taken to the warmer for the administration of the ointment so baby is taken away from mom during the initial bonding period and the ointment may then also interfere with the baby's sight during that time.  However the most common reason may be that most parents do not want to give unnecessary medication to their children and from a societal perspective the use of unnecessary antibiotics contributes to the growing problem of antibiotic resistance.  Even C-section babies are required to get the medication and, particularly if their amniotic sac was intact prior to surgery, there is almost no likelihood of an infant acquiring an ON infection - even if mom is positive for Chlamydia or Gonorrhea.  Given the numbers of babies being born surgically, that means just by method of birth alone, upwards of 60% of babies are receiving unnecessary antibiotics within moments of their arrival.  That's quite a welcome! 
So where does that leave expecting parents? 

  • Decide if this is an important issue for you.  Ask your care provider when you were last tested for gonorrhea or chlamydia and honestly assess what your risk is of having acquired one since that test.  Find out your hospital's policy on opting out of the eye ointment.

  • If the hospital does not have a waiver,  you may ask to have the ointment administered while you are holding your baby and bring a soft cloth to wipe your baby's eyes.  Even if you want the ointment, it is still wise to ask if the procedure can be done while you are holding baby.  This will keep your bonding time from being interrupted.

  • Decline the ointment with either a waiver or be willing to have CPS give you a call.  (I have had clients where this happened and CPS was totally cool about it, but no promises that will always be the case.)