Obstetricians Criticize Speedy Discharge Of Mothers And Newborns

Leading obstetricians charged Wednesday that profit-driven insurance firms are conducting an “uncontrolled experiment” on American mothers and their newborns by forcing them to leave hospitals just hours after delivery.

In what is shaping up as a major clash between health insurers and health professionals, doctors at the annual meeting of the American College of Obstetrics and Gynecology said there is no scientific basis for sending mother and child home so soon, and there are signs the practice is taking a toll.

Just this week, the University of California at San Francisco reported five recent cases of bilirubin encephalopathy - a severe form of jaundice that causes brain damage. The disease, almost unseen in American hospitals for over 20 years, is easily averted if signs are caught early.

A growing number of insurers and health maintenance organizations allow only a 24-hour stay for mothers and newborns unless there are complications, and some hospitals are discharging them within 6 hours of delivery.

The insurers say that longer stays are too costly and that many women do not want institutionalized care for their newborns and want to get home as soon as possible. But the obstetricians, meeting in San Francisco, said the pressure to get mothers home early has gone too far.

“The recent trends are not driven by consumer demand, but by financial considerations,” said Philadelphia physician Michael Mennuti, chairman of the college’s obstetrics policy committee. “The burden of proof for the safety of early discharge rests on those driving this change.”

At a press conference at Moscone Convention Center, Mennuti called for a “timeout” on the part of HMOs and other purveyors of managed care “until we know what is best for American women and their families.”

The trend toward shorter stays, he said, amounts to “a large, uncontrolled and uninformed experiment” by health insurers.

Dr. Carol Miller, a neonatalogist at UCSF Medical Center, said a newborn’s first day of life is critical for both mother and child. The recovering mother needs time to learn how to nurse her baby, she said, and the baby must learn how to nurse.

The average length of stay for women who give birth vaginally decreased 49 percent, from 3.9 days to 2.1 days, between 1970 and 1992.