NC rules for vit k & eyedrops?

[WriterMom2be]

I've been reading conflicting things about this on the web. I had my last baby in NY where refusal is grounds for a cps intervention. What were your experiences here?

I'm thinking of either UNC hospital or the Chapel Hill birthing center.

[beanma]

I had my youngest (now 6.5) at the birth center. At that time waiving the eye goop was no big deal at all. Certainly CPS has never been to my house. I think maybe I had to sign a form.

Maureen who is the director of the Birth Center really strongly encouraged the vitamin K. She would have let me opt out, but I think I was swayed by her testimonial. I really don't even remember now for sure. I do remember that she told me she used to be pretty easy-going about it, but she was present when a couple who had refused the K lost a baby (presumably due to a clotting/bleeding issue) and ever since then she had really encouraged the shot as an extra precaution. So if you go with the birth center (which is a wonderful place) be prepared that Maureen may still give that same speech. I think you could opt out, though. I would encourage the birth center if you've got the possibility. I think the hospital is not going to be as mellow about it, although UNC is better than some.

Hopefully someone more connected to the current birth scene in the area can chime in, too. Things may have changed in the last 6.5 yrs since my baby girl was born.

[SeekingJoy]

I refused both at my DD's birth 2.5 years ago at Rex. All I had to do was sign a waiver and listen to a speach from the nurse about how the doctor was "not happy" with me.

[rhiOrion]

I was with the birth center but had to deliver at UNC. The PP is correct that the birth center lost a baby due to a bleeding disorder, so they're big on the vitK shot.

I had already decided to do it, and then I came down with Cholestasis which can affect vitamin K levels, so I extra-super decided to do it. But when they asked me if I was going to (before the cholestasis) it wasn't in a judgemental tone. I think they would have encouraged it, though.

I declined the eye drops and hep b, and neither the hospital nor the birth center batted an eye about it. They just had me sign a waiver. I honestly think that since I was from the birth center that UNC just assumed I was going to decline them, their tone of voice suggested that they would have been surprised if I'd said yes (and it also wasn't a negative tone)!

[maotmsmi]

*

Edited by maotmsmi - 5/21/11 at 12:40pm

[DoulaVallere]

Originally Posted by beanma

I had my youngest (now 6.5) at the birth center. At that time waiving the eye goop was no big deal at all. Certainly CPS has never been to my house. I think maybe I had to sign a form.

Maureen who is the director of the Birth Center really strongly encouraged the vitamin K. She would have let me opt out, but I think I was swayed by her testimonial. I really don't even remember now for sure. I do remember that she told me she used to be pretty easy-going about it, but she was present when a couple who had refused the K lost a baby (presumably due to a clotting/bleeding issue) and ever since then she had really encouraged the shot as an extra precaution. So if you go with the birth center (which is a wonderful place) be prepared that Maureen may still give that same speech. I think you could opt out, though. I would encourage the birth center if you've got the possibility. I think the hospital is not going to be as mellow about it, although UNC is better than some.

Hopefully someone more connected to the current birth scene in the area can chime in, too. Things may have changed in the last 6.5 yrs since my baby girl was born.

that:

Both of my boys were born at the WBWC (fabulous experiences, both times! I highly recomend it!) and I had the same experience with Maureen. I ended up caving in...I had decided NOT to do it before the births, but then afterwards I think I was emotionally drained and just went with it. No eye goop or Hep B, though. The birth center doesn't even do Hep B - you'd have to get your ped to do it, if you wanted it done. We're having a homebirth this time and decided to just do oral Vit K after researching the vit k shot more and not feeling comfortable with it. We never had any issues at all with the eye goop or even the Hep B with our ped. Just sign a waiver and you're good.

[WriterMom2be]

Thanks for all the helpful posts! I'm going to do more research on the oral vit k. We never did the hep b with our ds, but I was advised to say our pediatrician will be giving it to him even if that wasn't true. I'm not sure if there would have been a problem if I had simply just refused. I didn't want to risk it.

[mamajjr]

You may want to call individual hospitals and ask. Each hospital has it's own policy on how they interpret NC rules. For example, CMC in the Charlotte area allows for the Vitamin K to be turned down, but not the eye drops citing NC Administrative Rules. I was able to opt out of both, but delivered at a Presbyterian Hospital.

North Carolina Administrative Ruling 10A NCAC 41A .0204 CONTROL MEASURES - SEXUALLY TRANSMITTED DISEASES

http://ncrules.state.nc.us/ncac/titl...a%20.0204.html

g) All newborn infants shall be treated prophylactically against gonococcal ophthalmia neonatorum in accordance with the STD Treatment Guidelines published by the U.S. Public Health Service. The recommendations contained in the STD Treatment Guidelines are the required prophylactic treatment against gonococcal ophthalmia neonatorum.

For example, this is the ruling at CMC Hospitals regarding Eye Drops and Vitamin K (from their guidelines):

● NEWBORN PROPHYLAXIS FOR GC CONJUNCTIVITIS: MANDATED WITHOUT AN OPT OUT*

- Given to prevent neonatal gonococcal ophthalmia (conjunctivitis) which causes blindness. While gonorrhea (GC) is a leading cause of blindness worldwide, it is rare in the US because of the success of newborn prophylaxis. Newborn GC prophylaxis is the universal standard of medical care. GC is the second most common sexually transmitted disease after Chlamydia. NC averages nearly 16,000 cases of GC a year.

- Prophylaxis is mandated because: GC is common, maternal GC infection can be asymptomatic and can be missed, GC eye infection in a newborn are so serious, and preventing that kind of infection is so easy,inexpensive, and safe.

- CMC uses erythromycin ophthalmic ointment for GC prophylaxis. It is well-tolerated but does cause briefly “gooey” eyes. Application of the ointment can be delayed for up to one hour after birth to facilitate bonding. An occasional infant has very mild and temporary eye irritation for a day or two.

- In the event of a shortage of erythromycin ophthalmic ointment, other similar products may be substituted for the erythromycin.

- Silver nitrate drops which did cause severe irritation of the eyes are not used and are no longer manufactured in the US.

- Common parental concerns about GC prophylaxis include:
(1) that it will interfere with bonding
(2) that it will affect the baby’s appearance
(3) that it will be uncomfortable or painful to the infant
(4) they don’t want their baby exposed to a foreign substance
(5) that prophylaxis is unnecessary if the mother believes that she is not at risk of having GC
(6) they want as little done to the infant as possible (don’t want to “bother” the baby)
(7) they don’t appreciate the seriousness of the infection and its sequelae if the mother does in fact have GC
8 they don’t appreciate the public health significance of preventing GC infection
(9) they think silver nitrate drops are still used
(10) they don’t realize that many pediatricians and family practitioners will not accept infants as patients if parents refuse medical recommendations, especially those that are state mandated
(11) they don’t appreciate that the state mandate is designed to protect the best interest of all infants.
*Parents who do not want their infant to receive GC prophylaxis must obtain a court order before delivery to enjoin CMC staff from administering the eye ointment.

● VITAMIN K ADMINISTRATION: Standard of care but not required by NC State Law

- An injection of Vitamin K is given at birth to prevent hemorrhagic disease of the newborn (HDN).

- HDN can occur in newborns because they do not have enough Vitamin K to help their blood clot normally.

Without sufficient Vitamin K, excessive bleeding from just minor trauma and spontaneous intracranial bleeding with sudden death can occur. It can take up to 3 months for an infant to have normal Vitamin K levels. Unprotected infants, especially those who are being breastfed, are at risk of serious bleeding during this time. In the past, HDN was a common cause of death in infancy. The risk of HDN in an infant who has not received a Vitamin K injection at birth is as high as 7 per 100,000 infants.

It is a low risk but the risk is not zero.

- Vitamin K is made by our own bodies. In this regard it is not a foreign substance.

- Why don’t newborns have enough Vitamin K? While humans absorb most vitamins from food, most of our Vitamin K is actually produced by special (normal) bacteria in our intestines. Newborn infants do not have these bacteria yet (they weren’t needed in utero). It takes about 12 weeks for newborns to acquire enough bacteria that are mature enough to produce the levels of Vitamin K needed to protect against uncontrolled bleeding.

- The vitamin K injection is an extremely effective and safe way to protect infants against HDN. The intrasmuscular injection can be deferred for up to an hour after birth to facilitate initial bonding.

- Oral vitamin K is not as effective and is not recommended in place of the injection. It can be considered as an option which might provide some protection but the optimal dose and how many doses are needed have never been established. Parents who want oral Vitamin K for their infant cannot be assured that their child is adequately protected against HDN.

The American Academy of Pediatrics (AAP) strongly endorses the administration of injectable vitamin K at birth.

- The only mention of Vitamin K in NC law is in reference to midwifery (they are required to have it available).

- Common parental concerns about Vitamin K injections include:
(1) that it will interfere with bonding
(2) they don’t their baby exposed to a foreign substance
(3) that it will be painful for the infant
(4) they want as little done to the infant as possible
(5) they think that HDN is not a common enough to worry about (“it won’t happen to our baby”)
(6) they don’t appreciate the potential seriousness of HDN when it does occur
(7) they think there is an acceptable alternative
8 they think that vitamin K is a vaccine
(9) they don’t realize that some pediatricians and family practitioners will not accept as patients if their parents refused standard medical recommendations which are intended to protect children
(10) they are concerned about an unproven risk of leukemia (two small studies in the early 1990’s showed an association but a number of very large, better done studies have not shown a
causative effect).
- Parents may “opt out” in writing from Vitamin K administration (use AMA form)

[rhiOrion]

So, for the hospitals that state there is no "opt out" ... what do they do if you just say no? If you state it clearly, write it down, put it on the bassinet, and never let the baby out of your site?

I mean, I suppose they *could* call CPS, but would CPS even care, considering NC doesn't require it?

[mamajjr]

CMC threatens to call CPS. I honestly don't know if they have ever done it. I delivered at Presbyterian and had a birth plan excluding the administration and the baby never left my sight; even the newborn screening was done on my chest. They made me sign forms excluding the eye drops, vit k and hep b. I just crossed out what I didn't like and signed the forms. NC does "require" the eye drops; at least this is what the NC Administrative Rules say.

I don't understand why they just can't test the mother right there.

[pinky]

I had both my babies at UNC and they didn't even blink at refusing the eye goop and Hep B. We did get the vit k, but one of the nurses actually double checked with me to make sure that I wanted it. I wouldn't anticipate any problems on that front.

[Carhootel]

I transferred from the birth center in Chapel Hill to UNC and nobody even mentioned the eye goop or hep b after I said I didn't want them

[Lady Lilya]

I hope having a homebirth makes it easier for me to opt out. It did in NY.

But in the event of a transfer, if they try to make us do either of these, I am going to put up a HUGE fight.

I hope you guys don't see me on the evening news screaming about vitamin K and eye goop.

[mamajjr]

You can also write the following, which covers all statue bases:

XXX (your child's name), born XX/XX/XXXX is exempt from receiving vaccinations in accordance with NC General Statute 130-157A.

Sign and date



You do not have to explain you religous beliefs or what specific vaccinations that you oppose. NC is not an all or nothing state. However, if my child received some vaccinations, I would only provide them with the exemption.

[Lady Lilya]

But vitamin K and eye goop aren't vaccinations exactly. Does it cover them?

[NICURN57]

As a Neonatal Nurse for 18 years, you women scare me. If you could see what I have seen, you would want everything in the world done for your children. Normal newborns are a blessing, as anything and everything can go wrong. Just because you have been "tested" does not mean you have been tested for the hundreds and hundreds of things out there. Emycin does not interfere with bonding anymore than blindness. The babies cannot recognize a face. They just see faces. You will have 18 years and beyond to bond. I was raised in the 50's, was not breast fed, and loved my mother to death. She was the best.

 Trust me, the meds are out there for your protection. The research behind it is outstanding, and the reason for the med. No one makes a profit out of it. In fact, there are 90% Medicaid patients born at my current facility. Educate yourself. Don't be an Earth Mother simply because its a fad, and you feel all warm and fuzzy doing it. Have your baby at home, fine. Then don't cry in the ER when I have to revive it. Yes, I have done that.

 PLEASE educate yourself, There is areason for everything we do. We work hard, and are not making money off of you. It is frustrating when you refuse, that is why we just walk off, trust me, we are saying it all in our head.

 Educate yourself,.

[greenhands]

...and that, folks, is why educated people who prefer true informed consent rather than scare tactics choose home birth.

[amia]

Could you please tell us then what erythromycin or other eye drops protect against that is not sexually transmitted? And/or not included in prenatal testing. A link to an authoritative site, or even quasi-authoritative site would be helpful. It's actually difficult to find anything supportive of eye drops beyond they are believed to be safe and protect, possibly, against infection due to gonorrhea and maybe chlamydia.
 

Originally Posted by NICURN57 

As a Neonatal Nurse for 18 years, you women scare me. If you could see what I have seen, you would want everything in the world done for your children. Normal newborns are a blessing, as anything and everything can go wrong. Just because you have been "tested" does not mean you have been tested for the hundreds and hundreds of things out there. Emycin does not interfere with bonding anymore than blindness. The babies cannot recognize a face. They just see faces. You will have 18 years and beyond to bond. I was raised in the 50's, was not breast fed, and loved my mother to death. She was the best.

 Trust me, the meds are out there for your protection. The research behind it is outstanding, and the reason for the med. No one makes a profit out of it. In fact, there are 90% Medicaid patients born at my current facility. Educate yourself. Don't be an Earth Mother simply because its a fad, and you feel all warm and fuzzy doing it. Have your baby at home, fine. Then don't cry in the ER when I have to revive it. Yes, I have done that.

 PLEASE educate yourself, There is areason for everything we do. We work hard, and are not making money off of you. It is frustrating when you refuse, that is why we just walk off, trust me, we are saying it all in our head.

 Educate yourself,.

[abc123xyz]

Umm...yeah! That scare into submission post is ridiculous! It is apparent that medical professionals have no earthly idea what they are talking about since the erthrymician is for two STD's only! Nothing else! And there are severe side effects from them! And if a baby hasn't been born vaginally, then they don't need it! WOW! From what I have researched on Vit K, in rare cases, it is necessary but a baby born in a low-zero trauma birth and only handled gently by mom from the moment of birth should not need the vit k. Breastmilk stores give all they need in the first week or so. It was made standard as an insurance policy for mishandling of infants in the hospital. Ie: in case they drop your baby or cause some sort of trauma; or in the event of a traumatic birth. I guess I feel it should be a case by case basis instead of across the board and definitely in the oral form vs. injection!

Anyway, there are letters you can have prepared from http://www.vaclib.org/exempt/northcarolina.htm

They give you the stance the state takes and your letter for refusal! It's great! I had my first by way of homebirth transfer and CPS was called in for refusal of normal routine infant care. (eye goop, vit k, hep b, circ, nursery care) We also refused a spinal tap and full antibiotic flush they recommended from a birth fever. He's fine...He's almost four and never been sick! They were mad we contested their routine and CPS did visit our room before we were "allowed" to leave and she stayed and chatted with us for over 2 hours and then declared the situation void. It was all very silly and stupid to put on a new mother! Bottom line: your body, your birth, your baby, your decisions! If you don't want something, you make it very clear to every single person you come in contact with in the hospital because in the hall you are regarded as "that lady who doesn't know what she's doing" and nurses/dr's with agenda WILL ignore heresy for others! I would keep a sign with the baby in their bassinet if you plan to send him/her to the nursery so that you are certain it's clearly seen. Or screen print a sleeper! LOL!

My second was born at home with none of the above and when we got his birth certificate, it was no problem. Moving back to the same city we were living in with our first birth, I called to find out about birth certificate request and she told me that I "may" have to meet with CPS since I am not having a skilled birth attendant! LOL! So, I guess, here we go again! I don't know if she was just trying to worry me or what but I will gladly meet with them and my two toddlers running around their office!!!

Whatever you decide, many birth blessings in your upcoming birth!!!

[JensZen]

Ladies, I can't express the gratitude I feel for having found this thread in the Google trail....The recommendation for CH Birthing Center is a God-send.  Our 2 boys are 14 & 10, but we just discovered we are expecting.  After my 1st birth I was enrolled in nsg school for 2 yrs, top of my class w/a 4.0, but so many things didn't sit well with me, however I was so young & only educated in what that particular program (of course, mainstream) taught me, so I couldn't quite connect the dots of discrepancies.  Since having our 2nd son, I've gradually learned a wealth of info regarding natural health.  We are in the position of needing Medicaid for this birth, but I was so worried that refusal of vaccines would cause CPS to be called.  With our 2nd son, I had stated (based on my nsg education; this was prior to any natural health research) that I did not want him to get the HepB b/c he was too young.  I was sharply told (at Forsyth Memorial in W-S) that "You will not be allowed to leave with the baby without it."  To have learned the legalities, my rights, & also the incredible facility CHBC seems to offer, my 1 true worry once I found out we were pregnant:  mandatory vaccination has now been settled. 

JKSeawell, Your story is fascinating & I'd love to get to know you better!  :D 

OH, & to NICURN57, our 1st son required resuscitation b/c I was overmedicated via both pc pump & narcotic injection.  He nearly died.  Thank dear God he did not.  He is healthy, intelligent, talented, & such a gift.  Your callous remark "Have your baby at home, fine. Then don't cry in the ER when I have to revive it "...reflects it's time you should retire.  Like the next poster said, it is exactly that attitude that has mothers looking elsewhere.