Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, July 30, 1995 TAG: 9507310076
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
Kim Halsey gave birth to her son, Christopher, at 7:43 on a Saturday morning. She was home from the hospital by noon Sunday.
Halsey's insurance company subscribes to the policy that an uncomplicated birth is worth only 24 hours of recovery time.
"I didn't have a problem with that," the Roanoke woman said last week. "I was ready to go."
Halsey, a first-time mother who had her baby July 1 at Community Hospital of Roanoke Valley, suspects she may be an exception, however.
"Some people have more pain. Some are not emotionally ready to go home," she said.
The length of hospital stay for a mother and new baby should be decided case by case, Halsey said.
But it's not.
A two-day stay is still common in Western Virginia, but a growing number of insurers will pay for only 24 hours in the hospital after delivery when the birth is routine, meaning that the baby was delivered vaginally without complications. A woman who has a Caesarean section generally gets to stay 72 hours after giving birth.
Nationally, some insurers are trying to crunch the hospital stay down to 12 hours.
The trend toward what is being labeled "drive-through deliveries" has so alarmed some health care activists that two states, New Jersey and Maryland, have set standards for length of stay or requirements that there be follow-up visits to the family.
Maryland's Mothers' and Infants' Health Security Act, which goes into effect Oct. 1, allows a woman to be released from the hospital in one day if the newborn is having no problems and if the insurer pays the hospital for a follow-up home visit. New Jersey's legislation is tougher. It requires that a woman be allowed a 48-hour stay when a birth is uncomplicated unless the insurer pays for three follow-up home visits.
Western Virginia hospitals began offering home visits as a safety net for new mothers last fall.
Community Hospital in Roanoke, which handles about 3,000 deliveries annually, began follow-up visits in November. Lewis-Gale in Salem, which has about 1,000 births a year, started its program in December. Radford Community Hospital and Franklin Memorial in Rocky Mount also offer new-baby visits.
The visits are more for the baby's sake than for the mother's, health care workers say.
A quick return home after delivery is not much of a problem for mothers, because they can tell a doctor if they don't feel well, said Dr. George Maxymiv, an obstetrician with Lewis-Gale Clinic in Salem.
"But, for babies, the first 24 or 48 hours are very critical times, and the babies need to be monitored," he said.
Extending the period of observation through home visits has "worked out pretty well," he said.
When health care workers go to a new baby's home, they look for the signs of jaundice, a yellowing of the skin or of the whites of the eyes. Jaundice, a condition of too much bilirubin (a bile pigment), is easily remedied, but if left untreated it can lead to mental retardation.
The baby's eating habits also are a concern, because insufficient nutrition can cause dehydration. Infants who are breast-fed are especially at risk for dehydration until the breast-feeding process is working smoothly.
Also, if a newborn isn't being fed often enough, he or she can quickly become lethargic and want to eat even less often, explained Georgianna Gibson, a Community Hospital nurse who makes home visits.
The American College of Obstetricians and Gynecologists issued a statement in May saying that early hospital discharges could lead to problems of jaundice and dehydration in infants. The professional group recommended 48-hour stays for mothers who had normal deliveries and twice that for mothers who had Caesarean sections.
After almost 500 home visits by Community Hospital nurses, Gibson said she knew of only three babies who had to go back into the hospital because of jaundice. Nationally, the worry that a jaundiced infant might go untreated has been used as the main argument against short hospital stays.
Readmissions for problems are under 2 percent at Community, and the staff believes the follow-up home checks are one reason for that.
```How is my baby?' That is the big question when I go see my moms," said Gibson, a mother who can recall when five-day hospital stays were routine after childbirth.
Gibson, who has worked in nursing three years, and Cindy Marcum, who has 16 years' experience, were the first Community Hospital nurses to go on home visits. Recently, two more nurses volunteered for the program, which requires further training, especially in how to counsel mothers on breast-feeding.
Three of the four nurses have completed courses to become breast-feeding educators, and on Monday Marcum is scheduled to take a national exam to be certified as a lactation consultant.
Questions that come up during a home visit range from how to get an infant to suck properly and how to dry up milk in the breasts of a mother who isn't breast-feeding to the proper procedure for cleaning the baby's belly button before the umbilical cord fully drops off.
Even though new mothers have access to literature and videos on everything from how to care for themselves to how to select car seats, they don't have much time to take advantage of it.
Community Hospital's staff calculated that in a 24-hour stay, a mother might have about 71/2 hours to devote to getting to know the new baby.
The time spent on child care combined with the need for the mother to get some sleep and cope with visitors doesn't leave much room for education, said Sandy Adams, who visits new mothers for Lewis-Gale Hospital.
"By the time they have the baby, they're exhausted. And here we come to tell them things to educate them," Adams said.
Adams has been a registered nurse since 1979 and had done consultations with new mothers for private home health companies before Lewis-Gale set up its program.
Adams said she knew many mothers needed something beyond the in-hospital instruction, if it was nothing more than assurance that everything was going fine.
Even a veteran mother can use the extra attention, said Karen Russell of Roanoke, who already had a 5-year-old son, Jarale, when she gave birth to daughter, BreAnna, on July 5.
During the first pregnancy, Russell became diabetic. And between Jarale's and BreAnna's births, she had two stillborn babies. When she became pregnant this last time, she and her husband, Ernest, were concerned not only with keeping her diabetes in check, but whether the baby would not be all right.
"We were so glad to see that baby," said Adams, who first met Russell when the mother-to-be spent several days in the hospital prior to delivery.
During Adams' visit to Russell's Northwest Roanoke home, they talked about how a slight rash on the baby's face might have been caused by lotion. Also, she said Russell shouldn't worry about the "white stuff" under BreAnna's arms. It was vernix, which protected the skin while the baby was floating in the womb.
Adams then wanted to know how much rest Russell was getting and how her diet was going. Russell hopes she won't always need the two insulin shots she takes daily.
Finally, they got down to cleaning around the umbilical cord, which seems to be a universally uncomfortable task for mothers, the nurses say.
"I just can't stand to touch that thing," Russell said. "I'm afraid I'll hurt her."
"Well, you won't," Adams said.
Adams works in the labor and delivery area and often gets to follow a mother through the birth process and then see the family together at home.
"It was a wonderful change that we could go into the homes," Adams said. "We just see what their needs are, and we try to meet them."
by CNB