Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, October 11, 1995 TAG: 9510110064
SECTION: NATL/INTL PAGE: A5 EDITION: METRO
SOURCE: ASSOCIATED PRESS
DATELINE: CHICAGO LENGTH: Medium
``The fact that a short hospital stay ... can be accomplished does not mean it is appropriate for every mother and infant,'' the American Academy of Pediatrics said in a policy statement.
Increasingly, insurers are refusing payment for hospital stays beyond 24 hours after an uncomplicated delivery, said the 49,000-member academy, based in suburban Elk Grove Village.
Three states - Maryland, New Jersey and North Carolina - have enacted laws to ensure that mothers and newborns have at least 48 hours in the hospital under most circumstances, according to the American College of Obstetricians and Gynecologists.
Similar bills are pending in Congress and in California, Delaware, Illinois, Kentucky, Massachusetts, Minnesota, New York, Ohio, Pennsylvania and Rhode Island, the organization said.
The obstetricians' group and the pediatricians have recommended in the past that hospital stays after childbirth range from at least 48 hours for vaginal deliveries to 96 hours for Caesarean sections.
The new guidelines refine the old ones, said Dr. William Oh, chairman of the pediatricians' Committee on Fetus and Newborn. The guidelines are published in the October issue of Pediatrics.
``Mothers are very upset because some of the hospitals are discharging mothers within 6, 12 and, at most, 24 hours,'' Oh said by telephone Tuesday. ``Many of the mothers are still recovering from labor.''
Pediatricians are very concerned for medical reasons, said Oh, chairman of pediatrics at Brown University School of Medicine in Providence, R.I.
Discharging babies only hours after they are born does not allow time to spot developments such as jaundice and infections, which can have devastating consequences if not caught early.
The timing of the discharge should be decided by the doctor and not by ``arbitrary policy'' established by a third-party, the guidelines say.
Mothers and infants should be hospitalized together until 16 certain conditions are met, which generally takes more than 48 hours, the academy said.
The conditions include: an absence of medical complications; completion of at least two successful feedings; the baby has urinated and passed a stool; a documented ability of the mother to care for the baby, including receiving training in feeding, newborn care and infant safety; performance of certain lab tests; and identification of a continuing source of medical care.
The conditions also include assessing whether the mother abuses alcohol or drugs, has a history of child abuse or mental illness, is homeless, has been a victim of domestic violence or lacks social support.
Lynne Fritter, a spokeswoman for the Health Insurance Association of America, agreed that decisions about when to discharge mothers and newborns should be made on a case-by-case basis.
``I'm not aware that there is a policy out there where they refuse to pay after 24 hours,'' Fritter said from the Washington headquarters of the association, which represents more than 200 insurers. ``It has always been up to physicians whether to keep the mother and child in the hospital after 24 hours.''
Susan Pisano of the Group Health Insurance Association of America, which represents 360 health maintenance organizations, voiced the same view.
In a telephone interview from Washington, she said her group opposes legislative mandates on how long mothers and babies stay in the hospital.
by CNB