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Is 48 Hours So Much to Ask?


In my mother's time, the word "natural" did not under any circumstances precede the word "childbirth." Birthing babies was a medical trauma, a slightly more joyful operation than amputation, say, but like amputation, something that required massive doses of sedatives, painkillers and tightly closed eyes.

And that was just the fathers.

After a woman's water broke back then, her frantic husband drove her to the hospital, dropped her off, found a bar where he chain-smoked and got sloshed. The mother-to-be had a similar experience, except she had to stub out her butt before the delivery.

Doctors medicated her into the 10-martini range then hovered at her feet holding forceps. When she awoke--good job, Mom!--she had a baby. (At least she presumed she did. She couldn't be sure until a nurse confirmed it since the baby had been whisked to the nursery while she was still knocked out.) And then she spent a week in the hospital resting from her trauma while learning, presumably, why formula was so superior to mother's milk.

How differently the circle of life arcs today.


A little too differently, in fact, for the tastes of some medical professionals, patients and politicians, who are furious that hospitals and insurance companies are kicking new moms and babies out within 24 hours of delivery in many cases, and in as little as eight hours in others.

They say sending mothers and babies home too soon can cause trouble. Some common and easily curable problems, such as jaundice or dehydration, may not show up in newborns for 24 to 36 hours. What little hard data exists indicates that early releases save lots of money, but create a risk of readmission for babies. Anecdotes abound. Last year, at a congressional hearing in Washington, many senators were moved by the testimony of a Petaluma woman who blamed the death from heart failure of her infant son on being sent home too soon.

"When someone says 'push' in a delivery room," said one legislator, "you don't know if it's to get the baby out of the womb or the mother out of the hospital."

And so the outraged have joined forces in an unprecedented and deeply satisfying attempt to force insurance companies and HMOs to pay for a woman to stay in the hospital for at least 48 hours after giving birth. Sixteen states--including New Jersey, but not California, though a bill has been introduced in Sacramento--have passed bills outlawing "drive-through deliveries."

President Clinton, recognizing a no-lose proposition when he sees one, endorsed a federal version of the legislation last weekend, just in time for Mother's Day.

Short of imposing jail time on fathers who fail to wait hand and foot on new mothers for the first month following childbirth, I really think this is the least our government can do.


It is difficult, verging on impossible, to summon much sympathy for the providers of managed care, who have brought this medical meddling by the government on themselves.

California's own hallowed progenitor of the HMO, Kaiser Permanente, instituted a voluntary policy last year urging that new moms and infants be sent home if possible a mere eight hours after birth.

An unofficial memo posted at a Kaiser hospital, "Positive Thoughts Regarding the Eight-Hour Discharge," outlined benefits to patients ("Hospital food is not tasty.") and staff ("Reduce our overhead costs to remain competitive in a fluid marketplace and thus retain our jobs and attract more patients." Yes, the italics are mine.)

Naturally, those who stand to make heaps of money by sending women and children home fast warn that mandatory minimum postpartum stays of 48 hours will bring, horrors, higher premiums. And yet, The Times reported last year in the first in-depth investigation of the managed care industry, that the six largest California HMOs earned profits of more than $1.13 billion and had accumulated combined cash reserves of $5.6 billion.

Meanwhile, doctors are being squeezed to provide services at lower costs or risk being dropped by managed care groups. A lot of docs, as a result, are not too happy. One managed care consultant described doctors to a Times reporter last year as "an angry, demoralized profession feeling confused and threatened."

I don't know about you, but when I'm lying helpless on that crisp white paper with my feet in those cold steel stirrups, the last face I want to be looking into is that of an angry, demoralized doctor.

If requiring payment for 48-hour stays helps mom and babies be healthy, improves the mood of grumpy physicians and teaches the managed care companies a lesson, we should do it, stat.

* Robin Abcarian's column appears Wednesdays and Sundays. Readers may write to her at the Los Angeles Times, Life & Style, Times Mirror Square, Los Angeles, CA 90053.

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