"Eyes & Thighs"

[RootedRedwood]

By "Eyes & Thighs" I am referring to the Vitamin K injection and antibiotic eye ointment that are routinely administered to newborns shortly after the birth.

Where I work, we have a significant incidence of refusal of these medications by the parents. Often the parents have never even heard of them prior to their arrival to the hospital for the birth. That is a huge part of the problem. Isn't it the provider's responsibility to explain the purpose of this treatment to parents before the birth so that they at least have true informed consent should they decide to accept or refuse the treatment?

I'm not saying that we aren't responsible for educating our patients....but, I have found that during labor or shortly after the delivery is a terrible time to explain these medications to the parents. The parents tend to be exhausted and/or distracted and are often unable to process the information. I was wondering if other nurses have this same issue and how you deal with it?

Do you have written material to give to patients that explains the benefits/risks of this treatment in words that non-medical folks really understand? I'd like to put something like this together and was wondering if anyone had any examples from their facility. Thanks for any responses!

[cjcsoon2bnp, MSN, RN, NP]

As an educated mom who has refused both Hep B and Vit K for my baby (who is now a happy and healthy unvaccinated two-year-old) please don't assume that those parents who refuse these unnecessary procedures are uneducated. Informed consent is great and it's absolutely important that parents understand the healthcare provider's rationale for wanting to administer them, but it's also important that HCPs understand that it's the parents' decision. Administering a drug to a baby whose parent did not consent is illegal. Whether or not the administration of the drug causes harm is irrelevant.

I know its a bit OT but just out of curiosity Kate do you plan on ever vaccinating your child for any disease or are you against vaccines completely?

!Chris

[KateRN1]

I know its a bit OT but just out of curiosity Kate do you plan on ever vaccinating your child for any disease or are you against vaccines completely?

!Chris

I'm am not against vaccines, just against unnecessary procedures of any kind. I am fully vaccinated myself, for many reasons, among them is that I'm a nurse and would get exposed to lots of interesting germs. If we were to go somewhere that has, say polio, at pandemic rates, then sure--no brainer. He runs into a rusty nail, absolutely he'll get a tetorifice shot, but no point of having him get one when recommendations are that he get booster in case of a possible exposure. But for the most part, I don't see the point of vaccinating children for diseases that they're not likely to run into or that are so mild that the risk of side effects from the vaccine are greater than the risks of the diseases. I'd rather he go through a bout of chicken pox and have natural immunity than the artificial assault of a vaccine whose effectivess is questionable. Aforementioned toddler is also uncircumcised, despite my religious beliefs, but that's a whole 'nother story.

[howsoon]

I'm am not against vaccines, just against unnecessary procedures of any kind. I am fully vaccinated myself, for many reasons, among them is that I'm a nurse and would get exposed to lots of interesting germs. If we were to go somewhere that has, say polio, at pandemic rates, then sure--no brainer. He runs into a rusty nail, absolutely he'll get a tetorifice shot, but no point of having him get one when recommendations are that he get booster in case of a possible exposure. But for the most part, I don't see the point of vaccinating children for diseases that they're not likely to run into or that are so mild that the risk of side effects from the vaccine are greater than the risks of the diseases. I'd rather he go through a bout of chicken pox and have natural immunity than the artificial assault of a vaccine whose effectivess is questionable. Aforementioned toddler is also uncircumcised, despite my religious beliefs, but that's a whole 'nother story.

KateRN1 - I think you are my kind of mama:)

As a mom of 4 selectively vac'd children, 3 of whom are boys & intact - it irks me when others assume I am "uninformed" when infact I'm MORE informed than the majority who blindly come in & accept the "standard."

(I'm not saying that's what the op is dealing with - just stating my experience.)

I've never done hep B or eye ointment at birth. Only 1 (rough LONG labor) of my babies have recieved vit K at birth.

[RootedRedwood]

KateRN1 - I think you are my kind of mama:)

As a mom of 4 selectively vac'd children, 3 of whom are boys & intact - it irks me when others assume I am "uninformed" when infact I'm MORE informed than the majority who blindly come in & accept the "standard."

(I'm not saying that's what the op is dealing with - just stating my experience.)

I've never done hep B or eye ointment at birth. Only 1 (rough LONG labor) of my babies have recieved vit K at birth.

I am speaking of those that are uninformed by their own admission. I always assess the parents knowledge of the medications before asking if I can give them. No assumptions here. I support patient autonomy completely- it is our collective right to make our own (and our babies) health care decisions. Thanks for your responses.

[KateRN1]

KateRN1 - I think you are my kind of mama:)

If by that you mean baby-wearing, breast-feeding, cloth-diapering, organic-eating, non-vaxing, non-circing, co-sleeping crunchy hippie freak, then yes, I am your kind of mama. :)

[CMCRN]

American Acadaemy of Pediatrics guidelines actually are for eyes and thighs in first 6 hours following birth.

I think erythromycin is a state law in California.

Studies are showing that exclusively breastfed babies are getting adequate Vit K through breast milk. Oh course we don't know who will be exclusive.

CDC actual guidelines are for Hep B within 48 hours of birth.

As a lactation consultant I object to any thing that interfers with skin to skin and breastfeeding, especially initially. You can never get back the first hour of life.

Since most of our patients get epidurals I find that an excellent time for teaching, the quiet time before the birth.

[RootedRedwood]

American Acadaemy of Pediatrics guidelines actually are for eyes and thighs in first 6 hours following birth.

I think erythromycin is a state law in California.

Studies are showing that exclusively breastfed babies are getting adequate Vit K through breast milk. Oh course we don't know who will be exclusive.

CDC actual guidelines are for Hep B within 48 hours of birth.

As a lactation consultant I object to any thing that interfers with skin to skin and breastfeeding, especially initially. You can never get back the first hour of life.

Since most of our patients get epidurals I find that an excellent time for teaching, the quiet time before the birth.

Do you have a link to the American Academy of Pediatrics guidelines that recommend a specific timing for administration? I searched their website but couldn't find it. Our pediatricians want us to give the meds by the first hour. I'd be interested to see if there was any research to back up their recommendations.

To interfere as little as possible with bonding/breastfeeding, our policy is to try and leave babies skin-to-skin for about 2hrs post-birth and do the medications while baby is latched or lying skin-to-skin with mom.

We don't routinely give HepB vaccine in the hospital if mom is HepBsag negative. If mom is HepBsag positive or unknown status- our protocol (and the CDC's recommendation) is to give it by 12 hrs of age... since that comes much later after the birth there is no trouble with the education aspects. See: http://www.cdc.gov/hepatitis/HBV/VaccChildren.htm ----> "Admission Orders for Labor & Delivery and Newborn Units to Prevent HBV Transmission"

Doing teaching once the patient gets an epidural is a good idea, but (thankfully) our epidural rate is about 5-10% so the teaching opportunity is most often not there.

Thanks for your comments.