The Problem With Birth E3: Erythromycin
This is the transcription of episode 3 of our podcast, The Problem With Birth. This transcription is made available so that those who are hearing impaired can still benefit and learn from this free resource we provide. This script has not been evaluated for spelling and/or grammatical errors.
Hello everyone, I'm your host Holly Clayburn and this is The Problem With Birth. If this is your first time tuning in, then welcome! This is a podcast intended to discuss all of the issues with giving birth today, and to talk about the hard topics or things that simple aren't talked about enough, This week, as requested, we are going to talk about a topic on the postpartum side... Erythromycin. If you don't know what erythromycin eye ointment is, it's the eye goop that you see on some newborns. It is an antibiotic ointment that is put into their eyes to prevent infections. From that description, it kind of sounds like a no brainer right? Well listen on to find out why so many, including myself decline this routine newborn procedure.
Before I get started this week, I want to say that probably more often than not I will talk about topics that can spark debate. In my professional business with my clients I don't share my opinion because as a doula, that is not my job and I don't ever want my clients to feel judged. In this podcast though, I will give my opinion on things as well as the facts. It's not ever to judge anyone, it's just my personal experience or thoughts, which I feel like people want which is why they listen to me each week. The things that you choose and the way that you give birth doesn't matter to me. The only thing that matters to me is that you are respected, educated, and able to make a choice based on informed consent. With that being said, let's dive in.
Erythromycin eye ointment is routinely used in hospitals on all newborns unless specifically declined. It is used to prevent an infection called Ophthalmia neonatorum or ON. It is available in out of hospital settings such as home or birth centers as well, but it's almost never used in these settings so the focus of this episode is really based on hospital birthing. I definitely still recommend listening though, even if you are planning an out of hospital birth, just so that you can make an informed decision.
According to a source that I absolutely love called Evidence Based Birth, the cause of ON was discovered in the late 1800s. In that time around 10% of newborns caught ON, and it caused blindness in 3% of those cases. Following the discovery of the cause, routine eye preventative was administered to ALL newborns instead of just those at risk. At that time though, the preventative was silver nitrate instead of the erythromycin used today.
So what exactly is the cause of ON? Gonorrhea and chlamydia. Chlamydia is the most common cause, but gonorrhea is the most serious. If you're thinking, well I don't have either one of those so why does my newborn need erythromycin? Then welcome to the reason that so many decline it. Even if you tested negative for both STDs during your pregnancy, and even if you deliver by cesarean your newborn will still receive erythromycin unless you specifically decline. Typically it's not even a newborn routine that is ever discussed with parents before hand, consent is never asked, and no side effects are ever given. They just hand you your baby back with gooey eyes after being weighed and measured.
In recent years, hospital providers have actually threatened to (and did) call child protective services on their patients who declined the eye ointment. Typically if CPS was called it was open and shut, or not even looked into but they should've never been called in the first place. Everyone has a right to medical freedom, and I think it's pretty disgusting that the threat of calling CPS has scared so many new families into an unnecessary medical decision. Some did this because of the law regarding it, others because they simply didn't agree with their patients choices. I know a lot of you are now going "what law?"
Almost all US states require by law that a medical professional is to administer an approved preventative to every newborns eye's within two hours of birth or they can be subject to legal action. Many states have updated this law's wording to include that the provider will not be held responsible if the parent's decline this newborn routine, but even with the previous wording, that was always the case. Parents have always been able to opt out, but with the laws written the way they were providers heavily pushed the use of erythromycin and used the threat of CPS when parent's decline. I can't tell you about each state's specific law regarding erythromycin, but in Texas the law was changed a few years ago and makes it abundantly clear that your provider will not be held legally responsible if you decline. Random fact... When I was researching more about this episode, I actually discovered that it was a doula, now midwife in Washington State, named Jodilyn Owen who helped changed the law in her state many years ago, and I thought that was pretty cool.
So what exactly are the risks of the erythromycin eye ointment? Chemical pink eye or eye irritation, and blurred vision. It actually may not even be effective at preventing chlamydial ON either, which is the leading cause of it, and it's only about 80% effective at preventing ON from gonorrhea. Studies show that both STDs are now becoming resistant to the erythromycin. The risks of using erythromycin are relatively low, but it's suggested that the blurred vision can interfere with bonding. Bonding is hard to study, but there have been several studies that believe the use of erythromycin eye ointment disrupts the bonding process because newborns can tell between direct and indirect eye contact and they prefer direct eye contact.
With the risks outweighing the benefits in my opinion, and the fact that it's not even very effective anymore, it's no wonder that so many are opting out of using the eye ointment.
There are also other alternatives that are likely to be more effective than erythromycin as well. You can use povidone-iodine which is popular in several other counties, it wouldn't be available in a hospital, since it's not approved for use here. There may be a way to order it before hand though, then either you or a medical professional can administer it. I can't say for sure that you would be able to order it, but it's worth looking into.
Colostrum is another alternative you can use, and it is definitely available. You can simply put a few drops in each eye. If you don't know what colostrum is, it's the first milk you produce. It typically takes 2-3 days for your full milk to come in, so colostrum is what feeds your baby during that time. This is the option that I would personally choose since I routinely use breast milk for everything anyways. It is great at treating pink eye, ear infections, burns, eczema, and even bad credit. Totally kidding about that last part but I seriously use breastmilk for everything.
The last alternative is simply waiting to see if ON develops. The UK currently uses this method because they don't regularly screen for either STDs during pregnancy.
What about the use of erythromycin in patients who have a cesarean? Since the baby didn't pass through the birth canal, there is almost no risk of the newborn contracting ON from an STD if the mother is a carrier, yet it is routinely given to them as well. Going back to 1974 a total of 30 cases have been found where a newborn contracted ON even in a cesarean birth. It is believed that in all but one of those cases, the mother's water had been broken for over 18 hours prior. The actual risk of a newborn contracting ON after a cesarean birth is unknown because it is so rare.
Routine STD screening during pregnancy is important in my opinion because then there is no question whether or not to use the erythromycin. If you are positive then you can receive treatment during your pregancy and then the problem is solved with one dose of medication. Even if you are in a completely monogamous relationship, I still reccomend it. Men have almost no symptoms of chlamydia and even women can carry it for a long time without realizing it's more serious than a PH imbalance or BV. Either you or they could have picked it up previously without realizing it. Gonorrhea and chlamydia are the two most reported sexually transmitted infections and both have a long list of harmful side effects to your body not pregnant, so they can have even more side effects while pregnant. That's why it is recommended to be tested at least once during pregnancy. Testing can be performed with a urine sample or a simple cervical swab. There are often low cost testing and treatment options for those who cannot reasonably seek prenatal care or regular medical treatment.
If you are somewhere where you cannot access prenatal care or simply choose not to have the STD screening then I would recommend doing colostrum and breastmilk in the eyes since there are zero side effects of that and it can prevent an infection from happening. If you aren't planning on breastfeeding you can still hand express colostrum or even milk into a bag, bowl, cup, or directly into their eyes. If you can swing the $15 then I recommend getting milk collection cups that sit in your bra so that you can still catch what leaks out and save for future uses.
There are a few other things besides gonorrhea and chlamydia that can cause ON, but again, erythromycin doesn't do much to actually prevent the infection from happening. Antibiotics can certainly treat ON if it occurs, but the use of erythromycin eye ointment seems to be an outdated practice and one that definitely isn't appropriate for all newborns.
For over 130 years newborns have all been given one size fits all treatment instead of individualized care, parents have been bullied into an unnecessary medical intervention without any informed consent, and THAT is the problem with birth.
What do y'all think of erythromycin? Is it something you already knew a lot about, or something you had no clue on? Did you have a provider threaten you with CPS? Going forward will you opt to have the ointment administered, go a different route, or decline all together? Let me know! Prior to becoming a doula I had no idea that you could decline it or even WHY it was administered. I have learned a lot about it over the last few years but I honestly loved doing this episode because I learned a few things that I didn't know already and I love to learn. So y'all keep requesting topics, keep me researching, and let's keep talking about The Problem With Birth.
If you have a question, or want to request a topic you can do that through the website at theproblemwithbirth.com or you can find me on Facebook or Instagram at East Texas Birth Co and chat with me there. As always the transcription of this episode is available on my blog at etxbirthco.com.