Ontario Newborn Care Explained: Vitamin K, Eye Ointment, and Hep B at Birth
When it comes to parenting, one of the most important things I want you to know is this: I will not judge your choices. Whether you choose to breastfeed or bottle-feed, co-sleep or use a crib, have a home birth or deliver in a hospital—my focus is not on what you choose, but on how you choose. I care deeply that you feel informed and supported. Because when parents understand their options and feel in control of their decisions, it changes everything. Confidence rises, stress lowers, and the bond with baby often grows stronger. In fact, feeling in control during birth and postpartum is one of the strongest protective factors against postpartum depression and anxiety.
Let’s start with what happens in those first few hours after birth in Ontario. You have choices, and knowing what’s offered—and why—can help you feel empowered.
What Newborn Treatments Are Offered at Birth in Ontario?
Right after your baby is born, hospitals in Ontario will typically offer three standard treatments. None of these are legally required. You always have the right to ask questions, delay, or decline.
Vitamin K for Newborns — What Ontario Parents Need to Know
What Is Vitamin K?
Vitamin K is a nutrient the body needs to form blood clots and stop bleeding.
Babies are born with very low levels because Vitamin K doesn’t cross the placenta well and the newborn gut hasn’t developed the bacteria needed to make it yet.
Why the Vitamin K Shot Is Offered
Ontario hospitals and midwives routinely offer a single Vitamin K injection shortly after birth because it:
Greatly reduces the risk of Vitamin K Deficiency Bleeding (VKDB).
Protects against brain bleeds, internal bleeding, and late-onset bleeding weeks or months after birth.
Works quickly and is long-lasting.
Has a long history of safety with very few side effects (usually brief discomfort or minor redness at the injection site).
The Option to Decline
Vitamin K is not mandatory in Ontario. Parents can decline it.
If declined:
Some providers may offer oral Vitamin K, though it is considered less effective and requires multiple doses over several weeks.
Baby remains at a higher risk of VKDB, especially late-onset bleeds.
Parents must watch closely for signs of internal bleeding — which can occur without obvious warning.
Common Reasons Parents Choose the Shot
Strong protection against rare but serious bleeding.
Simple, one-time dose with high effectiveness.
Peace of mind in the first weeks and months.
Trusted by most pediatric associations worldwide.
Common Reasons Parents Decline
To honor true informed choice, here are perspectives some parents hold:
A belief in physiological design: some feel babies are born with low Vitamin K for a biological reason — possibly to prevent excessive clotting during birth.
Desire for fewer interventions: especially in families wanting a natural, low-intervention birth experience.
Concerns about ingredients: even though reactions are rare, some parents prefer to avoid injections.
Comfort with oral dosing: some feel confident following an oral schedule instead.
While these views reflect real parental thinking, it’s important to remember that current evidence strongly supports the shot as the most effective protection against VKDB.
If You Decline the Shot
Be prepared to:
Ask if oral Vitamin K is available and follow the full schedule.
Watch for subtle signs of bleeding (bruising, vomiting, pallor, excessive sleepiness, seizures).
Understand that late-onset VKDB can occur even in healthy breastfed babies with no warning.
Communicate your decision clearly in your birth plan.
If You Choose the Shot
It is usually given in the thigh within the first few hours.
Baby can stay skin-to-skin or nurse during it for comfort.
No further doses are needed.
Bottom Line
Vitamin K is a small decision with big implications. There isn’t one “right” choice for every family — but there is an informed one.
Know your options, understand the risks and benefits on all sides, and choose what feels aligned with your values and your baby’s health.
2. Erythromycin Eye Ointment
What is Erythromycin Eye Ointment & Why It’s Given to Babies
Erythromycin eye ointment is an antibiotic ointment applied to a newborn’s eyes shortly after birth to help prevent a serious infection called Ophthalmia neonatorum (ON). ON can be caused by bacteria — especially Neisseria gonorrhoeae (gonorrhea) — that might be passed from mother to baby during delivery. Canadian Paediatric Society+2AAFP+2
Historically, this prophylactic eye treatment started in the late 1800s, first with silver nitrate drops, then later with antibiotics like erythromycin. Ontario Midwives+2OUP Academic+2
In many places (including parts of Canada), it’s delivered universally to newborns, unless parents formally opt out. cmo.on.ca+2Public Health Sudbury & Districts+2
Potential Benefits of the Ointment
When the mother’s infection status is unknown, or if she carries gonorrhea, the ointment helps prevent the newborn from developing gonococcal eye infection — which, if untreated, can cause severe eye damage or blindness, sometimes within hours of birth. AAFP+2NCBI+2
In the past, before widespread screening for sexually transmitted infections (STIs), this prophylaxis was a critical public health measure to protect newborns’ vision. Ontario Midwives+1
In cases where maternal infection risk is present or unknown (e.g. untested, high-risk sexual exposure, limited follow-up), the ointment may be a useful precaution. Canadian Paediatric Society+2uspreventiveservicestaskforce.org+2
Potential Downsides, Risks & Critiques
The ointment may cause temporary side effects: mild redness, swelling, or irritation of the eyes. MedlinePlus+2NCBI+2
It often causes temporary blurred vision or cloudiness, which may limit early eye contact — something many parents value for bonding. Baby Chick+1
Some experts raise concerns about routine antibiotic use: overuse can contribute to antibiotic resistance, and unnecessary exposure may affect the newborn’s developing microbiome or cause other unintended effects. Essence Chiropractic & Wellness+2Dr. Green Mom+2
According to the Canadian Paediatric Society (CPS), the effectiveness of routine prophylaxis with erythromycin is now considered “questionable,” especially in low-risk pregnancies (e.g. negative STI tests, no risk factors). Canadian Paediatric Society+1
Erythromycin prophylaxis does not reliably prevent all newborn eye infections — notably, it has limited or no effect against eye infections caused by Chlamydia trachomatis. Canadian Paediatric Society+2KWMA+2
🎯 Current Practice & Parental Choice (in Ontario / Canada)
In Ontario, and some other provinces, newborn eye prophylaxis with erythromycin is or has been standard — but as of January 2019, parents have the right to opt-out. cmo.on.ca+1
Opt-out is possible only if: a healthcare provider gives thorough information about risks/benefits, the parents give informed consent (in writing), and the newborn is assessed as low-risk for infections that cause ON. cmo.on.ca+2OUP Academic+2
If parents decline, there may be no prophylactic protection against eye infections — but close monitoring after birth is recommended. Canadian Paediatric Society+2KWMA+2
What Happens If Parents Refuse the Ointment?
The baby remains at risk (though possibly very low) of eye infection if exposed to pathogens like gonorrhea during delivery. In such cases, serious complications — including blindness — remain possible. AAFP+2Nine Moons Midwifery+2
Some hospitals or care providers may require a written “opt-out form” before they agree not to administer prophylaxis. cmo.on.ca
3. Hepatitis B Vaccine (Birth Dose) What it is & why it’s offered
The Hepatitis B vaccine is sometimes offered at birth to protect newborns from Hepatitis B — a viral infection that affects the liver and can become lifelong if a baby is exposed at or around birth.
Babies are more vulnerable than adults because their immune systems are still developing, and if infected, 90% of newborns go on to develop chronic Hepatitis B.
In Ontario, the birth dose is not routinely given to all babies.
It is recommended primarily when the birthing parent is Hepatitis B positive or their status is unknown, or when the baby is considered at higher risk.
Otherwise, Hepatitis B vaccination begins later in childhood (often around Grade 7 in Ontario).
Potential Benefits
Protects against serious infection if the baby is exposed during birth. Hepatitis B can cause lifelong liver issues, cancer, or liver failure.
Very effective: when the birthing parent is Hep B positive, the birth dose plus additional medication (HBIG) reduces the baby’s risk of infection by over 90%.
Early protection for babies who may be at risk later in infancy if household members or close contacts carry the virus.
Potential Downsides, Risks & Critiques
Most low-risk babies in Ontario are not routinely exposed to Hepatitis B, so some parents feel a birth dose is unnecessary when the birthing parent tests negative.
As with any vaccine, there is a chance of mild reactions such as soreness, swelling at the injection site, or fussiness.
Some parents prefer to delay vaccines until later in infancy, feeling uncertain about adding medical interventions immediately after birth.
Concerns about giving a newborn multiple injections in the early hours of life, especially if the baby is considered very low risk.
Some believe that newborns should receive only what is medically essential at birth, and prefer to revisit vaccines later.
If Parents Choose to Decline the Birth Dose
If the birthing parent is Hep B negative and low-risk, declining the newborn dose is typically accepted without issue.
However:
If the birthing parent is Hepatitis B positive, the hospital will strongly recommend the birth dose along with HBIG, because the baby faces a significant risk of infection without it.
If the birthing parent’s status is unknown, they may request rapid testing or encourage the vaccine until results are back.
Parents who decline are usually asked to sign a refusal form acknowledging the decision.
Families can still choose to start the Hep B vaccine series later — at a doctor’s office, public health clinic, or during routine childhood vaccinations.
Different Perspectives (All Sides)
Some parents feel the birth dose is a powerful protective tool — especially when they want to reduce any risk of liver disease for their baby.
Others feel confident declining when:
They tested negative,
Their partner tested negative, and
There are no high-risk household contacts.
There are also parents who wonder if newborns are meant to begin life without unnecessary medical interruptions — and prefer to keep things as natural and undisturbed as possible unless there’s a clear need.
All of these perspectives are valid.
The key is informed choice, not fear—knowing the actual risk, the purpose behind the recommendation, and the alternatives available..
🕊️ Why Informed Choices Matter So Much
It’s not just about making the “right” decision—it’s about understanding what’s being offered so that you can make the decision that feels best for you and your baby. Feeling informed helps you feel calm, centered, and capable—and this has ripple effects. Research shows that when parents feel like active participants in their care (rather than passive patients), their risk of postpartum depression and anxiety goes down. Feeling in control helps protect your mental health.
You are more likely to bond deeply with your baby when you're not overwhelmed by fear or confusion. That connection—what we often call “bonding”—isn't about being perfect. It's built through skin-to-skin contact, eye contact, holding your baby close, and simply being present. When you’re informed and not second-guessing yourself, these moments come more naturally. And the “love hormone,” oxytocin, flows more freely, helping both of you feel safe and connected.
🤱 You Know What’s Best for Your Baby
Every parent’s path looks different. You might accept every treatment offered, or you might choose to delay or decline. There is no one right way—only what feels right to you. When you’re supported in your choices, your stress levels drop. You feel more at ease. And that sense of peace creates space for connection, confidence, and recovery.
So whether you’re still planning your birth or you're already holding your baby in your arms, remember this: You don’t have to do it all perfectly. You just have to feel empowered in the choices you make. That’s what truly makes the difference. And that’s what I care about most.
