In the words of one of my favorite midwives, “If you’re willing to bet your child’s eyesight on your husband’s faithfulness, then you don’t need the eye ointment.”
Let me explain. 🤓
Did you know that antibiotic ointment for your baby’s eyes at birth is normally NOT needed and is only needed IF you are positive for a STI at the time you give birth?
The fact is, most babies do not need it. If a mother knows she doesn’t have chlamydia or gonorrhea, there is no reason to routinely expose an infant to antibiotics in their first hour of life.
There are always reasons to look into routine practices.
We have to understand that anytime we interfere with physiological birth in any capacity, including but not limited to, 3rd and 4th stage of labor and newborn care — it will change how nature intended it to be. Sometimes, there is a need to intervene. But that is just the point, it should only be utilized when necessary. ⤵️
What about cesareans? If a baby is born by cesarean, then it is extremely unlikely that the baby will develop Ophthalmia Neonatorum (ON — the complication that the ointment prevents if exposed to the STI at birth). But unless denied, every cesarean-born baby in the United States is routinely given erythromycin eye ointment.
🔻 What are the facts?
The use of erythromycin eye ointment in newborns has its roots in the late 1800’s and it’s purpose was to try to prevent ON. Even then, ON resulted in blindness in only 3% of affected infants. When we take a look at that, isn’t it very concerning that in 2019 we are still using a practice that came from the late 1800’s, where such a small percentage of infants were affected over a hundred and thirty years ago?
We have to realize we have come a long way in almost 140 years.
First, antibiotics have made it possible to treat pregnant people who have sexually transmitted infections as well as any infant who contracts bacterial ON, making blindness highly unlikely in developed countries.
Does the ointment prevent other infections, like staph? Non-gonorrheal and non-chlamydial bacteria in the newborn’s eye are not dangerous and do not progress to blindness. Next we ask, is the antibiotic ointment effective?
After the use of prophylaxis, infectious ON still occurred in 13%, 15%, and 18% of newborns treated with povidone–iodine, erythromycin, and silver nitrate, respectively.
Compared to the group that received povidone-iodine, groups that received silver nitrate and erythromycin had overall rates of pink eye that were 34% and 16% higher, respectively. Erythromycin was first introduced in 1953 and by 1968, strains of Streptococcus bacteria had developed resistance. That means 50 years ago, strains were already becoming resistant and we still routinely use this now.
What are the benefits?
1️⃣ Erythromycin prophylaxis may be helpful if the mother and her partner(s) did not receive adequate screening and treatment for gonorrhea/chlamydia during the pregnancy AND it’s not possible to test the mother at the time of birth and treat the infant as needed.
2️⃣ Erythromycin prophylaxis may help to protect a newborn from gonorrheal ON if the mother was infected after a negative screening result earlier in the pregnancy (for example, due to a partner’s infidelity).
What are the risks?
1️⃣ Adverse effects can include chemical pink eye, or eye irritation. A study in Kenya found that 13% of infants who received erythromycin developed pink eye with no evidence of infection.
2️⃣ Blurred vision could potentially interfere with bonding by disrupting early eye gazing between the newborn and parents.
3️⃣ Erythromycin is not 100% effective at preventing gonorrheal ON — it had a 20% failure rate in the past and might be less effective now due to growing resistance.
4️⃣ Erythromycin may not be effective at preventing chlamydial ON or ON from other non-gonorrheal bacteria.
What other options are there?
I’m glad you asked! ⤵️
Colostrum, or the first breast milk after the birth. Three randomized trials have looked to see if applying drops of the mother’s first breast milk into the newborn’s eyes can help to lower the risk of ON from non-chlamydial, non-gonorrheal bacteria. All three trials found that drops of the mother’s first milk can lower the risk of ON from non-sexually transmitted bacteria.
So… What do we do with all of this information? 🤰🏻
It is up to the birthing parents to discern the risk versus benefit and if they choose to safely decline the ointment, their decision should always be respected.
Today, laws in many U.S. states still mandate the use of (remember this does not mean you cannot decline. This simply means the hospital has to routinely use unless declined) erythromycin with all newborns even though the erythromycin may not be effective and even though other preventative options are available. Given the fact that other options can be used to safely prevent and treat newborn eye infections, the mandatory nature of these erythromycin state laws should be discontinued.
❗️Did you know all of the facts when your baby received the eye ointment?❗️
Did you know you had a choice in the matter and could say no? In my personal experience, it was not even offered because my doctor knew our baby was not at risk. But in the experiences I hear all the time from other people, informed consent with the erythromycin ointment is very rarely given. If it was, the care provider would give the birthing family all of these facts I’ve given here and let them decide if they want it or not.