In Ontario, it is the law that all babies must receive erythromycin eye
ointment at birth.  It used to be that the midwives and even the
hospital would allow parents to conscientiously object and sign a
waiver.  However the newly formed College of Midwives has instructed
their midwives that they must enforce this law.  If parents refuse the
ointment they can be reported for endangerment.  The pressure to enforce
this law leads many hospitals to write strict policies about giving the
ointment within the first hour as this is commonly the length of time
the baby remains in L&D.  Asking the staff before birth if these can be
delayed until after the first feeding can be helpful.  It is also
possible for the staff  to do all immediate newborn care while baby is
skin to skin with mum.  Vitamin K can be delayed or refused.  Consuming
Alfalfa during pregnancy might be an alternative for a mum or care giver
who is concerned about clotting in the newborn.

Some local hospitals are writing policies which make getting the baby to
the breast within that same hour a priority too.  BF in the first hour
may become a QA check list item. Charting and vital signs checks have
always been a priority in the immediate pp period.  Perhaps policy will
now work in favour of mums and babies.  Just like lowering their c/s
rate became an inter hospital competition, perhaps BF initiation rates
in L&D will too.  It's a start, literally.

Janet Vandenberg
RN, BScN