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Birthing Blues : New Parents, Insurers at Odds Over One-Night Maternity Stays

October 17, 1994|BARBARA MURPHY | SPECIAL TO THE TIMES

Having a baby isn't what it used to be.

Just ask Tammye Martin of Oxnard. Pampered in the hospital for two days when her son was born 2 1/2 years ago, last month Martin had to go home just one day after she gave birth to her second child, a girl.

Linda Gladys Ramos of Oxnard didn't even get a full day in the hospital. After 11 hours of labor, she gave birth to her first child at 6 p.m. and was sent home 18 hours later with her newborn daughter.

These women didn't leave the hospital quickly because they are uninsured, but rather because they have coverage. Like most women having babies these days, they find themselves affected by a new and widespread policy of insurance companies to pay for only one night in the hospital following a normal delivery.

While families and health care providers adjust to the new insurance payment rules, many of them decry the practice and warn that mothers and babies are put at potential risk by being sent home so quickly.

As recently as two years ago, most women who had health insurance could count on at least a two-day stay in the hospital after giving birth.

Besides giving the woman a little time to recover from childbirth, the hospital stay enabled nurses to instruct the mother on how to care for the baby and observe the infant for what can be subtle indications of health problems.

Now, with hospitals discharging patients as early as 11 a.m., a child born close to midnight often is sent home when only half a day old.

"This is obscene and grotesque," said Dr. Kenneth Saul, a Thousand Oaks pediatrician. "There is a major risk to children who are going home so soon if the parents are not alert to the warning signs" of health problems.

Although several doctors said they could not cite examples of newborns who went home after one-night hospital stays and experienced serious difficulties, they say that potential problems include jaundice, dehydration, heart defects and breast-feeding problems.

Many physicians emphasized the need to keep the babies hospitalized longer, adding that short stays are also hard on the mothers.

"I think from an emotional point of view, my mothers aren't ready to leave in 24 hours," said Dr. Maynard D. Belzer, a Camarillo obstetrician.

But the insurance industry defends its new policy.

"This is just another managed-care technique," said Dan DiFonzo, spokesman for the Health Insurance Assn. of America, a Washington, D.C.-based organization that represents 250 small- and medium-size private insurance companies. "Mothers are just as healthy going home after one day as after two."

DiFonzo said an argument can be made for sending mothers and babies home as quickly as possible so they do not contract an airborne infection in the hospital.

"Insurance companies have found it is less expensive and just as efficacious to have a woman go home after 24 hours," he said.

Martin, who delivered her daughter at Community Memorial Hospital in Ventura, said she would have liked to wait an extra day before taking home newborn daughter Christina Marie.

Because this was her second child, she knew that the challenges of sleepless nights, diapers, laundry and caring for a newborn would be a major adjustment for her.

"I thought (the hospital stay) should be a little bit longer," said Martin, 31. "Mentally, I'd probably be a lot more rested. I think I'd feel more prepared to accept the new challenges of being a parent."

That view is shared by many in the medical community.

"It can be overwhelming for the mother," said JoLynn de la Torre, communications manager for Simi Valley Hospital. "You've gone through a tremendous change in your body, it's a very emotional time, you have a lot of things to remember. All of a sudden, someone says, 'Here, Mom. You're home with your baby. Carry on.' "

Dr. Raymond I. Poliakin, chief of obstetrics and gynecology at Los Robles Regional Medical Center in Thousand Oaks, said some women have no trouble going home within hours after giving birth. Others, especially first-time mothers, are in desperate need of sleep after delivering a baby, and they are not going to get that once they go home.

If the baby is delivered in the evening, Poliakin said, a mother typically will not fall asleep until 4 or 5 a.m. the next day. For the woman to be sent home five or six hours later is unfair, he said.

"They've gotten no sleep, and then they go home to a house where they might not have someone to help them," Poliakin said. "I think one good night's sleep in the hospital is what the woman needs, and it's typically not the first night."

*

Shortening the hospital stay for mothers and babies has been gradual, health workers say. At first it was just the health maintenance organizations, or HMOs, that dictated the one-night stay.

Eventually, however, other insurance companies changed their policies. Now, unless there is a medical reason to keep a woman longer--such as an infection or excessive bleeding--almost all mothers are sent home after one night in the hospital.

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