In the Hours Following Childbirth . . . : . . . There's Pain, Fatigue, Bonding and Joy-- but When Should Mom Go Home?


\o7 The debate over how soon is too soon to send a mother and newborn home from the hospital is heating up.

In April, Kaiser Permanente, Los Angeles introduced a voluntary program whereby mothers could be discharged as early as eight hours after childbirth. (On average, eligible mothers have been staying 15 hours.)

In May, the American College of Obstetricians and Gynecologists issued a statement of concern about the decreasing length of hospital stays. And on Wednesday, the American Medical Assn.'s governing body adopted a recommendation that the physician's judgment--not health care costs--should guide the decision to discharge.

The issue is complicated, since what happens in the first few hours after childbirth is as unique as each new set of tiny footprints.

Here is how one San Fernando family's childbirth experience earlier this week unfolded over the first eight hours.\f7


Monday, June 19, 1995, 6:55 p.m.: For several hours, Aurora Caudillo had been curled up in a labor room bed at Valley Presbyterian Hospital in Van Nuys, shifting her weight to ease the pain of contractions. But now it's over.

Her obstetrician, Dr. Kamrooz Houman, has just delivered a 7-pound, 12-ounce boy--just a bit above average for a full-term baby. He is 20 1/2 inches long with a shock of dark hair. This delivery, as one nurse describes it later, is a textbook example of an uncomplicated vaginal birth. Caudillo received only a bit of local anesthetic.

The baby's Apgar scores, taken at one minute and five minutes after birth to assess health status on a 10-point scale, look good. He first earns an 8 and then a 9.

7:22 p.m.: Nurse Sarah Baldwin bounds out of the delivery room, wheeling the newborn's Isolette and asking, "Where's Papa?"

Up steps Rafael Gomez, a grin spreading across his face as he meets his son. Identity bracelets, meant to deter kidnapers, are secured on Gomez's wrist and his son's. Gomez, a 29-year-old car dealership employee, looks intently at his son, the hair now all but hidden by a tiny pink, blue and white striped stocking cap. His eyes are gray-blue; his skin smooth.

"Let's get this baby warm," urges Robin Corcoran, assistant nurse-manager, wheeling the baby quickly across the hall to the recovery room, which will serve as temporary quarters for four moms and their babies.

7:31 p.m.: Caudillo, a 25-year-old secretary, is wheeled into the recovery room, the baby's inky footprints ingrained on a sheet of paper at the foot of her bed. She's handed the baby after her wrist bracelet and the baby's bracelet are compared for security reasons.

In seconds, the room fills up. There's Estela Osorio, Caudillo's aunt; Leticia Osorio, her cousin; Maria Cruz, her sister-in-law, with teen-ager Alonzo, and Rosa Gomez, another sister-in-law. Toting flowers and balloons, they create an instant party atmosphere.

Corcoran steps around and between people, beginning the crucial process of monitoring the mother. "I need a blood pressure cuff," she says.

Caudillo inspects her newborn, whom she has decided to name Manuel Alejandro Gomez. "It's the same mouth as my older son," she says. Her 3 1/2-year-old son Joshua, who had wanted to come along, is staying with Aurora's mother.

An intravenous drip of glucose and Pitocin helps to rehydrate and to keep the uterus contracted. The blood pressure monitor displays 112 over 72, a reading that pleases the nurses. Pulse and body temperature are normal.

"I don't feel tired," Caudillo says. Her hair is hardly out of place and her eyeliner still unsmudged. "But this labor was harder than my [older] son's. Last time I had back labor. This time, mostly in front."

Nurse Corcoran is back, donning examination gloves and gently shooing away family members so she can check Caudillo's uterus to be sure there are no problems, such as hemorrhaging.

Meanwhile, Caudillo's doctor stands at the recovery room desk, writing postpartum orders. "She probably is going to go home day after tomorrow," says Houman, in a hurry to finish his duties and get home to his wife and their 3-month-old son. "Usually the first eight hours [after childbirth] is uneventful," he says. Still, he's no fan of early discharge. "They sent my wife home after 11 hours," he says, clearly disapproving. The first 24 hours, he says, are especially crucial for observation.

8:08 p.m.: "You need anything for pain?" Corcoran asks. Caudillo declines, explaining later that she avoids medicine when at all possible.

8:23 p.m.: It's time for the transfer out of recovery.

"Cold?" Corcoran asks.

"A little," responds Caudillo, so Corcoran grabs a thermal blanket from a corner cabinet and arranges it over Caudillo, who by now is holding the baby.

He cries, breaking a long silence. She soothes him. "Probably hungry," she says, rocking him.

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