Achieving better care for new mothers, newborns
Typically, health insurance covers a 48-hour stay for a vaginal delivery and a 96-hour stay for a cesarean section. At times, due to staffing issues or a particularly high census, hospitals will encourage new mothers to opt for an even earlier discharge. Sometimes, an early discharge home benefits both the family and the hospital. However, other times, a new mother may not get all the education she needs during the length of stay approved by insurance. I aim to discuss the impact of early discharges as well as the possibility of individualizing care for new mothers and newborns. Moreover, I urge the creation of policies that allow for insurance coverage of additional services for new mothers and infants in need.
In my career as a labor and delivery and neonatal intensive care unit, or NICU, nurse, I have seen mothers and babies who benefit from an early discharge. An early discharge can promote mother-baby bonding and a more comfortable recovery for postpartum women who are medically well, confident in their ability to care for their newborn, and have support at home. For these mothers, a shorter postpartum length of stay may be a part of their individualized care. For other mothers, especially during the COVID-19 pandemic, this was not always the case.
I started my nursing career during the COVID-19 pandemic as a labor and delivery nurse. During that challenging time, there was a palpable sense of urgency for early postpartum discharge from both patients and providers. In fact, short postpartum lengths of stay were much more common during the pandemic (Handley, et al., 2022). Hospital systems were strained by the pandemic and patients were fearful of contracting the virus while in the hospital. Additionally, visitors, family members, and doulas were extremely restricted in this hospital, which may have contributed to the patients’ desire for early discharges.
Although this increase in early postpartum discharges may have proven beneficial for some postpartum women and newborns, it also demonstrated the need for more individualized discharge planning for others. In particular, firsttime mothers, mothers who experienced pre-eclampsia, postpartum hemorrhage, or other medical complications, and late preterm infants may require special consideration. A study by The Journal of Maternal-fetal and Neonatal Medicine found that a longer postpartum stay for mothers with preeclampsia who experienced cesarean deliveries had a reduced risk for readmission related to postpartum hypertension (Wen, et al., 2020).
In order to provide the highest quality care for these especially vulnerable subpopulations, discharge planning and use of resources in and out of the hospital must be tailored to their unique needs. Individualized care for postpartum women and their newborns may include varying lengths of postpartum hospital stays that allow for adequate nursing education regarding postpartum care and routine newborn care. Mothers who experienced medical complications before, during, or after delivery, must receive this education and practice newborn care after they are medically stable enough to do so effectively. Late preterm infants who do not require admission to the NICU would also benefit from an increased length of stay with their mother or the presence of lactation and nursing support in the home. The availability of such services in the home can help promote adequate nutrition and more close monitoring of the neonate’s hemodynamic stability, including temperature and blood glucose monitoring. Additionally, coordination of additional resources before and after discharge such as lactation consultants and home nurses can help promote mother-baby bonding, successful breastfeeding, and maternal recovery.
For these changes to postpartum care to come to fruition, I believe lobbyists in the field must advocate for policy changes that support insurance coverage of increased length of postpartum stay, when necessary, and coverage of services such as home health nurses and lactation consultants in the home. Policies that expand insurance coverage of these services will result in increased use of them by new mothers. In turn, I believe that postpartum women and newborns will receive better care and more support upon discharge from the hospital, resulting in improved patient outcomes and fewer readmissions.