Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, November 26, 1994 TAG: 9411280049
SECTION: VIRGINIA PAGE: C-3 EDITION: METRO
SOURCE: Associated Press
DATELINE: NORFOLK LENGTH: Medium
Insurance companies initiated early discharge policies in the 1980s as a way to save an extra hospital day and reduce costs. Many insurance companies and hospitals require that new mothers and babies go home 24 hours after birth if there are no complications. Women who deliver by Caesarean section are usually home within two or three days.
Laurel S. Garzon, director of Old Dominion University's perinatal/neonatal graduate program, said some women who are discharged early remain exhausted months or even a year after delivery because they never have a chance to recover.
``We have one of the most regressive models for health care after delivery in the world,'' she said. In contrast to the United States, many women in Sweden spend a few days after birth in a '`Ringblomman,'' or a maternity house.
Norfolk pediatrician Robert Fink said new parents learn important skills in the hospital, such as accident prevention, proper breast-feeding and feeling comfortable holding the baby.
``A lot of education takes place in the nurseries, not only by the physicians, but especially by the nursery staff,'' he said. ``All of those parenting skills are crucial, and once they're out of the hospital we've lost the opportunity to teach some of those things.''
Ruby Garnett of Portsmouth and her first baby, Lewis, stayed 32 hours at a hospital after he was born five weeks early. Two days after they went home, Lewis was admitted to Children's Hospital of the King's Daughters suffering from dehydration. He stayed 11 days.
Garnett said their short hospital stay after Lewis was born didn't give her enough time to absorb the many details of breast-feeding and caring for a new baby.
Most insurance companies now pay hospitals a fixed rate for delivery, regardless of how long mother and baby stay. So it's often the hospital - not the insurance company - prodding mothers to leave.
``If the insurance company is paying you [a flat rate], then it behooves you to find ways to get them home sooner,'' said Terry McCenna, nurse manager of the mother/baby unit at Virginia Beach General Hospital.
At the Virginia Beach hospital, doctors and nurses were so concerned about early discharge pressures that, eight months ago, they formed a team to discuss how they could provide quality care and education in just 24 hours.
The team filmed a video for new mothers and began a home-health nursing program in which maternity unit nurses visit new mothers at home.
``Initially, the pediatricians were hesitant about letting the babies go home at 24 hours,'' said Dr. John W. Knispel, a Virginia Beach obstetrician. ``But there wasn't any choice with the insurance. This helps them feel more comfortable.''
The hospital is absorbing the cost for the nurse, Knispel said.
``It costs the hospital a lot more for the woman to stay there than to provide a home nurse,'' he said.
But Garzon said videos and a single home-health visit are not enough.
``The issue is more access to information and more nursing before and after the time of delivery,'' she said. ``And there has to be sharing of costs because the hospital isn't going to do it for free.''
The Maternal and Child Health Bureau, a division of the Public Health Service, is holding a meeting next week to discuss early discharge policies. The American Academy of Pediatrics will release more stringent guidelines early next year for early discharge, updating those first issued in 1980.
by CNB