The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
If you know any birth attendants who are still practicing premature clamping and cutting of the cord, encourage them to watch this video of a grand rounds with Dr. Nicholas Fogelson at USC. It's got lots of research and an open-minded perspective. |
Clinical
Trial
of Eye Prophylaxis in the Newborn - "The results suggest that
prenatal choice of a prophylaxis agent including no prophylaxis is
reasonable
for women receiving prenatal care who are screened for sexually
transmitted
diseases during pregnancy."
Some midwives suggest prophylactic eye ointment for babies born in
the
hospital, even if they wouldn't make the same recommendation for a
birth
that takes place in the home or birth center. The logic is that
hospitals
are full of more and worse germs.
I agree that the logic is appealing, but consider that the worst
germs
in the hospital are resistant to antibiotics. When you use an
antibiotic
to kill off the non-resistant germs, then there is nothing to keep the
resistant germs in check. In particular, the normal skin flora
that
work to prevent infections in the first place aren't allowed to
colonize
the eyelash beds.
From a mom:
My midwife initially tried the same stuff on me this last time (there are other bacteria in the vagina...) Well, there are other bacteria in the vagina- good ones. Is there any proof that this bacteria causes infection in a newborn's eyes? I kept asking for proof, for medical references, and finally she broke down and admitted that the real reason Dr.s and midwives tell you it's for other reasons than STD's is because *they* can get in trouble for not administering it, not because there is truly a medical need. So I suggested if it would soothe her conscience, she could let *us* administer the drops. And we would miss.
You might try this with your own health care professional. My
last two did not have the eye drops, and there was an amazing
difference
in their ability to focus on my face compared to the others. I
for
one found that the weeks of deep, soul-searching gazes exchanged with
these
children in their early days and weeks is too valuable to trade for
some
unnecessary goop in their eyes for no valid reason.
Quite a high number of woman who have gonorrhea have no symptoms of it (20%?). They are the main reservoir of this illness in the population. That's why it's not exceptional pregnant woman are tested on STD during their pregnancies. Testing during pregnancy is however not a proof at all there won't be pathogen germs in the vagina by the time of the delivery.
The use of ointments and AgNO3 is in this perspective obsolete that
nowadays eye infections, caused by gonococci or other germs, easily can
be treated and cured from the moment of onset. In the rare occasion the
eye infection is caused by gonococci this approach will reveal which
woman
have gonorrhea but not the symptoms. Both mother and baby and likely
the
partner(s) too then can be treated and cured. This approach is safe and
effective. It will too safe clients and health care a lot of
unnecessary
costs (imagine the pool of silver nitrate or the pile of ointment (or
the
$$$) used to treat something that wasn't there!!). The use of AgNO3 and
ointment is no full guarantee an eye infection won't occur. Quite often
AgNO3 causes some eye irritation itself.
gonorrhea It has been calculated that this disease accounted for one third to one half of all the persons in blind asylums, so destructive of sight it is; but now that it is more vigorously dealt with and is notifiable by doctors and midwives its incidence has been kept down. [This was written in 1930.]It was a very obvious infection and very difficult to treat.
Delee's Obstetrics for Nurses (1937 edition):
[gonorrhea] quickly sets up a violent inflammation of the conjunctiva. at first the lids grow red , then there is a thin, irritating discharge, with yellowish flakes. After a few hours this becomes purulent and th lids become so swollen that the eyes are closed. Unless active and constant treatment is instituted, the inflammation gains headway, the cornea may ulcerate, leaving ugly scars which shut out the light, or the lens may escape and the whole eye be destroyed. A large part of the blindness in the world is caused by this dreadful affliction, and it is primarily venereal in origin. pg 496-497There is a HORRIBLE picture of a baby with the disease -- eyes --really the entire upper face -- swollen and distorted, red, oozing yellow pus. Believe me, it looks nothing like any conjunctivitis I have ever seen. I can't imagine anyone not noticing it, or ignoring it.
The treatment in those days consisted of frequent "irrigations" with warm saline and/or applications of ice packs made of sterile saline poured over sterile ice cubes. The nurse applies these "ice-cold pledgets (cotton balls) on the lids, changing them every minute, and throwing the waste into a paper bag at the side. The order may be to keep up the application of cold for twenty-four hours and not to interrupt it while the child is nursing." And days and weeks of constant care were required to fight the infection, prevent eye damage and attempt to prevent its spread to the family and caregivers.
It's really very sad to see the pictures in this book.
Contrast this treatment with a later book- Handbook of Pediatrics (1975: post-penicillin)-- "The prognosis with treatment is generally very good, and cure should result within two to four days."
I frequently send up a prayer of thanks for the discovery of
antibiotics.
The whole notion of gonorrhea causing blindness in this day and age
is ridiculous. GC in a newborns eyes is supposed to cause an
outrageously
awful infection. They go blind from abscesses and ulcerations -
not
a silent destructive subclinical infection. Nobody would miss
it.
It's like other pathological conjunctivitis's: if the eye is extremely
purulent, swollen, and red they need antibiotics. Even if the
babe
developed the beginning of a GC positive eye infection the treatment
would
still prevent blindness. Nobody would be home with a lavender and
saline compresses, mistaking it for a plugged duct. I saw a film
once of the treatment before antibiotics, when all they could do was
irrigate
the eyes with who knows what. I was impressed.
How about chlamydia and blindness? Is that symptomatic
as
well?
Though the erythromycin doesn't burn, it is an antibiotic which I
suspect
will enter the bloodstream through the eye, thus it is my assumption
that
the potential for candida diaper rash, thrush, digestive problems and
antibiotic
resistance are raised when eye prophylaxis is administered.
I don't know about those problems, but I have noticed that we tend to see more sticky eyes in babies who have had the erythromycin. My thought on that one is that there is likely some kind of local irritant reaction to the ointment, which causes swelling of the tear ducts and blockage. With improper drainage, a breeding site for bacteria develops and, voila, a sticky eye (almost always just one, we've noticed).
Would be good to see a clinical trial on this. I think mandatory
eye prophylaxis is a stupid notion, frankly. For all the reasons cited,
thus far.
The mom can try the following: cut fingernails really short,
hold
her finger in hot water and massage the inner corner of the eye.
Also, have her drip breastmilk in the eye at every feeding.
Clogged tear ducts are usually one-sided. A bacterial infection will usually infect both eyes pretty quickly. Sometimes a clogged duct will resolve on one side and then the other side becomes clogged. Clogged ducts can last for weeks and weeks.
If they want to try alternative remedies, I'd recommend an infusion
of plantain made fresh daily; personally, I consider goldenseal too
strong
for a baby.
Plantain may be used in place of antibiotics for drawing infection out of the eye. Be diligent and treat with warm, infusion-soaked sterile 2x2 or 4x4, TID to QID. Drizzle a little into the open eye as well. Be sure infusion is strained of all bits of plantain. Fresh and dried plant works equally well, use more of the fresh when making the infusion (strong tea). Works well for pink eye, too. Takes 2-3 days of treatment. If it still hasn't cleared up, consider a ped visit.
It's very common for newborns to get minor eye infections or a simple clogged duct. Like the newborn's skin, the newborn's eyes have to be colonized with the normal, healthy flora, and there may be little skirmishes with abnormal bacteria in the first few days after birth.
It's also very common for my clients to decline erythromycin eye ointment, based on clinical evidence, and they often get very worried if their baby develops a minor eye infection.
So I'm including some links here to photos of the kinds of
gonococcal
eye infections that can cause blindness. If your baby's eyes look
like this, take them to the doctor immediately!
General Google search for images of gonococcal conjunctivitis
#include "trailer.incl"