Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, July 17, 1995 TAG: 9507180014
SECTION: NATIONAL/INTERNATIONAL PAGE: A-4 EDITION: METRO
SOURCE: Associated Press
DATELINE: TRENTON, N.J. LENGTH: Medium
Many insurers say there's no reason for most mothers to be hospitalized more than a day after a normal birth or two days after an uncomplicated Caesarean delivery.
Many doctors and nurses argue that's too quick: Some medical problems don't show up in the first day and brand-new moms haven't yet learned to feed, care for and spot health problems in their newborns.
When insurance companies' efforts to cut medical costs run up against mothers' pleas for more care, the political choice is obvious.
``It's outrageous for insurance companies to push women out of hospitals after a day, after 12 hours in some cases,'' says Sen. Bill Bradley, D-N.J. ``I was appalled that this was happening.''
Bradley and Sen. Nancy Kassebaum, R-Kan., are sponsoring a bill requiring insurers to pay for at least two days in a hospital after vaginal childbirth, if the mother wants to stay. Two such bills were introduced in the House, two states have passed similar laws and at least six more are weighing them.
Insurers are vigorously lobbying against the bills, which generally require they cover a 48-hour stay after uncomplicated vaginal deliveries and four days after Caesarean sections.
Most proposals also would require insurers to pay for follow-up care. For deliveries at home or at birthing centers, most bills mandate home care for 48 hours.
There's little data on exactly what the proposed guidelines would cost insurers. But Rep. Robert Torricelli, D-N.J., notes that with about 4 million births a year and maternity beds averaging $1,000 a day, insurers save $4 billion annually for every day they slice off the average stay.
That average fell from 3.9 days in 1970 to 2.4 days in 1993 - figures that include births with complications. Now most insurance guidelines call for discharge in 12 to 24 hours after uncomplicated vaginal births, and one Los Angeles hospital, Kaiser Permanente, has let a handful of ``the healthiest of moms and babies'' leave after eight hours if they want, says spokeswoman Kathleen Barco.
Insurers and hospital officials say that pleases mothers who want to go home quickly, limits risk of hospital-acquired infections and lets the family start bonding sooner.
``We believe any legislation that mandates hospital length of stay is a bad idea,'' says Barbara Gracey, spokeswoman for the industry group Health Insurance Association of America.
Appearing last week with doctors and new and expectant mothers, Rep. Frank Pallone Jr., D-N.J., said he made his bill a priority this year after his wife and infant son were rushed out of the hospital much more quickly than when their daughter was born 17 months earlier.
``With my daughter, I had classes on breast feeding, bathing and how to learn to read the signs'' of trouble, Sarah Pallone said. ``With my son, they handed me a videotape as I left the hospital.''
Doctors say health plans that force mothers home before they are ready and provide insufficient follow-up care can allow easily treated illnesses to go unchecked, resulting in organ damage, mental retardation - even death.
Michelle and Steve Bauman of Williamstown lobbied for New Jersey's minimum-stay law after their 2-day-old first child died of meningitis.
Michelle Bauman, 28, and Michelina Alanna were discharged 23 hours after she was born on May 16. ``The baby looked beautiful'' and was taking formula well, recalls the 30-year-old father.
Then she cried all night, and wouldn't eat or sleep. They started calling their pediatrician at 6 a.m. Despite escalating symptoms - jaundiced skin, cloudy eyes, a pin-dot rash - Bauman says the doctor told them not to worry. About 5:30 p.m., the baby stopped breathing and later died.
Doctors concede it's probably all right to discharge the healthiest, best-prepared mothers in 24 hours - if the physician is certain they will return soon to have the baby examined for problems best detected after the baby starts feeding, which usually takes more than a day.
by CNB