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)