Women and Maternity Experiences in Managed Care

Protection for Mother and Baby
The amount of time that a mother and newborn are allowed to stay in the hospital after delivery has become the subject of a heated debate. Managed care organizations have been pushing for shorter and shorter lengths of stay. Many mothers feel that they are not being allowed the medical care that they and their baby require. The federal Newborns' and Mothers' Protection Act of September 1996 requires insurance companies to cover a postpartum length of stay of up to 48 hours. There is little evidence to support either the critics or supporters of this debate, although a recent study may begin to help clear up this issue.

The Evidence
The study consisted of a survey of female enrollees of a large managed care organization who had recently had a normal vaginal delivery. The survey examined the relationship between length of hospital stay and a variety of maternal socio-economic factors, pregnancy factors, the mother's preference for length of stay, and the mother's post-discharge experience. The authors of the study acknowledged that the ideal content and timing of pre-natal and postpartum healthcare for women is not yet understood.

The survey included 5,201 respondents, of which 60% were discharged from the hospital within 24 hours of giving birth. Women who experienced complications (such as diabetes or hypertension), longer labor (more than 9 hours), or a pre-term or low birth-weight infant, were allowed longer lengths of stay. Of the women surveyed, over 56% thought that they should have been allowed a longer hospital stay due to the need for more rest, not feeling well, the need for more information on caring for their baby, the need for information on self care, and inadequate support at home.

99% of the babies were screened for PKU either during their initial hospital stay or after they were discharged. The length of stay was not significantly associated with readmissions, as only 1.6% of the mothers and 4% of the newborns were readmitted to the hospital. Surprisingly, the women who were discharged after only 24 hours were consistently less likely to be readmitted. However, newborns discharged within 24 hours were slightly more likely to be readmitted than those discharged after 48 hours. It is quite possible that mothers and newborns require different periods of time to recuperate after delivery. How hospitals and managed care organizations choose to deal with this information remains to be seen.

Information for this article was obtained from the National Association of Professionals in Women's Health.

REFERENCES
a listing of scientific articles and texts used.