Midwife says that it is mandatory for me to stay in the hospital for at least 24 hrs for testing...

[FreeRangeChicks]

We are pregnant with our 3rd baby.  DS1 was born in the hospital and DS2 was a home water birth.  We chose to see a midwife that works at the hospital because we can not find a homebirth midwife that takes our insurance.  I have easy pregnancies and very easy/quick labor/births. 

My concern is that I had previously thought that we can have the baby in the birth center (in the hospital) and stay for a few hours then return to our home.  But today the midwife told us that it is mandatory that once the baby is born we will have to stay in the hospital for at least 24 hours after so they can do the newborn screening.  And she also said that they 'have to' either to the Vit. K injection or eye drop- which we do not want. 

Any advice??  My husband just wants to avoid any problems at the hospital and just have another homebirth.  But if we *need* the hospital I want to know my options beforehand. 

[Katherine73]

If I were you I would find out the laws in your state.

In CA, it's mandatory that our baby be tested for certain metabolic diseases, but it can be done in the hospital or later in the doctor's office. Vitamin K and eyedrops are optional and we can decline.

If it's not the law then I would let the midwife know what you have found out.

[fruitfulmomma]

I am not sure why she would say either vit. k or eye goop, they are for two totally different things and are both done unless parents refuse. Even in a state where they are mandatory you should have the option of signing a refusal waiver. Whether they make an issue of it is going to depend on the staff, no way to really know until you are there.

Does she not do pku herself? My midwife did and we just continued our post care with her after our 2 unplanned hospital births. I don't think the hospital staff really cared one way or the other, except with the second they tried to hold us longer because they lost my gbs results.

So if the 24 hour period is mandatory you would be checking yourself and the baby out ama if you leave early. The problem there would be baby,not you because you could up with a hcp who decides to call cps.

Personally when I transfered I was too tired to think about packing up and driving 20 minutes home so the 24 hour thing was not an issue.

[JudiAU]

Yes, in CA the genetic testing is mandatory and the state pays for it. It is mandatory that care providers offer Vitamin K and eye goop but you can decline.

In a hospital setting, they are going to do a variety of different screening, many required by state law and probably can't coordinate it in less than 24 hours. For  instance, hearing screen, newborn exam, etc.

[finnegansmom]

I've birthed in 2 different states (with midwives) and both times left the hospital within 8-10 hours.  In both instances we declined the Vit K and eye goop, circumcision, vax, etc etc.  We did opt to have the ped check out the baby and do the hearing test.  Since I tend to give birth in the middle of the night (3am and 4am), we had to stay until the ped came in (8am-9am) and then left by lunch ish. 

We did have to agree both time to take the baby to our family ped  48 hours later for the PKU.

I actually thought the PKU wasn't supposed to be taken same day?  That the results are better if you wait a few days (actually if you wait until the milk comes in?)  Or am I making things up?

And FWIW, we did call our ped both times right away to schedule the appt 2 days later, in case the hospital wanted to call to confirm.

We would have loved a homebirth but paying OOP for it was just not in our budget.  I had really great experiences with natural births in the hospital though, and am planning another one this fall.

[rnra]

Call the hospital directly, ask to speak to either the charge nurse or the nurse manager for the birth center, and ask them your questions.  In my experience, the CNMs/OBs aren't always the most up to date with actual hospital policies and it is better to ask the hospital yourself.  In the hospital system I am familiar with, there is no mandatory time for patients to stay after giving birth.  While most stay 24-36 hours, some choose to leave 8-12 hours after birth and that has never been an issue.  Call the hospital to find out the hospital policies, rather than relying on the info from your midwife.

[cristeen]

Originally Posted by Katherine73 

If I were you I would find out the laws in your state.

In CA, it's mandatory that our baby be tested for certain metabolic diseases, but it can be done in the hospital or later in the doctor's office. Vitamin K and eyedrops are optional and we can decline.

If it's not the law then I would let the midwife know what you have found out.

Even in CA, the PKU can be declined.  DS didn't have it, and my MW this time indicated it wasn't a problem to waive it.  Regardless of the law though, it shouldn't be done within the first 24 hours post-partum.  I'd clarify with your MW WHY you "have to" stay 24 hours, and then double check the info with the state and the hospital both. 

[eleuthia]

Some insurance companies will offer 1-2 home visits by a nurse if mom & baby are discharged early. The PKU can be done at the first visit (it just needs to be scheduled in the right time frame) along with other screenings. Even if this isn't something your insurance offers, I'd find out if it is an option in your state/with your hospital. My freestanding birth center does this as standard practice, since they discharge w/in 12 hours, and I'm sort of surprised this isn't something offered by your hospital-based midwives, unless it really does conflict with state law (or with the wishes of their supervising docs). 

[FreeRangeChicks]

Thanks for all of the great info!  We are in CT and have quite a bit of research to do!!!  My husband doesn't have a good feeling about going to the hospital.  (and I don't either)  We are going to continue our search for a homebirth midwife that takes our insurance and in the mean time continue with the midwife at the hospital.  (she knows that we want a homebirth and she has had all of her babies at home so she understands) We are going to plan on staying home for the birth (just in case) and make sure that we are informed on all of the 'hospital policies' if we have to have a hospital birth. 

(((Hugs))) to all! 

[MamaJenese]

Which hospital? 

[cryswilkins]

I didn't read all the replies :)

We had DS in a Birthing Center that was attached to the hospital.  We were only "required" to stay four hours.  They gave us the lab orders and the card for the PKU testing and we just had to go to any lab within 24 hours to get it drawn.  As for vitamin K and the eye ointment we just denied it when it was offered.  I can't think of a single state that "requires" it.  If you don't want it then they can't make you do it.  

[clovergirl]

I'm in CT and that's not mandatory state law (a 24hr stay), as far as I know.  Maybe she means the hospital can't *make* you leave before 24hrs?  Hospital policies are just that, hospital policies, not actual law.  You can always decline the stay and sign yourself out AMA if all is well.  Additionally in CT, you can absolutely decline, well, pretty much everything (eye drops, vitamin K, hep B shot, hearing test, etc). 

The insurance thing with homebirth midwives in CT is a drag for sure... do you know about Birth&Beyond though?  They are a CNM practice that attends homebirths and accept most insurance.  They travel pretty much anywhere in CT as far as I know.

Good luck with everything! 

[sassyfirechick]

I gave birth in CT in a hospital with a midwife.  We declined vit K, eye goo, Hep B and delayed the PKU until right before we were discharged.  The hearing test isn't at all invasive, I was nursing when they came in to do it and I said I wanted to continue doing so during the test and there was no issue.  A friend of mine used to work on the post-partum side and I learned afterwards that I could have asked for fewer checks (which was the most annoying part of being in the hospital, having someone check my rear-end ever hour!!)  I don't think there are any laws regarding length of stay, but they certainly aren't going to tell you that.  Part of that comes from what your insurance is willing to pay, and since the hospitals want money, they don't want to discharge early.  There are waivers for everything.

I am curious about this Birth and Beyond....I wanted a homebirth but DH was not into it :-P  After seeing how messy things were at the hospital I would only do a homebirth if someone was going to clean up after though!