A quarter-century ago, it took nine months and four days for a human embryo to grow from a single cell to full-term infant and for the mother to recover sufficiently from childbirth to leave the hospital. Today it typically takes nine months and a day.
There has been no change in gestation, but maternal recovery time has shrunk dramatically by 75 percent. The former is dictated by evolution, the latter by health insurance companies.
Nationally, hospital maternity stays that in 1970 had averaged 3.9 days after an uncomplicated vaginal delivery dropped to 2.1 days by 1992, according to the U.S. Centers for Disease Control. Since then, health insurance companies have yanked the medical-benefits purse strings even tighter, sending mothers still exhausted from giving birth packing from their hospital beds 24 hours or less after normal vaginal birth and three days after Caesarean-section.
Terry Parker works on the front line of so-called drive-through-delivery obstetrical care that, she says, often leaves mothers desperate for rest, relief and reassurance. “If a new mother bursts into tears when I call and tell her who I am, I’m real sure I’ll be going out to her home the next day,” said Parker, a registered nurse at Edward Hospital, Naperville, who splits her on-duty time between the postpartum unit and visiting mothers and their babies in their homes two to six days after they’re discharged from the hospital.
Contrary to the budget slashing that currently dominates the health industry, a few hospitals are giving away their maternity services in an effort to reduce the risk of undetected postpartum complications to mothers and babies.
Edward Hospital and Delnor-Community Hospital, Geneva, offer free home visits by staff nurses to women two to six days after they are discharged from the hospital, and in September, St. Joseph Medical Center in Joliet began tacking on a free day of room and board to the stay of every mother who wants it.
“We need to do things for the right reason in these days of economic pressures,” said Connie Hardy, director of maternal-child services at Edward. “And what is the right thing? Does that mean having mothers stay in the hospital where they can rest, or does that mean providing support in their homes? . . . What’s driving this situation is who’s going to pay for what and how can insurance companies get the biggest bang for their buck.”
Judy Smith, director of maternal and child services at Delnor-Community, which introduced the Mother-Baby Home Visit Program in 1992, said: “We don’t have whole families all living on the same block anymore. We have transplanted families. Grandma lives a thousand miles away, and Sister lives in California. Mom may have moved here six months ago and not have had time to make new friends.
“If she’s a working mother, she may have stayed on the job right up to the day of her delivery. She doesn’t know her neighbors and hasn’t got anyone to help her with her 2-year-old when she gets home.”
In May, the American College of Obstetricians and Gynecologists (ACOG) called the trend toward earlier dismissals “a large uncontrolled, uninformed experiment that may potentially affect the health of American women and their babies.”
Among the problems that may not be apparent in the first 24 hours after birth are infection, certain congenital heart defects, infant dehydration (often related to breast-feeding problems) and newborn jaundice (yellowing of the skin), which in serious cases can cause brain damage. Newborn jaundice is caused by a buildup of bilirubin, a yellowish-red byproduct of the normal breakdown of red blood cells in the bloodstream, which is processed in the liver and excreted. Immediately after birth, a baby’s immature liver may not be able to break down the bilirubin as fast as it’s produced, resulting in a yellowing of the baby’s skin. ACOG says it has collected “anecdotal reports of serious problems in newborns such as dehydration and jaundice following early discharge.”
The Cradle Connection at Edward Hospital was started 10 years ago as a goodwill gesture when maternity hospital stays were typically three days and nurses had more time to mentor new mothers in baby care, but it has evolved into a vehicle for much-needed follow-up care.
“I visited a baby yesterday that was jaundiced,” Parker said, “and neither the mother nor the grandmother had noticed. . . . The kid was flaming yellow!”
If a newborn develops potentially serious problems and the mother doesn’t recognize the symptoms, the infant’s condition can quickly become life-threatening, said Pam Forster, a staff nurse at the New Life Maternity Center at Delnor-Community who began making home visits two years ago. Case in point: “I visited this mom who lived way out in the country. Her baby was real little, just about 5 pounds (at birth),” Forster related. “The baby was only nursing for five minutes every four hours and was very, very dehydrated. The infant hadn’t wet a diaper in 36 hours. If I hadn’t come out, that baby could have been in big danger.”
Hardy said it costs up to $100,000 a year to operate Cradle Connection, and Smith said the annual tab for the Mother-Baby Home Visit Program is about $112,500. Mothers interviewed insisted that the home visit investment paid invaluable dividends in peace of mind.
“I felt very reassured knowing that no matter what, somebody was going to come here and see how things were going,” said Laura Lutz, 28, of St. Charles, who gave birth to her first child, Brent, at Delnor-Community April 29. She went home the next day.
The home visit a few days later was the right support at the right time, Lutz said. “The nurse gave Brent and me a mini-physical. Brent was a little jaundiced, so she took a blood sample on the spot. . . . I was getting so frustrated with breast-feeding, but she really helped me. My milk came in that night, and I knew just what to do.” When the 90-minute visit ended, “I felt like the nurse was one of my good friends. I could talk to her about anything.”
The day after Katharina Linder, 34, Naperville, went home from Edward Hospital with her first child, Alexander (born Oct. 10), she got a phone call from Parker asking how she and her son were faring. “I especially appreciated that call; it really eased a lot of my fears,” Linder said.
The home visit a few days later proved to be an eye-opener. “Here was someone who is a professional saying, `Why don’t you try this?’ or, `This might work better.’ Thanks to her prodding, I got answers to questions I didn’t even know I had.” Without the 90-minute visit, “I wouldn’t feel as confident of what I’m doing.”
Federal and state legislation that would require longer maternity-stay health benefits is pending. State Rep. Lauren Beth Gash (D-Highland Park) introduced a bill in June that would prevent insurance companies and health maintenance organizations from restricting a woman’s hospital stay to less than 48 hours after normal vaginal delivery and less than 96 hours after Caesarean-section. If the woman chooses to leave the hospital sooner, she would have the option of receiving up to four post-delivery home visits by a maternal-child registered nurse.
In July, State Sens. James DeLeo, Arthur Berman and John Cullerton, Democrats from Chicago, introduced a similar bill in the Senate. U.S. Sens. Bill Bradley (D-N.J.) and Nancy Kassebaum (R-Kan.) are cosponsors of federal versions.
Insurance companies oppose any legislation that would mandate an increase in the time mothers and babies spend in the hospital. “We do not think these decisions are the province of legislators,” said Richard Coorsh, spokesman for the Health Insurance Association of America.
“It’s not appropriate for legislators or insurance companies to be dictating medical care,” Smith said. “The practice of medicine belongs in the hands of medical professions. The physician should be making those decisions.”
