When Stephanie Hall gave birth to her daughter, Tiffany, she was filled with the same joy and apprehension that many first-time mothers feel as they marvel at the tiny hands and mighty cries of their newborns.
“I was so happy, but I was worried. I was concerned about my baby coming home so soon,” said Hall, 33, whose daughter is now nearly a year old.
Like many healthy mothers who have given birth during this era of cost-cutting by insurance companies, Hall and her daughter were discharged from the hospital within 24 hours of the birth. The shortened hospital stays are intended to save money and keep insurance premiums down.
Unlike many other mothers, however, Hall, who is single and lives in Chicago, was not left entirely on her own to navigate the transition into motherhood. Her daughter’s first critical days of life were monitored, too.
Through a pilot program called Mother-Baby Home Care, Hall received a visit from a registered nurse at her home the day after Tiffany’s birth. The program, which is funded by a grant from the Alberto Culver Corp. in Melrose Park, is offered by Little Company of Mary Hospital in Evergreen Park.
It was started by hospital officials who wanted to educate new mothers on how to care for themselves and their newborns despite the shortened hospital stays that have become the norm. They sought a $10,000 startup grant from Alberto-Culver, which provides funding for a number of programs that have a benefit for women’s health. The program is offered to both insured and uninsured patients of Dr. Wilfredo Rendon, an obstetrician affiliated with the hospital; he was chosen for the program because he sees so many patients.
Dr. George D. Wilbanks, president of the American College of Obstetrics and Gynecology in Washington, D.C., and chairman of the Department of Obstetrics and Gynecology at Rush Presbyterian St. Luke’s Medical Center, commends Little Company of Mary for this program, but the stance of the American College of Obstetrics and Gynecoloogy is that more study needs to be done to determine the safety of being discharged early from the hospital. “Not everyone is ready to go home in eight hours. The decision whether to go home should be made by the doctor and patient, not by the insurance companies.
Describing her in-home visit from a nurse, Hall said, “The nurse checked Tiffany to make sure she was okay, and she asked me how I was feeling and how I was moving. She answered my questions about caring for Tiffany.”
The home care visits are made by any of a staff of 12 nurses assigned to the hospital’s Mother and Baby Unit, which serves those in the hospital’s nurseries before and after they go home. Mary Grimm of Oak Lawn is the nurse manager of the unit and also oversees the Mother-Baby Home Care program, which was started in October 1994. During that time, about 100 home visits have been made to mothers and their infants, all patients of Dr. Rendon.
The visits, which last about an hour and a half, involve the same type of assessment that would be done in the hospital to determine how the mother and baby are faring physically.
“We check to see that the baby is feeding well and has urinated,” Grimm said. “We also weigh the baby, take vital signs, listen to the breath sounds and check the baby’s color.” Tests are performed for genetic diseases, including PKU, which cannot be detected in infants until a day or more after birth.
The mothers are evaluated, too. “We check their stitches and want to know how they are feeling now that they have been home a day or two,” Grimm said. “Their bodies have gone through a lot of changes.” If a problem is discovered, patients are referred to the doctor.
Although this visit is the first and probably only time a nurse will see the mother and baby in their home, it is not the first contact between the mother and one of the staff nurses. Visits between the mother and a nurse take place at four of the mother’s appointments with Rendon starting around the 32nd week of the pregnancy. The visits are scheduled in the doctor’s office.
“Each week that you go in (to an appointment), they explain things that you should know. The nurses were very informative,” said Jean Luchene of Alsip. The 27-year-old gave birth to her daughter Elizabeth in September.
During the in-office visits, Grimm said the nurses cover topics from how to bathe and breast-feed a baby to how a mother’s sexually transmitted diseases could affect her baby. The nurses also determine what kind of support system will await the mother when she takes the baby home.
“We want to know if her husband, parents or an older child will be there to help her,” Grimm said.
Such a support system was in place in Luchene’s case. She was accompanied to her visits by her fiance, William Ashley, who lives with her. In Hall’s case, her mother would be available to help her in the first days after she went home with her baby.
Luchene said the in-office visits were especially valuable because they calmed her anxieties, were private and allowed her to get the information that she and Ashley needed.
“They made you feel more comfortable because you could ask a lot more personal questions,” Luchene said. “It was just you and your partner and a nurse, not a whole classroom of people.”
Learning how to take care of yourself and your baby before the first pang of labor is a good idea, Grimm said.
“It’s overwhelming to learn all of these things, to take in all this information, after you’ve just gone through 20 hours of labor,” she said.
Luchene and Ashley said they liked many aspects of the Mother-Baby program, but Ashley wished that the nurses could have made more than just one in-home visit. Michelle Dignan, a clinical nurse specialist with the program, said several visits to each patient are not possible because of funding constraints.
“If (after a home visit) there was any concern in our minds or hearts (about the mother or child’s health), we would refer them to an obstetrician or pediatrician,” she said.
Dignan noted that a followup phone call is made to the mother in the week following the home visit. Any concerns that the mother might have had during the home visit, such as concerns about breast feeding, are discussed in the phone call. The call is usually the last contact between nurse and patient.
“Our closure to the relationship is the followup phone call. However, the patient is always free to call the hospital,” said Dignan, who lives in Chicago.
While shortened hospital stays for new mothers and babies have become the norm in the 1990s, Grimm is aware that they also are controversial. Critics charge that mothers and babies who are released very soon after childbirth could face health problems. Grimm disagrees.
“Concerns about short stays are often because the mother hasn`t had time to learn about how to care for her baby or herself,” she said. “We address that in the prenatal education.”
As a mother herself, Grimm said she would have appreciated a shorter hospital stay.
“When I gave birth 10 years ago, I stayed in the hospital for three days. It was too long for me,” she said. “I wanted to be home, and I felt I’d be more comfortable and would recuperate better.”
For healthy mothers like Hall and Luchene, the program seems to have been a success. Luchene said she was perfectly happy to leave the hospital so soon after giving birth.
“I’m a firm believer that the quicker you get up and get motivated, the quicker you’ll feel better,” Luchene said.
Hall said that the program increased her confidence in her ability to cope as a mother. She said the program taught her how to deal with at least one worrisome situation that did arise.
“(Nurses) told me that a baby could choke on her milk. When that happened, I turned her over and I patted her on the back and she was fine,” Hall said.
Today, Tiffany has grown from a cooing infant into a bubbly, precocious toddler. Her mother can hardly believe how much she has changed in just a few months. “She’s walking, she’s talking, she’s almost doing on her own,” Hall said with a laugh.
