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NPA policy: mothers and children come first.

The timing of hospital discharges after birth is a vital concern for families, health care provides and volunteers who work for healthy outcomes of pregnancy. Third-party-coverage limitations and financial incentives for "early" discharge may put the health of both new mothers and newborn infants at risk.

As a multidisciplinary association of health care professionals and volunteers, the National Perinatal Association and its members advocate for both public- and private-sector policies and actions that promote appropriate care at appropriate sites before, during and after birth. Certainly a major consideration is current state and federal legislation. Voluntary actions, however, can also create appropriate policies in this arena. Certain hospitals, for example, now offer new mothers and infants an "extra" day before discharge or a stay in a less-intensive medical setting than a hospital. Along the same lines, some insures have agreed to specific post-partum hospitalization-coverage rules in lieu of discharge legislation: Nine insures in Arizona, for example, voluntarily agreed to cover 48 hours of inpatient care for vaginal births and 96 hours of inpatient care for cesarean births. They also agreed not only to follow the discharge guidelines of the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, but to inform physicians and patients of those guidelines.

NPA principles

Whether hospital-discharge policies are set by legislation or negotiated voluntarily, we of the NPA recommend that they be based on eight basic principles.

No risk acceptable. There should be no limits on the length of hospital stay that put the health of either new mothers or newborns at risk.

Professional guidelines lead the way. The most recent guidelines set by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics provide the best direction for making discharge decisions. These not only represent the consensus of medical nursing and other perinatal-care disciplines, but have been enclosed by a number of voluntary organizations, such as the March of Dimes.

Health care is the key concern. Healthy outcomes from pregnancy are determined both by the content and the setting for health care. Appropriate care before as well as after birth, communicating critical information to families during and after a hospital stay, and collaboration among hospital and non-hospital caregivers are all essential to good health. Concerns with length of hospital stays after birth should not divert attention away from them.

Clinical decisions lead. Decisions about the timing of discharge after birth are clinical decisions that should be made by the mother and health care providers. These judgments must take into consideration: the medical condition and circumstances of the mother, the content and quality of prenatal care, the experience of labor and birth, the condition of the newborn, and the availability of qualified personnel to provide early postpartum and newborn assessment and care.

Clinical judgment rules. Economic factors should not override clinical judgment in deciding on a discharge date. In addition, post-discharge care should be adequately reimbursed.

The burden of proof The impact of early discharge on health is not fully understood. Third-party payors that propose to disregard the reasonable recommendations of clinicians and families should provide adequate evidence that doing so will not be harmful to either mother or newborn. It should not be up to heath care provides and families to show why an early discharge should not occur.

Ongoing research. Research is needed to resolve questions about appropriate discharge timing and the content of post-partum care. Those who want to limit coverage for post-partum hospital stays should contribute to the study of the outcome of such policies. Contributions should be financial in the form of support for independent research projects, and informational in the form of appropriate access to clinical records and other data.

Purchasers' power. Employers, business alliances, public-assistance agencies and other institutional purchases of health care benefits should insist that the coverage they pay for support appropriate decisions by clinicians and families on the timing of hospital discharge.

This column is prepared in collaboration with the National Perinatal Association (NPA, 3500 E. Fletcher Ave., Ste. 209, Tampa, FL 33613-4712). NPA is a multidisciplinary association of individuals and organizations concerned with perinatal (time of birth) issues from preconception through infancy.

Elizabeth Wehr, J.D., chairs the Pablic Policy Committee of the NPA. This article is adapted from a recent policy statement developed by that committee.
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Title Annotation:National Perinatal Association
Author:Wehr, Elizabeth
Publication:The Exceptional Parent
Date:Apr 1, 1997
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