New 2019 Erythromycin Law in Ontario

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This slipped under the radar very quietly nearly a year ago, but it’s worth repeating.

A huge change was made to how newborn erythromycin treatment is handled in Ontario, and as of January 1st of this year it is no longer required that every newborn get the eye ointment after birth.

Prior to this change, it was considered mandatory by law, and subject to a $5000 fine (to the healthcare provider) for every day the treatment was not administered. In addition, many parents who declined had social services knocking at their door.

In fact, “the obligation to comply with the regulation respecting newborn eye prophylaxis overrides the Health Care Consent Act, 1996. That is, whereas the Health Care Consent Act, 1996 would normally require a midwife (or nurse or doctor) to obtain client consent before providing treatment, no consent is required before newborn eye prophylaxis must be carried out.” (College of Midwives of Ontario)

Parents still have to decline the treatment - meaning that it may still be administered if parents don’t explicitly say no - but declining will no longer trigger public health being called, or healthcare providers being fined.

Erythromycin is used to prevent serious newborn pink eye in the first month of life, primarily caused by chlamydia or gonorrhoea (with gonorrhoea accounting for the more serious cases of pink eye that, if left untreated, can lead to blindness).

So it’s a good thing, right?

Well, maybe not so much:

• Because we’ve “antibiotic’d” the shit out of ourselves (is that a word?), erythromycin is only around 80% effective against gonorrhoea

The risk of acquiring infection is quite low (gonorrhoea makes up only 1% of reported sexually transmitted diseases), and

• If acquired, infection is treatable with antibiotics

As well, some babies could develop chemical pink eye (fun!), eye irritation, and blurred vision (which could disrupt those first bonding moments) from erythromycin.

So what next?

I’d recommend printing out the first two links below and having an informed discussion with your care provider if you’re either unsure about declining, or already know you want to decline. Always make an informed decision that is right for you and your baby, no apologies!

Evidence Based Birth has a great article on erythromycin if you want more facts and statistics.

Here’s the link to the new law itself in all of it’s legalese glory.

And the link to the old CMO directive that I mentioned above.