Length of stay for c-sections?

[OBNURSEHEATHER]

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!

[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

[mother/babyRN, RN]

Way to go Heather...Maybe the doc has some deal with the insurance company of a kickback nature. I have had 3 c/s and in my opinion, a primip needs 4 days to be educated and multips just need some time for recuperation before going home.....Good for you! This must be a male doc...Obviously not someone who actually knows what they are talking about. Ok, probably he does, but doesn't seem like a real advocate for women or families for that matter. Actually, in the long run, you might be surprised to find that you are supported for your decision to be an advocate and stand up to the powers that be. A measure of respect as it were.....

[Debbielynn]

Heather, I had my son 19 years ago by c-section. I went in on a Monday around noon and left the hospital on Sunday. I don't know if this had anything to do with the fact they screwed up on my son (no one knew anything then) and he is now mentally retarded, but that is a whole nother Oprah show discussion. I say pat your self on your back. You did good gurl.

[obtnt]

I had 3 c/s; one in 86, 89, 92. I "lost" a days stay with each one, as the "rules" changed. My first child spent 7 wks in NICU on a vent, the 2nd stayed 2 days and the third one actually came to recovery with me and went home on time!!! I too am appalled that we are dumped out for the sole purpose of "saving money" and I know for a fact that doctors wives stay until they are READY and that is usually not related to their condition or their child's! It won't stop until there is a string of deaths related to this. We now send pts home 36 hrs after a c/s unless there is VERY SERIOUS complication with the MOTHER NOT THE BABY! Only when men have babies will things change. We have to continue to be pt advocates in the mean time no matter what that means to our personal relationships with drs. They take care of their own, we take care of the others!!!!