Length of stay for c-sections?

  1. I had a very frustrating experience today and could use some input!

    Where I work, the average stay for a c-section is 3 days (day of, day 1, day 2, day 3). However, it isn't uncommon for a pt to stay for the 4th day (about 25% do). Like I said, this is fairly common. I have been led to believe by my charge nurses that this 96 hour policy is mandated by some sort of law, and that if for some reason this isn't accepted by an insurance company, our hospital will write this day off as a "perk" for the pt. My coworkers & I have been doing this for the 2 years I've worked there, and it was happening long before I started there.

    Fast forward to today! I had a 3 day c-section whose baby is in NICU, and she desired to stay until tomorrow. When I mentioned this to her doc, he claimed to know absolutely nothing about this 4 day thing, and absolutely REFUSED to let her stay. I first mentioned this to my coworkers, who got nowhere with him. Then I took it to my clinical managers, who squirmed their way around the issue and refused to give me a concrete answer. I then took it to utilization review, who informed me that her insurance COULD NOT refuse to pay for the 4th day. When I told this to the doc, he went on & on about money, the bottom line, and how it would be beneficial to get the pt out (& make room for another I assume $ $ $ ).

    Ultimately, he cancelled the d/c, but was visibly upset with me. This upsets me as it is a doc I usually have a good relationship with. But it comes down to this, I'll lose less sleep having the doc pissed at me that I would have if I woud have sent the pt home upset with me. I was outraged that I was ridiculed so much for being my patient's advocate, by both the doc & my coworkers, and was told to just "let it go". I'm also frustrated that even my supervisors couldn't back me up on it, or at least give me a clear answer. I find it hard to believe that we've been doing it this long if it's against anyone's standards.

    Anyone's input on this situation and their own unit practices would be greatly appreciated! I'm so sorry that this is so long!

    Thanks, Heather

    BTW, the pt, a nurse herself, hugged me and thanked me for going to such great lengths for her!
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  2. 15 Comments

  3. by   timonrn
    Our policy is go home on 4th day post-op but most do go home on the third or even the second--this might be standard here in MN. The insurances tried the kick 'em out in 48 for vag. or 72 hrs for c/b but did not fly here...
  4. by   fiestynurse
    Newborns' and Mothers'
    Health Protection Act

    How long does your health insurance provider need to cover you for a stay in the hospital after the birth of your child? Some facts about the Newborns' and Mothers' Health Protection law:

    The Act:
    On September 26, 1996, President Clinton signed into law the Newborns’ and Mothers’ Health Protection Act of 1996 (the Newborns’ Act) puts the decisions affecting length of hospital stays following childbirth in the hands of mothers and the attending providers. This law was effective for group health plans for plan years beginning on or after January 1, 1998.

    A Revision:
    On October 27, 1998, the Department of Labor, in conjunction with the Departments of the Treasury and Health and Human Services published interim regulations clarifying issues arising under the Newborns’ Act. The changes made by the regulations are effective for group health plans for plan years beginning on or after January 1, 1999.
    The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mothers’ or newborns’ benefits for a hospital length of stay that is in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who is a person such as the mother’s physician or nurse midwife) may, in consultation with the mother, discharge earlier.

    The Newborns’ Act, and the new regulations, prohibit incentives in any way (positively or negatively) that could encourage less than the minimum protections under the Act as described above.

    More on coverage:
    The type of coverage and the state law will determine whether the Newborns Act applies to a mother’s or newborn’s coverage. For coverage that is self-insured, the Newborns’ Act provisions always apply.
    Many states have passed laws containing protections similar to the Newborns Act. Thus, in cases where health benefits are provided through insurance the state laws would apply.

    Notification:
    The Department of Labor issued an interim rule on April 8, 1997, that required ERISA group health plans that provide maternity or newborn infant coverage to distribute a notice regarding the Newborns’ Act rules on length of hospital stays following childbirth. Under the interim rule, group health plans were required to include the Newborns’ Act notice in a summary of material modifications (SMM) or updated SPD not later than 60 days after the first day of the first plan year beginning on or after January 1, 1998.
    On September 9, 1998, the Department amended the interim rule to clarify that the notice must explain that the mother’s or newborn’s attending provider, after consulting with the mother, can authorize a shorter stay than the 48 or 96 hour periods described in the Newborns’ Act. Administrators of group health plans must include this improved disclosure notice in the first SMM or updated SPD that is required to be furnished following the November 9, 1998 effective date of the amendment.

    For more information:
    Family and Medical Leave Act
    U.S. Department of Labor
    The Pregnancy Discrimination Act






  5. by   OBNURSEHEATHER
    Thanks Feisty and Kday for all the info. I did some searching around last night and did find the section of the Ohio Revised Code that calls for this. I've made copies of it, along with the Newborns & Mothers Health Protection Act, as I'm sure this is an issue I'll be defending at a later date with my supervisor.

    I've never had a problem like this with any other doc before. We've even had patients with perfectly healthy newborns want the extra day, and they've always gotten it. I'm not sure what this doc's problem was.

    Thanks you guys so much! It's just a shame I had to leave work to find some nurses with a backbone!

    Thanks again!
    Heather
  6. by   woopcrane
    Congratulations on your patient advocacy!

    I doubt you'll have problems with the physician, he was probably frustrated about other things, but have a copy of the act mentioned above if the subject comes up again.


    Your next step is to ensure your colleges understand the law.

    Post a permanent copy of the act on your unit, and give a copy to your supervisor. Consider doing an inservice or a (gosh) grand round. Next time you will have better support from your colleges
  7. by   Aussienurse2
    I have had four c-sections, not by my choice, god made some mistakes. All with a spinal and the only time I stayed for more than two days was because I ended up with a spinal headache ( the guy tried seven times to get the spinal into the actual spine!!!) and then had a blood tap and when home day five. But all by my choice, if you are well and want to go home well and good, but to have to cow-tow to someone who has never been scared and sore and in that position is a disgrace. If doctors have to be Oby's then they should have to give birth!!
  8. by   SmilingBluEyes
    Heather dear...

    ****YOU DID NOT HAVE TO LEAVE WORK TO FIND BACKBONE... NEXT TIME YOU ARE AT WORK, JUST LOOK IN THE MIRROR LOVEY! AHHH THERE, NOW YOU SEE IT, BACKBONE! ****

    I admire you for this standing up for the right thing. Seems folks like you are dying breed...Most of them are here at allnurses.com. Too bad. Anyhow, You are MY kinda nurse, hon! ROCK ON!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  9. by   HardDaysNight
    Great way to stand up for your patient! If you won't, who will, eh? And I agree with blueyes that people like us ARE a dying breed. Keep up the good work!
  10. by   OBNURSEHEATHER
    Thanks for all of your support and words of encouragement guys!

    It's been awhile since this all happened. My relationship with the doc in this scenario has returned to normal, maybe even a little better. He doesn't throw his little temper tantrums with me anymore, or like he still does with some of the other nurses. I've even gotten him to bend a little a few more times on the 4 day thing.

    I knew, the minute he gave in and let the original woman stay, that he was just testing me. I don't know if I passed or not, but my patients get what they're entitled to, and that's all that matters.

    Thanks again!
    Heather
  11. by   Mkue
    Wow Heather way to go !!

    I must be a wimp..lol. stayed 5 days for my c-sections


    Keep up the good work !!


    marie rn2b
  12. by   Jolie
    Dear Heather,

    Thank you for researching this issue and standing up for your patient!

    I just want everyone to be aware that even though this is a federal law, it does not apply to everyone. Many companies which self-insure are exempt from federal health insurance regulations on issues such as length-of-stay and infant immunization coverage. We really have to encourage our patients to read up on their policies and know what coverage they have.

    That said, good for you-you did the right thing for that mom and baby!
  13. by   OBNURSEHEATHER
    Thanks for the added info Jolie! This is something I didn't know. So I'll be safe if the ins. co. is one of the big hmo conglomerates (sp?), but I'll encourage others to research this themselves.

    Or maybe this is where the hospital picking up the day as a perk comes in? I'll have to check into this further. (again )

    Anyways, thanks again!

    Heather
  14. by   sandstormsdust
    This has no real relivence to the topic but I thought it would be if interest here.

    Long before I had my son I told my doctor "5 days in Hospital" - she said yes.... (later was induced w/ spinal tap)

    My sister stayed 7 days with c-section (no complications)

    My other sister stayed 6 days by choice - w/ two babys... no complications.

    Any friends I know stayed 48 hrs (hospital policy) to a week ... after delivery.

    This is Ontario... and it may be different in other areas... but usually it is a choice between the doctor and patient. Hospital want's reason if pt stays after a week.... but will do it under deferring circumstances - or when prescribed

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