Maternity law delivers shock


Maryland was hailed as the first to put its foot down against health insurers when it passed a law last spring to guarantee new mothers and babies a 48-hour hospital stay. But when the law goes into effect Sunday, women delivering babies in Maryland can expect to spend less time, not more, in the hospital.

A giant, but little-publicized, loophole in the new law makes it likely that most women who have routine vaginal births will be discharged from the hospital after only one night's stay. The law's fine print permits doctors to discharge new mothers and babies after 24 hours if insurers offer a post-partum visit from a home care nurse. Most insurance companies are expected to opt for the home care nurse instead of paying for mothers to

spend a second night in the hospital.

In fact, large insurers such as Blue Cross and Blue Shield of Maryland have begun denying an extra night's stay to women who deliver babies late in the day -- after 4 p.m. and up to 11:59 p.m. And hospitals are beginning to crack down on their own grace periods, which allow patients to stay six to 18 hours past the 24-hour cutoff.

Finally, to the shock of doctors, nurses, and new mothers, Blue Cross is refusing to pay for more than two days in the hospital for women who have scheduled Caesarean section deliveries. The typical stay has been three days.

"It's unbelieveable," said Victor A. Khouzami, chief of obstetrics at the Greater Baltimore Medical Center, which delivers 5,300 babies annually.

C-section mothers are being sent home before they are eating regular food, he said, and most have to return to the doctor's office to have surgical staples or clips removed.

He and other doctors are troubled by the continued erosion in post-partum hospital stays. The trend comes at a time when women think they are about to get a bonus day because of the fanfare surrounding the new law, which was billed in the media and by some politicians as a bold step .

But the new law gives insurance companies -- not new mothers -- the choice of 24-hour or 48-hour hospital stays for routine deliveries. Insurers are unlikely to choose the extra day in the hospital, which costs $1,000 to $2,000 compared with as little as $67 for a home care nurse. But the exception to the 48-hour stay is catching women by surprise.

Last week, Cathy Shapiro, nine months pregnant with her first child, received a letter from her insurer telling her she is entitled to a free home visit from a nurse after delivery. On page three of the letter, she learned the insurer will pay for only one night in the hospital if her delivery is routine.

Shocked, she called the attorney general's office and the insurance commissioner to report the company, thinking she was being denied her 48-hour stay under the new law.

Mrs. Shapiro, 36, who runs her own public relations firm in Baltimore, said she was misled by the publicity about the new law.

"Nowhere did I see that it wasn't 48 hours," she said, adding that people even called it the "48-hour" bill. "Myself and everybody else I know is under the impression we got a 48-hour stay."

Confusion all over the state

Confusion among women about to deliver is being reported by doctors all over the state. They attribute it to vague or mistaken media reports about the new law, some of them linking the Maryland law with a more liberal "48-hour" law in New Jersey. The New Jersey law allows the mother to choose between a longer hospital stay and early discharge followed by medical care at home.

Both the Maryland and New Jersey laws were inspired by public outrage over new mothers' being pushed out of hospitals so quickly and newborns being discharged before they can be properly tested for problems that can lead to mental retardation. In some cases, newborns have been brought back to the hospital suffering from dehydration, jaundice or other illnesses.

Plenty of women want to leave the hospital early, and some doctors say the germs in hospitals are good reason to send healthy babies home as soon as possible. But doctors also say that some women, particularly first-time mothers who undergo long labors, need more time to recover than insurers are allowing.

In Maryland, all but a few hundred of 25,032 mothers who had normal deliveries in the year that ended March 30 stayed in the hospital more than 24 hours, according to the Maryland Hospital Association.

But in the coming months mothers like Jane Bourgeois, who delivered a son in a routine vaginal birth at 10 a.m. last week, can expect to be discharged shortly after 10 a.m. the next day -- instead of at 1 p.m. or 5 p.m. or even 7 p.m. as they are now.

'I would have cried'

"I would have cried if I had to leave early," said Mrs. Bourgeois, who delivered at Greater Baltimore Medical Center. "This is my second child. If this was my first, I would be really nervous."

About 80 percent of the pregnant women in Claire M. Weitz's practice come in thinking the new law will give them an extra day in the hospital, Dr. Weitz said.

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