Birthing Blues : New Parents, Insurers at Odds Over One-Night Maternity Stays
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.”
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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.
For insurance providers, the shorter stays can translate into thousands of dollars in savings in a year. At St. John’s Regional Medical Center, which has facilities in Oxnard and Camarillo, a second night’s stay for the mother adds an average $400 to the bill, a hospital spokeswoman said. With 220 babies born at the two hospitals each month, the shorter stays allow insurers to cut $88,000 in monthly costs.
But this puts an extra burden on hospital staffs, which are charged with educating mothers on the care of their infants as well as tending to the physical needs of babies and their mothers following childbirth. The hospitals say they give special emphasis to breast-feeding techniques and determining if a baby is getting proper nourishment.
“It’s hard to give (mothers) adequate education and make sure the baby is feeding correctly,” said Dianne Saavedra, manager of the maternity department at Community Memorial. “It’s a lot of education to give in a short time.”
Most Ventura County hospitals have adjusted to the new insurance rules by offering more extensive education classes for expectant parents, as well as follow-up instruction by telephone or in person after a baby is born.
“Insurance companies really promote the mothers taking these classes, and a lot of them make it mandatory,” said Vickie Lemmon, director of nursing for St. John’s Regional Medical Center in Oxnard.
Many insurance companies have contracts with the hospital and pay for their members to take the education classes, Lemmon said.
“I think we’ve learned to cope by trying to get to the parents prenatally and offer a wide variety of classes,” she said.
But that alone is not enough, Lemmon acknowledged.
“Education before the baby is born is very, very good, but it doesn’t in any way, shape or form address all the situations that come up after the baby is born,” she said.
Hospitals in the county said their staff members try to call mothers a few days after they go home. In addition, mothers are encouraged to call the hospital day or night if they have questions or problems.
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Some pediatricians are concerned that parents might not know if their baby has a health problem that went unnoticed in the hospital during the short stay. Jaundice symptoms may not appear in the first few hours, and congenital heart defects also may go undetected.
“When the baby is totally under the care of the parents, then you have to count on the parents,” said Dr. J. Andrew Huang, an Oxnard pediatrician. “It just makes you more nervous.”
Saul said signs of dehydration and heart problems can be subtle and must be watched for closely.
“We just have to go into more detail educating the mothers about how to care for the new babies because we don’t have the nurses to watch for things,” he said.
Pediatricians see their newborn patients for the first time in the hospital, and traditionally, the next doctor visit is two weeks later. Saul, however, said he sees his newborns within a few days of the hospital discharge because he is concerned that health problems might go unnoticed at home.
Lemmon, St. John’s director of nursing, said she does not have those concerns.
“Healthy babies really transition very quickly and very well,” she said. “I don’t think the new insurance policy has diminished the care for babies. I think that is why the insurance companies have been able to revise their standards.”
DiFonzo, the insurance industry spokesman, said many companies will pay for a nurse to make a home visit after the hospital discharge. But that visit does not necessarily address another concern of doctors--that mothers will stop breast-feeding when they get home because they did not have enough help getting started.
“A new mom is going to need a lot of encouragement along those lines,” said Dr. Edward Gibson, an Oxnard pediatrician. “Those mothers are more likely to give up on the breast-feeding.”
Poliakin, the Thousand Oaks obstetrician, agreed.
“Breast-feeding can be a very trying and traumatic experience for first-time mothers,” he said. “A woman’s expectations about breast-feeding can crumble very quickly.”
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Huang said that despite his concerns about the short hospital stay, “I think we have to live with it because of the control of medical costs.”
Belzer and Saul were not as understanding.
Belzer, the Camarillo obstetrician, said his patients often get angry with him when they learn how soon they must leave the hospital. If they call the insurance company to complain, they frequently are told the dismissal date is up to the doctor.
“That’s not true at all,” Belzer said. In fact, he added, a doctor who lets a patient stay longer than an insurance company would like will receive a severe scolding, at the least, and could find his services no longer covered by the insurance company.
“It’s not up to the doctor,” Belzer said. “There are certain rules.”
Saul was even more pointed in his anger.
“Basically, we have to deal with it. We just have to take the best care of the patient we can with the circumstances we’re given,” he said. “But a child is being put at risk for the sole benefit of insurance executives, who are making hundreds of millions of dollars off these short stays.”
