Policy on leaving AMA w/baby?

Jolie, BSN · Apr 18, 2008

My only experience with an OB patient leaving AMA with her newborn was my co-worker (an experienced NICU nurse) who left the hospital (not where we worked) because they refused to allow her to do 24 hour rooming in. (This was about 15 years ago, before the practice was commonplace.)

She caused quite a stir, but there was no reason to stand in the way of her leaving with the baby. Both were perfectly healthy, had been observed for a few hours post delivery, and she was knowledgable about her own and the baby's care needs.

There is no requirement that parents give birth in a hospital, or even have an attendant at home, so it seems logical to me that there would be no attempt to stop a couple who wants to leave the hospital early with their child, unless there is reason to be concerned for the baby's health. In that case, I would contact social services, and let them make the decision about how to proceed. Ultimately, without a court order, we can't hold a patient or newborn against their will.

Here in the midwest, most lady partsl deliveries stay 24-48 hours, and C-sections 3-4 days.

scribblerpnp · Apr 18, 2008

If there IS an issue, and the doctor (pediatrician or whom ever is the primary for the baby) believed the infant (or child) was in danger, CPS can be notified, in which case the infant would stay reguardless of what the parent wishes.

Really, the only cases in which I have seen it happen are when the parent is scared about CPS to begin with and is trying to leave before the state can take the baby. If it is a healthy baby and knowledgeable parent (as in the above situation) sometimes an AMA is allowed.

I the FEW cases I have been involved in, once the parent is aware that CPS will be notified if they try to take the child, they usually don't mind staying that extra night!

Oops! 24-28 hours for lady partsl and 3 days for c-section. Our hospitals do allow room ins.

cherokeesummer · Apr 18, 2008

Our's is generally 48 hours for lady partsl and 3-4 days for c-section, occasionally vag moms will ask for 24 hour discharge and c/s moms will ask for 3 day discharge and generally no issue. I've never seen a baby leave under 24 hours of age though.

CEG · Apr 18, 2008

There was a case recently in the news. I believe it was in Atlanta and a father attempting to leave with the baby was tasered by the security guard while he was holding the baby. It created quite a media stir and I was hoping it would be addressed from the parental rights standpoint but I never saw anything come out of any of the organizations. There was some dysfunctional background to the family that I don't remember, however obviously tasering a man holding a baby was a poor choice.

My POV is you are the parent, that is your child, you are free to leave whenever you want. I haven't dealt with this personally yet but I will probably do whatever is in my power to help them. I mean, what do we think is going to happen in 24 hours that they are staying in the hospital? Is their home life magically going to improve? They are going to win the lottery? Dad is going to have an epiphany and stop being abusive? Mom will decide her cocaine habit is too much trouble?

If there was a serious health problem with the baby I could see trying to talk them into staying.... or helping them set up follow up care. After all the hospital's providers may not be their choice. And it is so frequent that things are performed without consent in hospitals that as a parent I would much prefer my child be treated in an outpatient setting with the provider of my choice if possible.

I also believe PCP should take more responsibility for follow-up with their patients. That is an important six week transition and if the OB or midwife followed up frequently with patients, either in the office or on the phone, problems like breastfeeding issues, epis/tear healing issues, etc would be more likely to be detected early. And particularly PPD. Most of the issues mom will face will not occur in the hospital anyway, endometritus, late hemorrhage, etc, so there is not a ton to be done in those 24 hours.

beckinben, CNM · Apr 18, 2008

In my practice, if we have someone who wants to go home less than 24 hours and is medically stable, we will discharge them. What usually keeps people is that the pediatricians will not usually discharge at less than 24 hours due to the metabolic screen done at 24 hours. But I have occasionally gotten an early discharge for baby from them for a patient really dead set on going home early who talks about leaving AMA. Most of us would rather just discharge with early followup than have someone actually leave AMA, and my patients who want to leave early really do come back in for followup. Especially with our military families, they get good early followup (2-3 days after birth for baby, with home breastfeeding nurse visits) through the base in town.

pirap · Apr 18, 2008

If the mom is so dead-set against leaving ASAP then why in the world did she birth in a hospital anyway? Medical intervention OK to bring your baby into the world but then abruptly rescind it? I would think mom knew the "standard" stay by having a good dialog with her OB/GYN and speaking with the pediatrician prior to delivery. Maybe the mom should have had a home birth and arranged a home visit by a pediatrician or family doctor.

Nicky30, BSN, RN · Apr 18, 2008

Unusual that you ask this as it only happened yesterday.

Mother 21 years old had one antenatal care appointment, LSCS for previous delivery, from another town, and really had no idea about her birth choices, i.e. VBAC or repeat elective LSCS. (i.e. she called the hospital stating that that she had SROM and contraction 10 min apart). I told her to come to hospital now (she took her son to the dentist instead):uhoh21:.

Anyway.... (sorry off track), went to LSCS and left the hospital with the baby AMA less than 24 hours later. Doc was furious, but there was no stopping them. Babe was only 2.3kg but it wasn't the babe we were worried about.

Usual stay for normal delivery is 2-3 days, and section is 4-5.

Nicky.

CEG · Apr 19, 2008

If the mom is so dead-set against leaving ASAP then why in the world did she birth in a hospital anyway? Medical intervention OK to bring your baby into the world but then abruptly rescind it? I would think mom knew the "standard" stay by having a good dialog with her OB/GYN and speaking with the pediatrician prior to delivery. Maybe the mom should have had a home birth and arranged a home visit by a pediatrician or family doctor.

Many insurance policies do not cover out of hospital birth so women do not have a choice, other than to pay thousands out of pocket. If the rights/desires/wants of the women were respected in the hospital this wouldn't be an issue.

Jolie, BSN · Apr 19, 2008

Please don't assume that a patient desiring an early DC following delivery is/was resistant to receiving appropriate medical and nursing care.

I worked in one hospital with an associated birth center where we cared for a substantial number of self-pay patients. These were typically very motivated and well-prepared couples who sought out midwife care, but had to be realistic about expenses and their ability to pay for services. The charge for labor was determined by the number of hours of 1:1 care, so they usually labored at home as long as it was safe to do so. After delivery, they had the option of paying a daily rate for mother-baby care, or paying for 23-hour observation. The 23-hour OBS charge was hundreds of dollars less than the daily charge for mother-baby care, so that was the option they chose. Of course, on occasion that meant that we were discharging them home at odd hours, but it was really never a problem. We did the PKU before DC, and repeated it a day or two later, if necessary.

I enjoyed caring for them far more than the entitled patients who expected to be waited on during their 48-hour stays complete with champaigne dinners!

rph3664 · Apr 19, 2008

I know one woman who had her baby early one evening, and first thing in the morning, about 12 hours later asked to be discharged.

The nurses objected, but she said, "I am a physical therapist, my husband is a registered nurse, and we have a 15-year-old son at home" (husband's son by prior marriage of whom he had full custody). She knew all about the screenings, and said she would be happy to come back the next day to have it done. So, she went home at that time.

I know another woman who asked to leave the hospital that same day as well. She had planned to relinquish the baby until she learned that the father had to sign the papers; she knew who he was but he was long gone and she had some very good reasons for wanting to keep it that way. This was in Arizona, about 10 years ago. Her second child, from a subsequent marriage, was an emergency c-section a few weeks before the due date and she knew he wouldn't be coming home with her right away, and she wanted to be discharged the very next morning. Since she was eating and going to the bathroom, they let her do that as well.

From what I have seen from my distant vantage point, the women who do relinquish their babies usually want to leave the hospital as soon as possible. I have heard of women who wanted to leave as soon as the baby was born, not realizing that they weren't finished yet (i.e. placenta). One hospital where I used to work required women to stay for 2 hours after delivering the placenta, and then they could leave if they wished.

cherokeesummer · Apr 19, 2008

Many insurance policies do not cover out of hospital birth so women do not have a choice, other than to pay thousands out of pocket. If the rights/desires/wants of the women were respected in the hospital this wouldn't be an issue.

I've heard this before but I'm unsure on something, feeling really stupid here LOL but...what would they need insurance for? Meaning if they were at home having a baby on their own with no doctors there who would they need insurance to pay? (I know this has to be a stupid question since nobody else has asked it LOL but I figured I'd ask!).