[Nefertari1279]

Sorry if I sounded a bit rough, anything regarding CPS gets my blood boiling. My parents ran a group home for teen girls while I was growing up and let's just say I have an unflattering view of social services.

If there is drug use or abuse involved, then by all means protect that baby, definatly!

[crysobrn]

If we believed the baby were in danger we'd call cps... Personally I've never had a doc that denied an educated woman leaving with her baby prior to the 24 hr mark and returning for a pku at 24-36 hrs. I guess the problem would be if there was a problem with the baby or even mom that she was not willing to address or accept.

Most of the time if we have someone that does want to leave early they have it all arranged with the ob and the pedi.

Our average stay for vag deliveries is now probably 48ish hours considering gbs pos moms (or unknown) stay with babes that long. Most c/s stay 72 hrs but many want to go home sooner and our ob's are not opposed to that as long as they are stable.

[lisamct]

For a UK perspective;
We usually have women having vaginal deliveries in for 2-3 days with women having sections in for 3-4 days although this can extend for both groups if there is a need (breastfeeding issues/parent confidence/social problems) Or it can go the other way and Ive seen post section women up and about after 12 hours and going home after 2 days if they're happy to do so.
However we also offer a 6 hour discharge option to women having vaginal deliveries. It does mean that they need to either return the next day for the paeds to check the baby out or have one of our midwives who are trained in doing the full neonatal check to go out to see them.
Our community midwives so all the other metabolic testing etc at home within the first week so there's no issues with coming back to do that at the hospital

[Elvish]

Originally Posted by lisamct

For a UK perspective;
We usually have women having vaginal deliveries in for 2-3 days with women having sections in for 3-4 days although this can extend for both groups if there is a need (breastfeeding issues/parent confidence/social problems) Or it can go the other way and Ive seen post section women up and about after 12 hours and going home after 2 days if they're happy to do so.
However we also offer a 6 hour discharge option to women having vaginal deliveries. It does mean that they need to either return the next day for the paeds to check the baby out or have one of our midwives who are trained in doing the full neonatal check to go out to see them.
Our community midwives so all the other metabolic testing etc at home within the first week so there's no issues with coming back to do that at the hospital

I SO wish we could convince tptb that this is a worthwhile way to do things.

[CEG]

Originally Posted by lisamct

For a UK perspective;
We usually have women having vaginal deliveries in for 2-3 days with women having sections in for 3-4 days although this can extend for both groups if there is a need (breastfeeding issues/parent confidence/social problems) Or it can go the other way and Ive seen post section women up and about after 12 hours and going home after 2 days if they're happy to do so.
However we also offer a 6 hour discharge option to women having vaginal deliveries. It does mean that they need to either return the next day for the paeds to check the baby out or have one of our midwives who are trained in doing the full neonatal check to go out to see them.
Our community midwives so all the other metabolic testing etc at home within the first week so there's no issues with coming back to do that at the hospital

I would absolutely love to be a community midwife. I really wish we had those here. A friend of mine gave birth here in the US around the same time I did and went back to her home in the UK shortly after. The difference in follow-up was amazing- she had a community midwife at her house for quite a while afterwards checking in and helping her out.

[pirap]

"It's a shame that insurance companies haven't caught on to the fact that homebirths save them thousands of dollars per birth and reduce charges for unnecessary interventions. "

I have nothing against a home birth/birth center delivery..nothing at all, but frankly the above quote from another poster really got me to thinking. Imagine if a home birth goes bad..the midwife loses the heartbeat and the nearest hospital is 15-20 minutes or more away. They take the baby by emergency C-Section and revive the baby but it's brain dead/vegetable and for the next 80 years this person lives. Who is paying for this "savings?"

Yes this could still happen in L&D but the trip to the OR is less than 1 minute away. Risks are everywhere in OB and the liability is a huge burden on a lot of our minds. So I have to agree with another poster that the main reason we don't let our moms/babes leave is LIABILITY.

I'm just throwing the "vegetable" theory out there. I'm not mean hearted or mean spirited..just like to play devils' advocate.

[Elvish]

Originally Posted by pirap

I have nothing against a home birth/birth center delivery..nothing at all, but frankly the above quote from another poster really got me to thinking. Imagine if a home birth goes bad..the midwife loses the heartbeat and the nearest hospital is 15-20 minutes or more away. They take the baby by emergency C-Section and revive the baby but it's brain dead/vegetable and for the next 80 years this person lives. Who is paying for this "savings?"

Except that the evidence out there does not point to this sort of thing happening on any sort of regular basis.

[Jolie]

Originally Posted by Elvish

Except that the evidence out there does not point to this sort of thing happening on any sort of regular basis.

And whether health care providers like it or not, parents have the right to choose the location in which they give birth. Insurers may choose not to pay for out of hospital births, but no one can force a couple to the hospital against their wishes.

I think it is terribly arrogant of the medical community to assume that we know better than the couple what is best for them.

[CEG]

Originally Posted by pirap

"It's a shame that insurance companies haven't caught on to the fact that homebirths save them thousands of dollars per birth and reduce charges for unnecessary interventions. "

I have nothing against a home birth/birth center delivery..nothing at all, but frankly the above quote from another poster really got me to thinking. Imagine if a home birth goes bad..the midwife loses the heartbeat and the nearest hospital is 15-20 minutes or more away. They take the baby by emergency C-Section and revive the baby but it's brain dead/vegetable and for the next 80 years this person lives. Who is paying for this "savings?"

Yes this could still happen in L&D but the trip to the OR is less than 1 minute away. Risks are everywhere in OB and the liability is a huge burden on a lot of our minds. So I have to agree with another poster that the main reason we don't let our moms/babes leave is LIABILITY.

I'm just throwing the "vegetable" theory out there. I'm not mean hearted or mean spirited..just like to play devils' advocate.

This could also happen at the rural hospital I work at, where we do not have 24 hour OB or anesthesia coverage. Not to mention that even in a hospital with 24-hour coverage there are babies born all the time that suffer lifetime effects and require care. In fact, it's safe to say that many of our hospital interventions cause bad outcomes and cost more money, i.e. cord prolapse after AROM, nosocomial infections, increase in c-section rate due to CEFM, etc.

Also, my statement was only that homebirths would save money overall which is still true, even including those few bad outcomes. Even if we only take into account reducing the c-section rate of 33+% to the WHO recommendation of 10-15% that would save millions each year. Not to mention reduced costs for social inductions, unecessary procedures, fetal monitoring, nursery admissions, etc.

I'm not saying that everyone should birth at home. Obviously high-risk patients are not appropriate for home birth. Women should birth where they feel comfortable, it's just a shame that women who desire a homebirth are often unable to have it despite the fact that it is proven to be just as safe (if not safer, mortality vs. morbidity) for a low risk woman and is a more cost-effective choice. Both the UK and Canada's health plans provide homebirth options.

[vlatte7]

as far as i know, one of the reasons that vaginal deliveries and their infants stay in the hospital for 2 days has to do with risk of increased bilirubin. that is the reason that our watchful eyes assess newborns as often as we do. also at my institution they check the infant's bilirubin and do an metabolic screen before discharge. we allow some moms to do an early discharge, but they are experienced moms that know what signs/symptoms to look for and some of them go to their pediatrician the next day for the bilirubin check. all moms are not that proactive, so staying at the hospital for an additional night is for their newborn's safety. also before doing a metabolic screen the infant needs at least 24 hours of good feedings for the test to be useful.