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Problems for the baby with an early discharge Jaundice.  This can often increase to very high levels without treatment, leading to mental retardation, deafness, seizures, and even death. Failure of breastfeeding, or premature cessation. Dehydration, and nutrition problems. Missed identification of birth defects.  Some birth defects become obvious only after a day or two.  Some of these can be catastrophic. Delayed vaccination.  Some vaccines are given in the maternity homes itself.  Early discharge may prevent this, and the child may remain unprotected against serious diseases. Increased infections in the mother.  And fatigue, as you take up the work of the home, and anxiety, as there is no one at home to ask about the baby's care, and ...
Safety Measures Ensure the good health of your baby before checking out of the maternity hospital. If you join a health management plan, make sure they don't force early discharge on you.  Ditto for health insurance. Don't, of course, harass the doctor for discharge.  Rest and recovery for you, and observation of the baby are important.  The world can wait.

Going Home After a Baby

When is the right time?
Problems with early discharge
Criteria for safe discharge
Safety measures

What's the right time?

You've been through it all - nine tough months of pregnancy, several grueling hours in the labour room, and now the inconvenient hospital routine as you recover from the stress of delivery.  As you look at your new baby sleeping next to you, you want to go home quickly and get back to normal life.  Well, as normal as a newborn baby will allow.  So when is the right time to leave the hospital?

Once upon a time, women would stay in the maternity home for a week after a delivery, resting and recuperating, while the hospital staff took care of the baby.  These few days of rest and relative peace were invaluable for a new mother, as she also learnt about baby care from the nurses and other health professionals.  Breast feeding was established under expert guidance, the baby was observed for the many problems that newborns can have, and the mother was spared the fatigue of domestic chores.

Nowadays, however, a week's stay seems like a luxury.  Families are shrinking, there are other children at home, someone has to bring meals to the maternity home - it's all too much, and everyone wants to get home quickly.  

Haste can be dangerous.  Though there is less disruption of family life, and saving on costs, an early discharge after childbirth can be risky.  In countries where medical insurance and health maintenance organisations hold sway, discharge in 24 hours became common, and large numbers of babies suffered.

There are several conditions of the baby that can appear after 24 or even 48 hours, and may be difficult to detect at home.  These have been seen to cause lifelong disabilities, and even death, in babies who are discharged early from hospital.

So when is it right to go home? No one can answer that, because every baby and mother is different.  However, what is important is that the hospital staff is sure that the baby is normal, has adapted well to life in our world, and is likely to be normal in all ways at home.

Criteria for safe discharge

A normal child means a child born after a full nine months pregnancy, and who was born normally, and established respiration and other body functions after birth.  This baby should be able to maintain body temperature in a crib, have normal breathing and heart rate, and be free of obvious birth defects.  The hospital staff would like to ensure that the baby is taking breast feeds well, and tolerating the feeds.  Urine and motions should have been passed at least once each.  It usually takes 48-72 hours to ensure this.

Apart from this, your doctor would probably like to have the baby examined by a child specialist.  Discharge also depends upon your ability to care for the baby at home, the support avavilable at home, and the access to health care personnel in case of problems.

It is always possible to pressurise a doctor to discharge you.  With health insurance plans and managed care becoming more and more aggressive about cost cutting, these decisions may soon not be in our hands anyway.  However, we need to be aware of the problems, and not contribute to them.  Sure, it's inconvenient to stay in hospital, but compromising a baby's safety is a terrible risk to take.

Last revision: July 15, 2007

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