History of Childbirth Hospital Stays
The length of hospital stays for mothers and their newborns declined steadily from the 1970s until the 1990s. Many hospitals implemented early newborn discharge policies in the 1990s and most mothers were discharged 24 hours after delivery. By 1996, most states and the U.S. Congress passed laws to ensure a woman could stay in the hospital 48 hours after an uncomplicated vaginal birth and 96 hours after an uncomplicated cesarean section. Health plans and HMOs were required to cover this length of stay and not give incentives or disincentives to discharge earlier. Many new parents applauded the Newborn’s and Mothers’ Health Protection Act. But others wanted to maintain their right to go home as soon as possible after having a baby.
Discharge Timing Should Be Individualized
Research shows that the problem is not necessarily how long women are staying postpartum, but that maternity care systems often have an inflexible policy on how long mothers and babies stay after birth. A study published in 2007 found that 17% of mothers were not ready to leave the hospital at the time of discharge. Some mothers are ready to go home far fewer than 48 hours, while others need more time. The AAP’s Safe and Healthy Beginnings toolkit includes a discharge-readiness checklist to be used by doctors to prepare parents and babies for discharge. Factors that can influence the need to spend more time in the hospital can include:
Having a baby for the first time Insufficient education on breastfeeding or baby care Giving birth during non-routine hospital hours Having a chronic condition or complicated birth Little or inadequate prenatal care Certain ethnicities
The AAP recommendations are that women and their care practitioners have a say in the length of time they stay in the hospital. Giving a family a say in how much help they need can make the difference in women and babies being healthier and getting the proper support postpartum. Factors that must be considered include the medical condition of the mother and infant, the parent’s confidence in their ability to care for their infant, adequate support systems at home, and the availability to appropriate follow-up care. The mother and baby should be discharged at the same time. The AAP recommendations call for institutions to develop policies that implement these guidelines so care can be individualized.
