safety of early release? - Mothering Forums

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#1 of 13 Old 12-21-2005, 11:36 PM - Thread Starter
 
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Ok, I know homebirth mama's don't even have to worry about this, and I know that insurance companies have been mandated to pay for at least 24-48 hours after a birth, and I know that doctors and nurses tell you it's mostly for the baby to be observed, blah, blah, blah....so why does an 8-12 hour stay after birth at a birth center scare me? Is there really so much that can go wrong in the first 24 hours? And as someone said on another thread...midwives and peds don't come sit at your house for 24 hours after a home birth. Are there things I should learn to watch for in my new baby after we are discharged from the birth center since we won't be under the care of a hospital? Not that it makes much difference...I always had full rooming in during my previous hospital births so if anyone was going to notice anything it still would have been me.

My first three children will get to sleep at Grandma's house the first night we come home so I can have at least one night of semi-peace and recovery. So why is there such a big deal made about babies leaving hospitals before 24 hours, but no one says anything about short birth center stays or homebirths where there is no medical watchdog for more than just a few hours? I know birth itself is just as safe, if not safer, for birth center and home births...but what about after?

This is my first out of hospital birth, and while I am very exicted about the options it opens up for me during the birth, I'm just now starting to focus on the issue surrounding the short stay. My midwife did tell me that she doesn't have any particular time limit, she never boots anyone out before they are truly ready, she has had to encourage some mom's to stay a tad bit longer...but she takes each birth case by case, and has the mom stay for whatever time she needs. She said that on average it's about 8 hours.

Is there a medical risk to not being somewhere that the baby and I can be medically "watched" for a particular amount of time? Like I said, I know with homebirth there isn't anything...and moms and babies do fine. So is the hype about 24 hours in the hospital needed in order to watch the baby just hype?
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#2 of 13 Old 12-22-2005, 12:19 AM
 
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My birth center's average stay post partum is 6 hours (I'm the one who started the other thread about leaving the hospital AMA instead of staying 24 or more hours, which I think is ABSURD if the baby and you are healthy!). I actually stayed about 10 hours after my births.

Your midwife will tell you exactly what things you need to keep an eye on - how many wet diapers the baby is having, how often/how well the baby is nursing, maybe checking the baby's (and your) temperature, how to feel your uterus to make sure it is contracting down well, how to monitor much you are bleeding, etc. My birth center sends a nurse out the following day for a follow up, and I bet yours does something similar.

I believe if you and the baby are both doing well within the few hours immediately after birth and you are educated on what to watch out for, it is perfectly safe to be home. Safer than being in a germy hospital being interrupted constantly by nursing staff, actually.
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#3 of 13 Old 12-22-2005, 12:50 AM
 
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Originally Posted by danav
Safer than being in a germy hospital being interrupted constantly by nursing staff, actually.
Dana and squeakyneedle,

Same here even though I haven't been though this, but seening this every I volunteer in maternity at the local hospital by me. Rembering hearing accounts from aunt, maybe some other women that I know or my sister or my mom or dad, don't rember exactly. As I look back on those comments, I totally see why you or any postpartum mom should be in the hospital for a short time postpartum then what they recommed. Other stuff, which I'm not getting into.

Thank you.
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#4 of 13 Old 12-22-2005, 07:53 AM
 
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I think that ultimately it comes down to taking on this responsibility for your self. Sure you are probably going to count wet diapers and watch temps closer if you go home after 8 hours then after 38 hours, but no matter what this baby is really your responsibility. Not the nurse who has 4 other mom/baby pairs to watch and is fighting with her teenage son, not the doctor who is going to be in and out of your room in 8 minutes while checking on his other patients and preparing for his day ahead, just YOU. But my children also rarely go to the doctor, they have both been once in thier lives for illness and a couple of times each for stiches and x-rays, I consider thier health (and mine) my responsibility.

Your midwife will give you a list of things to watch and most things are picked up in those first 8 hours. If your baby is struggling to breath you'll probably know by then, they will have less of a chance to pick up germs- they are already getting perfectly tailored antibodies for all the ones at your home. There are some problems that take a little longer to notice, but the most common are rarely emergencies- difficulties breastfeeding or jaundice.

I also think one reason babies are supposed to stay that long is so that they are "stable" before having a circ.
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#5 of 13 Old 12-22-2005, 11:04 AM
 
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the birth centers I work at have an average stay of about 4 hours. Many wish to leave within 2 hours. As long as everyone is doing well, we don't have a problem with this.

When you are discharged from the hospital, the staff will not follow up with you. They are not available for middle night phone calls, and they will not visit you 24 hours postpartum. They need to remove the cord clamp after 24 hours, have the baby re-examined, evaluate your bleeding, etc. etc. They need to have a longer observation period to cover their butts. They used to keep mamas for 5 days to a week post partum (after normal vaginal birth! C-sections had a longer stay), but insurances didn't like paying for that length of hospital stay, hospitals liked getting paid for keeping healthy women and babies, and hospitals had to fight hard for the 24-48 hour stay they can get reimbursed for.

Midwives will usually give you instructions before you leave, about taking temps, how often you should be nursing the baby, how many dirty dipes, how many times baby pees, how many pads you should be using every 4 hours, and on and on. We have a printed sheet we give all mamas before leaving, because most aren't really paying attention to us after the birth, they're paying attention to their new baby. And, someone will be at your house by the next day, to remove the clamp, examine you and baby, repeat the PP instructions, make your next visit appointment. Plus, she will be available by phone for you 24/7, in case you are concerned about something. Follow up care makes out of hospital birth much safer for the postpartum period.
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#6 of 13 Old 12-22-2005, 06:28 PM
 
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As I suspect you already know, YES, the whole "24-48 hours" thing is HYPE..they have you stay that long because they get paid for it, period.

As to why the thought is bothering you....perhaps because you have been brainwashed to believe that birth and the newborn period are **DANGEROUS** your entire life? Don't feel bad, most of us have.......Perhaps some introspection into what it is you are truly afraid of will help you..??...
Obviously, there are NO real concerns about "going home" early......As you reference, homebirthing women are home the whole time and they are fine...(and tend to have exceptionally high health outcomes)

Also, the points brought up by PP's are GREAT!!

There is no reason for a woman to give birth in a hospital or remain in one for any length of time afterward, with the exception of the maybe 5% of births that would benefit from intervention.

CPST
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#7 of 13 Old 12-22-2005, 09:19 PM
 
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I left the hospital with my 3rd child after only 5 hours. I hate hospitals, and I live only 5 minutes from one, so if I noticed something wrong I could be there as fast a nurse would come and see me in my room if I was there.
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#8 of 13 Old 12-29-2005, 01:07 PM
 
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If you want to leave earlier, just do it. In Germany they have soemthing called an ambulant birth which means you go, deliver and leave after 4 hours. But then you also get a midwife to visit youd aily for 10 days. Maybe you can organize this for yourself in the U.S.,too.
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#9 of 13 Old 12-29-2005, 02:10 PM
 
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I think we had to stay 24 hours b/c the nursing staff couldn't get their acts together to do all of the tests in a timely manner. Hearing, PKU, etc. We were fine and I would have felt just fine being home earlier, really as soon as I could comfortably walk. We were living in a bad situation at home, though so it was kind of nice to be in the hospital as our nursing staff was really good and I was pampered a lot. But for our next babe, we're planning a homebirth b/c our living situation is so much better.

I think you're just buying into the cultural concern that birth and newborn period are dangerous. Let it go.

Keep your midwife on tap for questions and concerns, the phone is your friend.
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#10 of 13 Old 12-29-2005, 04:20 PM
 
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I was out of hospital in 4 hours with dd. It would have been less but dh had to go and pick the boys up as they had ended up staying overnight at a friends when I was transferred.

Dd was not checked over by a paed, no blood tests were done, they just wanted to see that she had fed and that I had peed. We had to promise to take her to our family doctor for newborn checks (hips etc) within 3 days but that was no problem.

What is different here in the UK though is that regardless of where your child is born you have a midwife visit you at home for ten days after the birth. It may not be the same one everyday but will be one of the local team who you will have met during pregnancy. This service is invaluable if you have questions in the early days especially with a first born. This time round it was more like a social visit each day as I had no worries or concerns but it was nice to see them and they took my bloods instead of having to go to the clinic everyday to monitor my clotting levels.

Even if you go home quickly then have worries about something, nowadays there is not much that you can't find out on the internet, especially here at MDC
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#11 of 13 Old 12-29-2005, 05:56 PM
 
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Quote:
Originally Posted by orangefoot
What is different here in the UK though is that regardless of where your child is born you have a midwife visit you at home for ten days after the birth. It may not be the same one everyday but will be one of the local team who you will have met during pregnancy. This service is invaluable if you have questions in the early days especially with a first born. This time round it was more like a social visit each day as I had no worries or concerns but it was nice to see them and they took my bloods instead of having to go to the clinic everyday to monitor my clotting levels.

Even if you go home quickly then have worries about something, nowadays there is not much that you can't find out on the internet, especially here at MDC
orangefoot,

WOW didn't know that UK did early release and follow up care. Wish US does this as well, which they don't as of now.

Thank you.
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#12 of 13 Old 12-29-2005, 06:03 PM
 
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checking your clotting levels? was this b/c you hemorhaged or something?
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#13 of 13 Old 12-29-2005, 08:54 PM
 
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was this b/c you hemorhaged or something?
No, I have Protein S Deficiency which can cause clots so previously I have meds after pregnancy but I had a clot 2 years ago so this time I will be on meds during the pregnancy as well.
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