Correspondence
Length of the Hospital Stay for Mothers and Newborns
N Engl J Med 1996; 334:1134-1135April 25, 1996
- Article
To the Editor:
As a regional medical consultant half a day per week for a large insurance company, i advise physicians throughout the country to limit postpartum stays to 24 hours (assuming a normal vaginal delivery and no complications). I agree that new babies and mothers need to be monitored and new mothers require education, but I believe such monitoring and education can be done more thoroughly and economically at home. The cost of the additional 24 hours of hospitalization for mother and baby could pay for an average of eight home visits by a nurse. Although I offer such visits as an alternative to inpatient care, many of the physicians I speak with are unwilling to make these arrangements.
Parisi and Meyer (Dec. 14 issue)1 state, “A two-day postpartum stay allows for intensive education about parenting skills, breast-feeding, maternal after-care, contraception, and care of the newborn.” In the hospitals where I am an attending physician, postpartum education usually consists of minimal guidance about breast-feeding, a handout about common postpartum problems (usually prepared by the physician), and a short talk before discharge. I would not categorize these measures as intensive education.
Hospital-based nurses are not always the best source of information about breast-feeding, even with appropriate education.2 They now have even less time with patients because of budget constraints. Also, many hospital policies discourage bonding and interfere with successful nursing by keeping babies in a central nursery and offering supplemental feedings.3 I think the visiting nurses who specialize in newborn care provide better support and education than hospital-based nurses.
If the legislative process is to be used in the United States to mandate care, we should be intelligent and efficient about it. We can all agree with the goal of protecting the health and well-being of mothers and newborns, but there are better ways to achieve this goal than providing more high-technology care.
3 ReferencesGil L. Solomon, M.D.
7230 Medical Center Dr., Canoga Park, CA 913071
Parisi VM ,Meyer BA . To stay or not to stay? That is the question. N Engl J Med 1995;333:1635-1637
Full Text | Web of Science | Medline2
Iker CE ,Mogan J . Supplementation of breastfed infants: does continuing education for nurses make a difference? J Hum Lact 1992;8:131-135
CrossRef | Medline3
Blomquist HK ,Jonsbo F ,Serenius F ,Persson LA . Supplementary feeding in the maternity ward shortens the duration of breast feeding. Acta Paediatr 1994;83:1122-1126
Web of Science | Medline
To the Editor:
Orthopedic surgery has practically eliminated traction as a treatment for femur fractures in children because of problems with the length of stay in the hospital. The main issue concerning length of stay is not the cost of maintaining a bed and simple services for a not-very-sick patient who requires three meals a day (such as most children in traction) but the cost-sharing mechanism in place in essentially every hospital. The unfortunate patient who must be hospitalized for a long time but requires relatively simple care bears an untoward portion of the hospital's redistribution of losses, which are levied on the basis of length of stay instead of resources used. It would be a wonderful thing indeed if the appropriate and forward-looking policies that allow a hospital to provide extended obstetrical care at relatively low cost could be applied to other areas, such as the use of traction in orthopedic surgery.
John D. DeWeese, M.D.
300 Carew St., Springfield, MA 01104-2356Author/Editor Response
The authors and a colleague reply:
To the Editor: We appreciate the thoughtful comments of Solomon and DeWeese. We believe that the debate about the length of stay after childbirth should not deteriorate into an argument about hospital care versus home care but should be based on a consideration of the best interests of patients in the context of their total care and lifetime health. Realistically, the best interests of patients vary depending on geographic factors and the degree of sophistication of hospital services and home health care. A continuum of prenatal care and education; a short, effective hospital stay; and excellent after-care for both mother and newborn are the key issues.
In response to Solomon, we believe that 48-hour stays allow for high-quality education and monitoring. Furthermore, universal decisions about a stay of a single day should not be based on regional statistics concerning medical efficacy. In some parts of the country, geographic considerations make it very difficult for women to bring their babies in for postnatal testing. Not all insurance companies have developed good after-care programs. Insurers and providers must start paying attention to all practices with cost implications, not just the easy ones. For example, reducing the rate of cesarean delivery and increasing the rate of successful vaginal birth after a previous cesarean delivery should receive high priority. Until intensive education and access to after-care are ensured, we believe that supporting the family with an extra hospital day is justified.
In response to DeWeese, applying the extra-day option to other types of care, such as orthopedic treatment, should be examined by individual institutions and physicians for their own patients and circumstances. If the overall length of stay decreases and the patient census is low, hospitals can consider using empty beds for such services as long-term care and rehabilitation.
In summary, shortened hospital stays for mothers and their newborns should not be required until appropriate outpatient continuity-of-care programs are in place. Even with aggressive management of the overall length of stay, there must be an ability to make decisions on the basis of the individual patient and diagnosis.
Valerie M. Parisi, M.D., M.P.H.
Bruce A. Meyer, M.D.
Michael A. Maffetone, D.A.
Stony Brook Health Sciences Center, Stony Brook, NY 11794-8091- Citing Articles (4)
Citing Articles
1
Andy H. Lee, Kui Wang, Kelvin K. W. Yau, Geoffrey J. McLachlan, Shu Kay Ng. (2007) Maternity Length of Stay Modelling by Gamma Mixture Regression with Random Effects. Biometrical Journal 49:5, 750-764
CrossRef2
K. Wang, Kelvin K. W. Yau, Andy H. Lee. (2002) A hierarchical Poisson mixture regression model to analyse maternity length of hospital stay. Statistics in Medicine 21:23, 3639-3654
CrossRef3
Stephanie Brown, Judith Lumley. (1997) Reasons To Stay, Reasons To Go: Results of an Australian Population-Based Survey. Birth 24:3, 148-158
CrossRef4
Stephanie Brown, Judith Lumley. (1997) Reasons To Stay, Reasons To Go: Results of an Australian Population-Based Survey. Birth 24:3, 148
CrossRef
