In the 19th century, 10% of newborns presented with eye infections after birth called opthalmia neonatorum (ON). 3% of those infants were blinded. Midwives and docs figured the babies were picking up something in the birth canal, but they weren’t sure what. At last, gonorrhea was discovered to be the culprit. So, they started treating all babies with silver nitrate after birth prophylactically (rather than wait to see if baby got sick), which dropped the ON rate profoundly.
Since then, more effective antibiotics – such as erythromycin gel – have been discovered, and chlamydia is has replaced gonorrhea as the leading cause of ON. Other bacteria can cause ON, too, such as Staph, and Strep A and B.
It is routine to apply erythromycin ointment to baby’s eyes within hours of birth. This will be offered in-hospital or out-of-hospital.
Some things to consider :
- A pregnant person with chlamydia has about a 15% chance of passing it on to baby. Gonhorrea’s transmission rate is 50-75%. Left untreated in a baby, gonorrhea has a high risk of blindness; chlamydia causes far less less vision damage.
- A care provider may test for gonorrhea/chlamydia (G/C) in early pregnancy, and again in the third trimester.
- You may request the test or ask if your doctor or midwife already tested you.
- The rate of false-negative for G/C testing is 0-15%, so testing twice is smart.
- Ask your partner to test.
- Since G/C can cause other problems in pregnancy, testing is worth it. These infections can be asymptomatic in some individuals.
- If you are in a monogamous relationship, your partner is negative, and you have tested negative as well, then refusing eye prophylaxis for your baby is a reasonable choice.
Erythromycin for baby has some drawbacks:
- Mild eye irritation
- Blurred vision
- It is not 100% effective at treating ON from G/C
Alternatives to prophylaxis:
- Test and treat for G/C during pregnancy
- Wait and see if ON develops. If the baby has G/C ON, they will be treated with injectable antibiotics and may need hospitalization.
- Povidone iodine drops. Popular in lesser-developed countries, they are not approved for use in the U.S.
- Colostrum in baby’s eyes. Colostrum appears to better at preventing non-G/C ON than no treatment at all. One study found colostrum to be more effective than the prophylaxis and one found it to be less for non-G/C ON.
Special thanks to Evidence Based Birth! Visit their site for a much more thorough review of eye prophylaxis evidence!