HEALTH WATCH : Pediatric Backlash

The American Academy of Pediatrics is absolutely right when it says that medical judgment, not the bottom-line concerns of insurers or hospitals, should determine when new mothers and their babies go home after childbirth. The nation’s largest group of pediatricians last week released a list of 16 conditions that it believes should be met before doctors release new mothers and their babies.

These criteria--among them the absence of medical complications, two successful feedings and urination by the baby--make obvious sense. Also sensible is the group’s recommendation that most mothers and babies remain in the hospital for at least 48 hours after a vaginal delivery and 96 hours after a Cesarean section. Common problems among newborns such as jaundice and nursing difficulties may not show up for a day or so but can be serious, even life-threatening. Addressing these problems quickly, in the hospital, is far safer than relying on perhaps inexperienced parents to monitor their newborn’s medical condition.

Increasingly, however, insurers are refusing to pay for hospital stays beyond 24 hours after an uncomplicated birth. Parents are ushered almost directly from the delivery room to the parking lot.

Hospitals and insurers are advised to encourage physicians to follow these prudent pediatric guidelines rather than the dictates of their accountants. The alternative is more overly prescriptive legislation mandating a minimum hospital stay, legislation that already is on the books in three states and under consideration in several others.