Giving moms, newborns more time in the hospital

April 24, 1995|By Diana K. Sugg | Diana K. Sugg,Sun Staff Writer

When she was wheeled out the hospital door with her newborn after just 24 hours, Stacey Berger thought she was prepared.

But as the snow piled up outside her Clarksville home that weekend, Mrs. Berger and her husband -- both attorneys who had painstakingly prepared for childbirth -- grew frightened. Mrs. Berger had trouble breast-feeding. Their tiny daughter, Melanie, kept crying.

When they finally made it to the doctor, they discovered the baby was malnourished and jaundiced.

Like other new parents, the Bergers were rushed out of the hospital as part of an effort to hold down health care costs. For several years, doctors have questioned this policy. Now they say they have proof it's a bad idea.

And they've persuaded the Maryland legislature to back them up.

A bill on Gov. Parris N. Glendening's desk would require insurance companies and health maintenance organizations to pay for 48 hours in the hospital after childbirth. If medically stable, mother and child could be discharged before 48 hours, but a nurse would have to visit them at home.

The bill, among the first such efforts in the country, would have made a big difference for the Bergers.

"I understand the early discharge and would not have a problem with it if there is some type of supervision of mother and baby," Mrs. Berger said. "But you don't get that, you're given this checklist."

Millions of first-time parents share her anxiety. As managed care and market forces have reduced the amount of time mothers and their babies stay in the hospital to roughly 24 hours, parents often find themselves struggling.

Some hospitals have responded by scheduling home visits or follow-up telephone calls by nurses, for which some insurance companies pay. Since the trend toward shorter stays started in Maryland four years ago, a mothers' support group at Greater Baltimore Medical Center has mushroomed from half-a-dozen participants to sometimes more than 30. Monthly calls to the hospital's breast-feeding specialist have almost doubled, from about 350 to about 700.

For years, studies of hospital maternity stays have yielded conflicting findings. Proponents of short stays say the mother and infant bond more quickly at home and aren't exposed as long to hospital germs.

Opponents counter that several serious illnesses that strike infants can't be detected until 24 hours after birth.

The controversy symbolizes the larger struggle over the future of health care in this country. Insurance companies and HMOs are looking to cut costs. One of their most successful tactics has been to reduce the number of days people spend in hospitals. But physicians and hospitals -- which are losing money because of the changes -- argue that quality care is being sacrificed.

Both sides are arguing over who draws the line -- who decides how much care patients get.

The often abstract debate becomes real for many new parents when they're told to pack up and leave the hospital long before they feel ready. Five years ago, the stay for childbirth was roughly three days; now it's about one. About 75,000 babies are born in Maryland annually. Nationwide, childbirth is among the top reasons for hospital admissions. It's an emotionally charged time.

Ellen O'Brien stayed at Greater Baltimore Medical Center with her baby for the standard 24 hours, until almost midnight, because she wanted the care and attention as long as possible. When she was informed that the child, her first, had respiratory problems and couldn't go home, she was crushed.

'This was the prize'

"It was, like, this was the prize," she said, holding up her 5-month-old son. "To think that I wouldn't get to take him home, and who knows what's going to happen to him . . . "

As she recalled that night, she began to cry, just as she had in the hospital before doctors relented and agreed to let her take Patrick home.

"I took him out of here in the middle of the night, in a pouring-down rainstorm," Ms. O'Brien said. "In hindsight, I should have let him stay, but I should have been able to stay with him," as a patient.

Doctors say that, more and more, mothers are discharged before their sick newborns, causing disruptions in breast-feeding and bonding. And even in normal, healthy deliveries, the shorter stay is causing problems, they say.

According to a state geneticist who tracks every Maryland birth, fewer newborns are being screened for genetic diseases, including some that can cause mental retardation or death if not detected early and treated.

In the first half of 1994, about one-third of Maryland's newborns were sent home within 24 hours, said Dr. Susan Panny, who heads the Office for Hereditary Disorders in the Department of Health and Mental Hygiene.

That renders worthless a routine test to screen for several genetic metabolic diseases and sickle cell anemia, she said. The baby must have 24 hours of milk feedings for the blood tests to pick up the disorders, so the early discharges are delaying valid screenings.

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