Newborns often do just as well going home early

Back in the 1990s, a public outcry over “drive-through deliveries” led 41 states and the federal government to pass laws mandating 48-hour minimum hospital stays for mothers after routine births. Proponents of the laws argued that sending mothers home from the hospital less than 24 hours after birth, as some health plans were doing, posed a health risk to infants.

Now a Harvard study has found no evidence that sending mothers home faster harmed the health of newborns.

“Short stays and long stays had no effect on the health of the newborn as long as there was good follow-up care,” said Jeanne M. Madden, the study’s lead author and a researcher at Harvard Medical School.

Newborns do equally well going home from the hospital one or two days after delivery, according to the study published last week in the New England Journal of Medicine.

The researchers concluded that home nursing visits could “adequately substitute” for longer hospital stays. Longer stays made no difference in how frequently babies returned to the hospital for emergency care or re-hospitalization, the study’s authors found.

“We’re not saying that this wave of legislation that guaranteed 48 hours was the wrong thing to do, because there may be other contexts where the early-discharge programs were not done as carefully and perhaps harm was done,” Madden said. California mandated the 48-hour stay in 1997.

The public outcry in the 1990s focused on health plan policies that limited patients’ insurance coverage to 24 hours in the hospital following a routine vaginal delivery. In some instances, mothers were sent home as soon as eight or 12 hours.

The study was based on records of 20,366 newborns delivered between 1990 and 1998 at a large Massachusetts HMO affiliated with Harvard University. Researchers compared newborn health during periods of time in which three different discharge policies were in effect. During the first, from 1990-1994, maternal length-of-stays were not mandated. The second period, from 1994 to 1996, was when the HMO’s policy was a one-night hospital stay followed by a home nurse visit. The final study period began in 1996, after Massachusetts passed a law mandating a two-night stay. (In many cases, mothers left sooner than 48 hours to take advantage of a home nursing visit that the health plan guaranteed for shorter stays.)

Longer stays had a downside: The babies were less likely to be examined on the third or fourth day when problems like jaundice or dehydration peak.

The researchers found that the longer stays did not affect insurers’ costs very much: They added about $100 to total costs of care. The authors explained that the cost difference between a one-night and two-night stay was negligible because some Massachusetts hospitals raised rates for shorter stays after the HMO began its short-stay policy in 1994, and also because women discharged earlier used more outpatient services.

Dr. Laura E. Riley, a maternal-fetal medicine specialist at Massachusetts General Hospital, noted that the findings only apply to families with access to care. “That’s very different from your [low-income] 16-year-old who goes home in 18 hours and her baby is not eating. She doesn’t know what to do and where to call.” Riley also noted that the study didn’t address maternal health.