Congratulations, Mom! Here's the door

January 23, 1996|By Robert N. Sheff

AMONG THE VARIOUS ''managed care'' controversies which have received attention of late, none has provoked more public reaction than the decision of most health-insurance companies to limit the hospitalization of mothers and newborns to one day.

As the father of three children, I have seen the postpartum hospital stay change from five days with our first child (1967), to three days with our last (1977), to one day with our first grandchild (1994). I also view this and other medical-care decisions from the perspective of 25 years as a practicing physician and over 10 years as a medical manager who has played a role in shaping this process.

Clearly, reducing costs has influenced the decision to shorten hospital stays for many medical procedures. It must be understood by patients and doctors alike that as a society we have reached the point of limited resources for medical care as a result of all the advances of modern medicine and the expensive technologies that support them. For all of us to have access to health care we must continue to assure that high-quality care is delivered in the most cost-effective setting.

To provide the life-saving and healing interventions now available to us some changes had to be made, such as how hospitals are used. Once hospitals were a unique medical resource which provided both needed medical care and rest for recuperation. Now less costly resources are needed to support the recuperative healing process. The timing for this move from the hospital is ultimately made by the physician.

In the case of when a mother and infant are released from the hospital, Blue Cross and Blue Shield of Maryland's medical policy follows the guidelines issued by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology for perinatal care. The one-day hospital stay is recommended only for women who experience a normal vaginal delivery without complications. If medical circumstances call for a longer hospital stay -- the decision is made by the woman's physician.

Best of alternatives

On a personal level I understand shortening the time that a mother spends in the hospital after the birth of her baby prevents her from receiving the recuperative care and nurturing that have always been an indispensable attribute of good medicine. I am saddened and frustrated by the necessity of making this difficult choice, but I know it is the best choice given the alternatives. I am comforted by knowing there are a number of reasons why a shorter stay may be advantageous for the mother and infant.

A quick return home enhances the involvement of other family members with the new infant. The risk of infection to mother and infant is greatly reduced outside the hospital.

Another factor in the shortened hospital stay is the visit by a trained home nurse. This visit provides mothers an opportunity to have one-on-one support and reassurance from a professional. The nurse monitors the health of the mother and infant, and if any problems are detected the patient's obstetrician or pediatrician are contacted. Family and friends, however, must be relied on to provide the nurturing environment in the home that is important to both the mother and infant.

As with any change in medical policy it is necessary to educate both physicians and the public to obtain their understanding and support. It is noteworthy that much of the resistance to the shortened postpartum stay has come from physicians, obstetricians and pediatricians, who not only wish to provide their patients care and nurturing, but also experience a loss of personal contact with new mothers and a decrease in their autonomy for using medical resources.

There is no disowning the role of cost savings in this and other managed-care decisions. However, to ignore the fact that society has reached a point of limited resources in the delivery of health-care services is denying the very heart of the situation.

Still, to retain a sense of ourselves as healers, physicians cannot be a part of any process that lessens the quality of patient care. Confidence in the commitment to quality of care has always been a component of the covenant between physicians and patients and is an essential part of healing that dignifies our work together.

Robert N. Sheff is president of the Blue Cross and Blue Shield of Maryland HMOs.

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