2.) Some also believe that shorter stays make it difficult to assess the mother’s ability and readiness to care for her newborn. Second, the studies do not control for factors other than length of hospital stay that may contribute to readmission rates. Finally, most of these studies address only hospital readmissions, an indicator of serious medical morbidity. Professional Guidelines Focus on Discharge Criteria Rather Than Timing

Health plans and some medical experts we contacted assert that a slightly longer hospital stay may not be enough to address newborn risks, because many neonatal medical problems cannot be reliably detected until 72 hours after birth. Integrated Approach to Maternity Care Should Accompany Early Discharge Policies

Increasingly, health care providers believe that the debate over postpartum hospitalization should focus on the provision of a full range of maternity services, rather than on the length of the hospital stay. Studies have shown that a home visit following a 1-day postpartum stay rarely occurs. Many of the programs we visited stressed the importance of flexibility in early discharge decision-making. Nevertheless, many short-stay maternity patients are not receiving recommended follow-up care. Advocates of a proposed federal maternity care law contend that comprehensive legislation that applies to all insurers is necessary to protect patients from unsafe early discharges. Many Health Plans Are Not Covered by State Requirements

Not all health plans are required to comply with state maternity care requirements. We estimate that about 44 million people in the United States have hospital insurance not regulated by state law because they or their spouses are employed by companies that self-insure. Maternity Care Recommendations From Obstetric and Pediatric Providers

Antepartum, intrapartum, and postpartum courses are uncomplicated Single birth at 38 to 42 weeks’ gestation Vital signs are normal and stable Newborn urinating and stooling successfully At least two successful feedings documented No abnormalities that require continued hospitalization No excessive bleeding at circumcision site for at least 2 hours No significant jaundice in the first 24 hours of life Demonstrated knowledge of breast- or bottle-feeding and of cord, skin, and infant genital care Ability to recognize signs of illness and common infant problems, particularly jaundice and dehydration Proper infant safety, for example, car seat use, positioning for sleep Family or other support persons available who are familiar with lactation and newborn care and illnesses Maternal syphilis and hepatitis B surface antigen status Cord or infant blood type and direct Coombs test result as clinically indicated State regulated screening tests—if performed before 24 hours of milk feeding, a system for repeating the test must be ensured during the follow-up visit Hepatitis B vaccine administered or an appointment made within the first week of life for its administration Identified physician-directed source of continuing medical care for both mother and baby If discharged less than 48 hours after birth, definitive appointment made for the baby to be examined within 48 hours of discharge; follow-up can take place in a home or clinic as long as personnel are competent in newborn assessment and the results are reported to the infant’s physician on the day of the visit Evaluation should include general health, hydration, feeding pattern and technique, stool and urine patterns, maternal/infant interaction, review of laboratory test results or screening tests performed as indicated (continued)

States With Maternity Care Requirements as of September 1, 1996

The first copy of each GAO report and testimony is free.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed issues surrounding shortened postpartum hospital stays, focusing on: (1) the risks that are attributable to short hospital stays for maternity care; (2) health plan actions to ensure quality postpartum care for short-stay newborns; and (3) state responses to concerns about patient protection.

What GAO Found

GAO found that: (1) many medical personnel are concerned that early hospital discharges for newborns delay detection of serious disorders that are not apparent in the first 24 hours after birth; (2) 24 hours may not be long enough to assess a new mother's abilities and readiness to take care of her newborn child; (3) studies have not shown a definitive correlation between early discharges and increased hospital readmissions of newborns, but many of the studies' methodologies are seriously flawed; (4) medical experts agree that the quality of maternity care is more important than the length of hospitals stays and that a full range of prenatal, delivery, and postpartum services should be provided; (5) some hospitals and health care plans with early discharge policies have developed programs to ensure that maternity patients receive quality services such as prenatal assessment and education, flexibility that allows physicians to make discharge decisions, and direct, professional follow-up care within 72 hours of discharge; (6) other plans may not provide all of these recommended services and their follow-up care may consist only of a telephone hotline number; (7) 30 states have enacted laws or regulations that require insurers to cover minimum maternity stays, but these efforts vary in scope; (8) self-funded employer insurance plans, and some state Medicaid and employee plans are not subject to these state regulations; (9) applicability questions also arise for those employees who live and work in different states; and (10) Congress is considering legislation to make maternity care more consistent and available to all privately insured women.