Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, August 8, 1995 TAG: 9508080088
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: LYNN ARDITI PROVIDENCE JOURNAL
DATELINE: PAWTUCKET, R.I. LENGTH: Medium
``It felt like I was still in labor,'' recounted Ardente. ``I had terrible, terrible contractions. I couldn't even walk.''
Ardente, 32, of Providence, R.I., was experiencing a severe form of ``after pains,'' the contractions the uterus makes after birth to shrink back to its former size, said her doctor, Patrick J. Nugent, obstetrician-in-chief at Memorial Hospital in Pawtucket. Though the process is normal, he said, it can be excruciating - especially for women who have given birth to several children.
Ardente ``begged'' to stay in the hospital another day - and Nugent begged the insurance company to pay for it.
Ardente was lucky. Her insurance company agreed to foot the bill.
Women increasingly are being pushed to leave the hospital 24 hours after giving birth - whether or not they're ready - by insurance companies trying to cut costs by limiting postpartum coverage.
Recently, Ardente joined Rep. Patrick J. Kennedy, D-R.I., and a half-dozen health care providers in the room at Memorial Hospital where she delivered her daughter, Lily, to show support for federal legislation designed to fight the trend toward shorter postpartum stays, or what critics call ``drive-through deliveries.''
Many insurance companies now limit coverage to 24 hours for vaginal deliveries and 48 hours for Caesareans.
A bill in Congress, introduced by Rep. Frank Pallone, D-N.J. and co-sponsored by Kennedy, mandates coverage for at least 48 hours for uncomplicated vaginal deliveries and 96 hours for Caesareans.
Rhode Island and Massachusetts are trying to accomplish the same thing at the state level, along with New Hampshire, New York, California and New Mexico.
``The well-being of mothers, and particularly their newborns, are unnecessarily placed at risk because of the greed displayed by the medical insurers and health maintenance organizations,'' Rep. Patrick J. Kennedy, D-R.I., said at a recent news conference. ``In the name of cutting costs, they are rushing mothers and babies out of maternity wards before the fathers even have a chance to pass out cigars.''
It wasn't always that way.
The average hospital stay for vaginal births has dropped from just under four days in 1970 to about two days in 1992, according to a study released in May by the federal Centers for Disease Control. The average stay for Caesarean births has been almost cut in half, from 7.8 days to 4 days.
A shortage of hospital beds during the baby boom years, the use of fewer invasive medical procedures during childbirth and the move away from viewing pregnancy as an illness initiated the trend.
Insurance companies then began pushing up the discharge dates to cut costs.
Today, insurance companies view a woman who has just given birth as requiring the same amount of hospital recovery time as a man who has had a routine prostate operation.
Doctors say that doesn't make sense.
``I don't think you can fairly equate them - I really don't,'' said Dr. Frank J. Schaberg, surgeon-in-chief at Memorial Hospital. ``Many of the surgical operations we now do in a day are less taxing than childbirth. I can't think of a truly equivalent thing to childbirth.''
Studies show that discharging women and their newborns too early can have serious consequences for both mothers and babies.
Taking home a newborn isn't like bringing home a new car, especially for first-time mothers, who often need lots of help learning to properly care for and breast-feed their baby. If the baby is not able to nurse, for example, they can eventually become dehydrated and risk organ damage.
Twenty-four hours also may not be enough time to detect potentially life-threatening conditions in the baby. For example, jaundice - the yellowish tint some babies have - typically doesn't become noticeable until 24 to 26 hours after birth. In serious cases, if untreated it can cause permanent brain damage and even death, Nugent said.
Early discharge also can foul up tests for disorders such as phenylketonuria, or PKU, a genetic disorder, which must be done two to three days after delivery to be accurate.
And doctors say that 24 hours often is not enough time to monitor mothers for hemorrhaging, infections, fatigue and postpartum depression.
To compensate for lost time in the hospital, some insurance companies now offer coverage for home visits and follow-up care.
Insurance companies say, and doctors agree, that some women are well enough to go home after a day - and prefer to do so.
Blue Cross and Blue Shield of Rhode Island ``still places the prime decision-making'' about when to discharge patients with the doctors, said Joseph Scanlon, a company spokesman. ``If the doctor has the slightest doubt that discharging patient or the baby is not in order, that's good enough for us.''
by CNB