Policy on leaving AMA w/baby?

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Hey all, just wondering - what does your hospital do (if you've ever had this occurence) if you have a patient that wants to leave AMA (on delivery day) and wants to take baby. Does the ped allow the mom to sign baby out AMA or does social work or someone else get involved?

On the same note, how long to your patients stay for routine vag deliveries and routine C-section deliveries? It's always interesting to see the differences from place to place.

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!).

Midwife fees? Ambulance charges if things go haywire? I've even heard of physicians who attended home births, although not for a long time since, among other things, you can't get if you do that.

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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!).

I am planning a homebirth with my current pregnancy. I need to pay for my prenatal care with my midwife, I had a pap smear, standard blood tests, an ultrasound next week, my midwife will be on call for me 24 hours a day 7 days a week and then stay at my home with me while I am in labor and until I am stable postpartum, then I will go back for a check-up in 6 weeks. Homebirth does not = unattended birth. As an L & D nurse I know I do not want to be subject to hospital protocols, continuous fetal monitoring, and all the other non evidence-based practices out there. I have pre-registered with my closest hospital in case of an emergency which my insurance company would also have to pay for.

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 am lucky that my insurance pays for hombirth but not everyone is that lucky.

ETA: there are several physicians also attending homebirths in my area, same info applies:)

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"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!?"

Were those normal healthy babies or one's with serious health concerns? That makes all the differance.

As long as Mom and Babe are stable and everything is good, early release shouldn't be such an issue. (Holding the threat of CPS over the parents heads, just to get them to stay doesn't seem right to me)

If the baby's health is in question , then I could understand getting CPS involved, but otherwise its overkill.

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Pirap:

Many women don't have any other option but to deliver in the hosiptal.

Just bacuase a woman wants to leave early, doesn't mean she has something to hide . . . . maybe they just want to be in the comfort of home.

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Specializes in OBGYN, Neonatal.
I am planning a homebirth with my current pregnancy. I need to pay for my prenatal care with my midwife, I had a pap smear, standard blood tests, an ultrasound next week, my midwife will be on call for me 24 hours a day 7 days a week and then stay at my home with me while I am in labor and until I am stable postpartum, then I will go back for a check-up in 6 weeks. Homebirth does not = unattended birth. As an L & D nurse I know I do not want to be subject to hospital protocols, continuous fetal monitoring, and all the other non evidence-based practices out there. I have pre-registered with my closest hospital in case of an emergency which my insurance company would also have to pay for.

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 am lucky that my insurance pays for hombirth but not everyone is that lucky.

ETA: there are several physicians also attending homebirths in my area, same info applies:)

Very cool information, thank you for sharing with me. I really and truly was wondering what the process was all about. I guess I was thinking like way back old days LOL when moms had babies on the farm or something! Like was said above, I was thinking unattended and home were the same things. Thanks for the information!

So say you have prenatal visits covered by your insurance all along and you have a midwife that cares for you, do you tell them from the start its a home birth and then the insurance decides whether or not to cover or is it pretty standard that insurances won't cover it so you have to do it at a hospital or pay out of pocket for the home birth that you want?

It's a very interesting topic and I can definately see how it would be cheaper for insurance co's.

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Specializes in OBGYN, Neonatal.

I think (not sure here) but think that maybe the reason why our docs and peds are so wary against sending moms/babies home is the fear of legal ramifications. I mean with mom she signs out AMA but I'm thinking maybe the peds are afraid something could happen to baby and mom would sue them for letting them go home early, I don't know but it seems legal fears are behind so much these days.

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Specializes in Pediatrics.
"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!?"

Were those normal healthy babies or one's with serious health concerns? That makes all the differance.

As long as Mom and Babe are stable and everything is good, early release shouldn't be such an issue. (Holding the threat of CPS over the parents heads, just to get them to stay doesn't seem right to me)

If the baby's health is in question , then I could understand getting CPS involved, but otherwise its overkill.

In my post I stated, "If there IS an issue," Meaning the health of the baby or safety of the baby was a concern. If the child/mom was healthy (as in the case of the OP), an AMA or d/c is OK, and obviously using CPS as a threat would be a terrible thing to do. In the hospital where I take call, I can't recall a time when the parent wanted to leave prior to the first 24 hours, but I have only been doing this for 5 years, so there is time for a first.

In the cases where I have had to call CPS, it has been due to a mother's + drug screen or the other children being in the care of CPS to begin with and the parents are trying to leave AMA thinking the child won't be taken away. In a couple other instances it has been due to the child's health (like fever at birth and a sepsis work-up in in the works.)

Thank you for pointing out that I needed more clarification to my origional post

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Very cool information, thank you for sharing with me. I really and truly was wondering what the process was all about. I guess I was thinking like way back old days LOL when moms had babies on the farm or something! Like was said above, I was thinking unattended and home were the same things. Thanks for the information!

So say you have prenatal visits covered by your insurance all along and you have a midwife that cares for you, do you tell them from the start its a home birth and then the insurance decides whether or not to cover or is it pretty standard that insurances won't cover it so you have to do it at a hospital or pay out of pocket for the home birth that you want?

It's a very interesting topic and I can definately see how it would be cheaper for insurance co's.

My insurance company as a policy covers homebirths, so I just had to make sure I saw an in-network provider so my out-of-pocket expenses would be lower. Some insurance companies do not have a specific policy not covering homebirth but do not have any in-network providers so women apply for an exception and have their homebirths covered. Still other companies have a policy of not covering homebirth so those women are out of luck. I think it is relatively rare for an insurance company to be as easy to deal with as mine.

I think ACOG perpetuates a lot of these difficulties with their policy statement against homebirth... which is not evidence based and has more to do with $$$$ than anything else. The other birth organizations (ACNM, RCOG, CSOG (Candian- is that the right name?) and of course NARM and MANA, endorse homebirth as a safe option in the low risk patient. And of course ACOG endorses birth center birth but not homebirth which is a little crazy, IMO.

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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!

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Specializes in OB L&D Mother/Baby.

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.

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Specializes in learning disabilities/midwifery.

For a UK perspective;

We usually have women having lady partsl 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 lady partsl 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

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Specializes in Community, OB, Nursery.
For a UK perspective;

We usually have women having lady partsl 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 lady partsl 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.

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