Hi Lisa:

Enkin, Chalmers and Keirse (1989) in the Guide to Effective Care... ( I have the
1995 version at work - will get back to you if they have updated their view) The
authors of chapter 45 - Immediate care of the newborn: Tyson, Silverman, Reisch
and Berger  write: erythromycin 0.5% opthalmic ointment or drops or Tetracylcine
(1% opthalmic ointment or drops ) are considered  "acceptable agents" in the
prevention of neonatal ophthalmia  (for gonococcus and chlamydia).    " There
have been no trials involving adequate numbers of infants with bacterial or
chlamydial eye infections to permit evaluation of their relative merits"
(p 298).   They go on to acknowledge the debate regarding WHEN to administer the
treatment following birth which is related  to concerns that it disrupts visual
interaction between  parent and infant during the quiet alert state.  They
write:  "While there is no evidence that this would have any long-term
detrimental effects on maternal-infant relationships, there is equally no
evidence to suggest that topical agents must be given within the first minutes
of birth" (p 298).

We instill the erythromycin ung into the eyes on arrival to the postpartum ward.
Other centres in the area instill the drops just before transfer to the
postpartum ward.  This occurs 1 - 2 hours after delivery. The normal newborn -
as you know - exhibits a quiet alert state for 1 - 2 hours following birth -
this is the best time for initiation of feeds and parent infant interaction.
Following this quiet alert phase there is typically a sleep state which lasts
from 4 - 6 hours - You can try and get the hospital to administer the
erythromycin after the initial 1 - 2 hours following birth as we have done.
You can also concede that babies do not have great vision at birth - they can
focus on an object  about 10 - 12 incles away best (a face when cuddled in the
arms) - and that  is the very reason you do not want to impair it any more with
the thick ointment in that initial early contact with parents.  I looked up
erythromycin ung in the CPS - and they do not state when the ung should be
instilled in the newborn - nor do they list adverse effects for opthamic
ointment - they have a string of them for the other forms of administration.

I used to teach prenatal education a few years ago - and I remember often being
misrepresented by my parents - it is amazing to hear what people think you
said.... versus what you actually said.  If often helps to have handouts on
controversial issues - and have them referenced - so you can refer your couples
to review them and go over them with their physicians ie - episiotomy,
circumcision, epidurals, narcotics,  induction,  etc....
Hope this helps.  Good Luck,

Kim Campbell RN BScN MN(c) IBLCL