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.

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 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.

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"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.

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Specializes in Community, OB, Nursery.
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.

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Specializes in Maternal - Child Health.
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.

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"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.

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Specializes in maternity.

as far as i know, one of the reasons that lady partsl 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.

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as far as i know, one of the reasons that lady partsl 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.

With both of my babies (here in the States, no less!) I had early discharge (12 to 24 hours after birth) with home follow up visits by an APN - either a NP or a CNM - provided by my insurance company. They did weight checks for the baby, checked my blood pressure, they could also draw bilirubins to send to the lab if needed. They were great with breastfeeding help with my first one. I had the metabolic screening done at the clinic, but really you could do that at home too. Imagine how much less that cost them than an extra night in the hospital, and I was soooooo much happier sleeping in my own bed and eating my own food.

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Specializes in Mother-Baby, Rehab, Hospice, Memory Care.

I have no idea about your other question, sorry!

At my hospital vag deliveries stay 24 hours (give or take) and c-sections stay at least 48 hours. This is the standard in my area. We are "supposed to" have a medical indication if the stay greatly extends those time frames.

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We are very particular about what is considered AMA. If a patient wants to leave early & there is no medical reason for her or the baby to stay then she is just discharged & is not leaving AMA. If there is a medical reason for her to stay & she chooses to leave, she signs out AMA. If the baby has a legitimate reason to stay (medically or otherwise), then social services gets involved.

lady partsl deliveries stay up to 48 hours, cesarean's 3-5 days.

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Specializes in OB:L&D, Nursery and Postpartum.

we rare;y have a problem with mothers wanting to leave before a doctor will discharge them. I think in my 5 years I have seen 2-3 discharges before 24 hours. It was usually because Pt and Dr. were not agreeing. Our common length of stay is lady partsl: 24-48 hours and c-sections: 48-72 hours. (also depending on GBS)

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