Can we discuss the Eye Ointment again?

[LaffNowCryLater]

I was all gung ho about refusing the eye ointment, because I thought that it only protected against ophthalmia neonatorum/neonatal conjunctivitis from chlamydia or gonorrhea- neither of which I have.

As I did some more research I see now that it also to protects the baby from getting ophthalmia neonatorum/neonatal conjunctivitis from Haemophilus influenzae and Streptococcus pneumoniae, and it doesn't protect from chlamydial ophthalmia (<--not that that matters).

OK now here is where I am clueless. I know I didn't have those vaccines as a child, so would that mean I may have some colonization in the birth canal? If so how "bad" is conjunctivitis from Haemophilus influenzae or Streptococcus pneumoniae? Is it something like pink eye? or is it something more severe that could causes blindness?

[nashvillemidwife]

Did your research turn up the incidence of infection from those organisms? It may be true that they protect against them, but that is not the reason the eye ointment is routinely given to all babies. I am wondering if a newborn baby is any more at risk of getting an eye infection from those bacteria than the general population. Everyone who has eyes is at risk of pink eye. The concern with newborns specifically is the incidence of STD-related eye infections.

[katelove]

I'm not sure of the answers to your specfic questions but I just thought that I would mention that here in Australia routine administration of eye ointment for neonates is simply not done and hasn't been for at least 16 years.

[LaffNowCryLater]

So the other two organisms simply give the baby pink eye? That is kind of what I was wondering (pink eye or something more serious). I'm not too concerned about that considering I allowed the eye ointment with my other 3 kids and it gave them chemical conjunctivitis.

[nashvillemidwife]

It's all pink eye. That's what "conjunctivitis" is. That's not to say it can't be very serious, it all depends on the pathogen. I do not know how serious an infection would be from the bacteria you named, but they are not common causes of infection.

[LaffNowCryLater]

Thank you. Do you happen to know what I would need to do to refuse the eye ointment at a hospital in TN? I called a few hospitals (to compare what they said) and the nurses there don't know much from what I could tell and one even told me a court order was needed (??). I was planning on typing up an affidavit and getting it notarized or something. Unless I am reading TN Code 68-5-202 wrong, it looks like it is only the law for the medical provider to offer and provide the ointment, but parents can refuse all they want.

http://www.state.tn.us/tccy/tnchild/68/68-5-202.htm

[nashvillemidwife]

It is up to the hospital or provider to decide how they want to handle it. Legally, there is no option to refuse. If the provider doesn't do it, they are committing a Class C misdemeanor. I don't know what an affidavit would do for you. What do you think you are going to be able to say on that piece of paper that will supercede the law? Legally speaking, your refusal is irrelevant and they are perfectly within their rights to require a court order to protect themselves from liability. Practically speaking, most places have some sort of waiver even though the law does not allow for it.

Personally, if I were having my baby in the hospital I'd just let them do it. I like to pick my battles, and this one just isn't worth it.

[LaffNowCryLater]

The law says:

It is the duty of any physician, nurse or midwife who assists and is in charge at the birth of any infant, or has the care of the infant after birth, to treat the eyes of the infant with a prophylaxis to prevent ophthalmia neonatorum or infections leading to blindness.The treatment shall be given as soon as practicable after the birth of the infant and always within one (1) hour

Unless I'm missing something, the law says it is the duty of the above medical professionals to treat the eyes of the infant within one hour, not the birth mother (unless they expect me to bring my own prophylaxis and do it myself).
http://www.state.tn.us/tccy/tnchild/68/68-5-202.htm

[LaffNowCryLater]

Originally Posted by nashvillemidwife

It is up to the hospital or provider to decide how they want to handle it. Legally, there is no option to refuse. If the provider doesn't do it, they are committing a Class C misdemeanor. I don't know what an affidavit would do for you. What do you think you are going to be able to say on that piece of paper that will supercede the law? Legally speaking, your refusal is irrelevant and they are perfectly within their rights to require a court order to protect themselves from liability. Practically speaking, most places have some sort of waiver even though the law does not allow for it.

Personally, if I were having my baby in the hospital I'd just let them do it. I like to pick my battles, and this one just isn't worth it.

BTW, the nurse said I would need a court order to refuse it. Not that they would acquire one to get me to comply. To be honest I called a few hospitals and none sounded too knowledgeable about the situation in general.

[nashvillemidwife]

Originally Posted by LaffNowCryLater

BTW, the nurse said I would need a court order to refuse it. Not that they would acquire one to get me to comply.

Right, that's what I meant too. I'm not sure you're seeing the situation quite head on. The law says the provider has to do it, and if they don't it's a class C misdemeanor (up to 30 days in jail and/or $50 fine). There is no exception for the parents refusing it. The law does not extend you that option. You can tell them you decline it or refuse it for your baby all you want, at the end of the day the burden is on the provider to do it, and if they don't they are breaking the law regardless of whatever you say or offer to sign.

[LaffNowCryLater]

Originally Posted by nashvillemidwife

Right, that's what I meant too. I'm not sure you're seeing the situation quite head on. The law says the provider has to do it, and if they don't it's a class C misdemeanor (up to 30 days in jail and/or $50 fine). There is no exception for the parents refusing it. The law does not extend you that option. You can decline it or refuse it for your baby all you want, at the end of the day the burden is on the provider to do it, and if they don't they are breaking the law regardless of whatever you say or offer to sign.

OK so I am thinking we are on the same page. IME (working at DCS) the law has to be pretty specific. No where does it explain what a parent has to do at all so I would not be breaking a law. Also I see that there was a code that was repealed (68-5-201) that said what exact prophylaxis to use, and now it is back to being just "prophylaxis" which is pretty ambiguous IMO, and I am wondering if breastmilk would suffice?

I don't plan on going into this all guns a blazin' if that is what it sounds like , but I figure it won't hurt to try to refuse. On my local board a lot of moms refused easily at various local hospitals, so I hope I have a similar situation.

[someguy79]

It depends on your state

Some states have religious or philosophical. Mine has religious. I am also allergic to emycin lethally so. I have handled it like this. I draft a document BOLD RED title advanced medical directives.

Toss a paragraph in about any employee or contractor etc is prohibitted from providing care if they cannot follow the directives that I reserve the right to charge anyone with medical battery etc, but based on exp. expect that wont be an issue since the staff usually follows my directives. My wife and I sign it before a notary. It gets a few frowns but they ask about everything after that. I cover the no-circ and the whole nine.

On the Emycin I combine the dad allergic with religion thing. Basically undo gambling with sacred life. I have always offered they can use tetracycline as Mayo says its also indicated. Everytime they say no that is fine mostly for STDs anyway.

[mamatolevi]

DH is a lawyer (in three states) and tells me that generally it's considered unconstitutional to force someone to comply with a medical procedure. Parental rights do supercede the law unless the hospital gets a court order from a judge that has determined it's in the best interest of the child to do the refused procedure. Given the expense, no hospital is likely to go to all that trouble over the eye drops. Usually that's reserved for major things like transfusions and chemotherapy (a classic example would be the kid w/cancer in MN last summer.)

Parental rights notwithstanding, many nurses will push the issue b/c the hospital requires they do so, even to the point of threatening calling social services. (Whether or not the nurse agrees with the policy is irrelevant; if they work there they have to tote the party line.) I had to put up with that "it's illegal to refuse x" garbage when I had my first (over what exactly I can't remember now - probably some vax I was going to have my ped do rather than them) and when I pointed out that a. they weren't lawyers and b. that my husband is, they dropped it real quick.

I view this whole "it's the law; it's required" stuff along the lines of "well your insurance won't cover x if you don't do y." I always ask if they even know who my ins. company is and they shut up real quick b/c they don't know anything about my insurance and are just using that tactic to enforce a hospital policy. (again, something they have to do, b/c it's their job to follow policy not b/c they are terrible people)

[Kidzaplenty]

The hospitals here are required to call CPS if you refuse the eye ointment. So, that is something to consider.

[Channelle]

Originally Posted by Kidzaplenty

The hospitals here are required to call CPS if you refuse the eye ointment. So, that is something to consider.

Can I ask how you know this? I'm trying to find out what I can and cannot refuse in my state and when they are required to call CPS, but not having any luck...

[Kidzaplenty]

Because I was faced with this decision when my son was born in the local hospital last year. And they have a very clear rule in the hospitals that I am guessing is based on the above law of the caregiver being required to give it. There were no opt out options and no way to refuse without CPS being automatically notified. My religious exemption form for vaccines was good enough for shots, but was not an valid excemption for the eye ointment.

Additionally, after a lot of research, I can not find a sinlge way for anyone to opt out written into our state law. I can refuse vaccines as well as any tests (PKUs and such) but there is no legal way to NOT get the eye ointment and possibly the Vit. K (because it is not a vaccine nor a test).

[lovebug]

I am sorry... but what STD's is it for? I it just for the oneslisted above or other ones too (like herps and other STD's)?

If the mother is STD neg why would they MAKE her get it?

[nashvillemidwife]

It's for chlamydia, gonorrhea, and syphilis. The other STDs are viral so not affected by antibiotics. They give it to every baby because despite a negative test, you can never know for sure that a woman does not have it. The test could have been a false negative, or she may have picked up the bacteria since the test was performed. Unless her partner is by her side every minute, every woman who is sexually active and does not use condoms is at risk for an STD; therefore every baby who comes out a woman's vagina is at risk too. If you are certain this is not the case with you and your baby it is your right to decline, but the provider and hospitals have to consider the basic truth everyone is at risk when making their policies.

[LaffNowCryLater]

Originally Posted by Kidzaplenty

Because I was faced with this decision when my son was born in the local hospital last year. And they have a very clear rule in the hospitals that I am guessing is based on the above law of the caregiver being required to give it. There were no opt out options and no way to refuse without CPS being automatically notified. My religious exemption form for vaccines was good enough for shots, but was not an valid excemption for the eye ointment.

Additionally, after a lot of research, I can not find a sinlge way for anyone to opt out written into our state law. I can refuse vaccines as well as any tests (PKUs and such) but there is no legal way to NOT get the eye ointment and possibly the Vit. K (because it is not a vaccine nor a test).

I work for DCS, but I'm giving birth in a different county about 20 mins away. But all calls go through the state capital office and some vile stuff gets screened out I would be really shocked if this made it through.

[mamatolevi]

call the PP dept and ask to speak to the nurse manager.