[World, October 7, 1995]
I got a “what’s wrong with this picture” feeling from reading the news clip: Sens. Nancy Kassebaum (R-Kansas) and Bill Bradley (D-New Jersey) were introducing a bill to require health insurers to provide a minimum 48 hour stay after childbirth. Over the last twenty years, the length of postpartum stays has shortened from four days to two or less.
Health insurers, not surprisingly, love the shorter stays. The most frequent cause of hospitalization is childbirth, and recovery at $800-$1000 per day adds up. A division of Kaiser Permanente ruminates over reduction to 8-hour stays in a leaked internal memo; these would “reduce our overhead costs to remain competitive in a fluid marketplace, and thus retain our jobs and attract more patients.” Most of that sentence makes business sense, but would 8-hour stays really attract patients?
Actually, eight hours sounds too long to me. As my obstetrician had explained, “Hospitals are for sick people. After the birth you’ll be tired, but you won’t be sick. Will you rest better at home or at the hospital?” Even if the hospital was more comfortable than home, even if I liked the food and the company better, I would have found it hard to rest anyplace that cost $1000 a day. Three hours after my daughter’s birth she and I and our brand-new daddy were all in the car going home.
When Megan was three, brother David was born, and our stay was four hours (longer because, as the nurse put it, “He had to get his pencil sharpened. “) Two years later, with Stephen on the way, we thought about the previous births. The last thing I felt like doing in labor was getting out of bed and into highway traffic, then lying in a cold, bright room while strangers came in to poke at me. I had an idea that the ending of the pregnancy could be more in tune with its beginning. So Stephen was born at home, with his daddy, a midwife, a nurse, and my best friend Nancy there to greet him with champagne.
So there were several reasons the Kassebaum-Bradley bill sat wrong with me. I worry when the government gives orders to private business about what it shall provide. I worry about a 48-hour federal standard presenting a bullseye for malpractice suits, making doctors reluctant to release women, like me, who want to go home early. I worry that longer stays mean more staph infections for babies. Postpartum lingering doesn’t improve their health: a survey of 1.4 million newborns found that the hospital re-admission rate rose slightly the longer the stay.
But mostly I worry that this is the wrong solution for the problem. Sen. Kassebaum fears that short stays don’t allow adequate time to observe the newborn or train the mother, both reasonable concerns. But is an extra 24 hours in a hospital bed going to do the job?
There are two problems here. First, in this age of fractured families and absent neighbors, we can’t presume that a cram course in baby care will be sufficient—especially during the overloaded hours after birth, when retention is not at its best. A more comprehensive approach, with education starting by mid-pregnancy, and support available as needed after birth, better fills the bill. If our real goal is improving babies’ health, nothing beats promoting breastfeeding. All a nursing mom’s problems will not arise, much less be solved, in the first 48 hours.
But secondly, there’s no reason to see these as medical needs requiring hospitalization. Visiting nurses, and even trained lay people (like lactation consultants), can give this care, because childbirth is an essentially healthy process. This bill’s presumption that postpartum care is necessarily hospital care reinforces a common misperception that pregnancy is sickness; such a view leads to malpractice panic, over-controlled labor, and a shockingly high Cesarean rate.
It also mistrusts God’s ability to design female bodies that work without technical assistance. If reproduction were consistently dangerous, the human race would have died out long ago. Yet we’re all descended from an long line of women who successfully gave birth, going back to Mother Eve. We should have confidence in the process by now.
My grandfather became an obstetrician in 1917, and he emphasized respecting God’s design. “Patience and prayer,” he would say. “You can’t rush childbirth; that’s when you get into trouble. At old St. Luke’s Hospital, there was a prayer framed over the scrub sink, and the last line of its was, ‘For without Thy help we can do nothing.’ It didn’t say, ‘without Thy help we can do a little bit’ —it said ‘nothing.’ I always thought about that before I went in to a delivery. So just remember you’re there to help at an essentially normal process; keep your hands off, and keep praying. Then you’ll have a happy birth.”