early discharge possible at Sibley?

[Anonymous]

She wasn't asking about birth plans or whether or not to go with the flow. OP, if you want an early discharge, talk to your OB about it. He can certainly help you advocate for it if he's on board.

[Anonymous]

OP I completely understand and am the same way. I bounce back quickly from things and get more stressed dealing with nurses and being in a hospital.

I delivered at GU and with my second they were fine discharging me after 24 hours. There is a test (I'm forgetting the acronym) that they do on newborns 24 hours after birth so they released us minutes after that was complete. I found it so much easier to get rest at home and I could be with my family. The post partum staff can really drive you crazy. They come into your room constantly for nothing. At 1am one nurse actually came in and woke both the baby and I up to give us the menu for the next evening's dinner and instructions to fill it out by noon the next day!

For my first, I had PE and had to be on Magnesium Sulfate for 24 hours after birth. After that was the ob/gyns had no problem with me not spending basically anytime in my post partum room so I could stay in the NICU with DD. They were even fine discharging the day after the Mag was off since they knew I would be downstairs in the NICU and was good antepartum with BP checks.

[Anonymous]

Also check with your insurance company. Mine had a program where they would send a nurse to your home the day after discharge if you opt for early discharge (clearly, they push the early discharge b/c of cost savings). In any event, availability of nurse visit may help your OB ok an early discharge if that is what you want.

Also, some unsolicited advice - in determining if you want to leave early, bear in mind how long you have been in recovery at the hospital. If you have an early morning birth, then discharge the next morning - 24 hours later - seems very reasonable. If you have a late afternoon/ evening birth, discharge the next morning might be pushing it.

[Anonymous]

The metabolic screening panel (PKU etc..) needs to be completed on the baby at least 24 hours after birth to be accurate. My pediatrician said most hospitals usually do it around 36 hours but can be pushed up to the 24 hour mark. I have been told that the metabolic screen can not be drawn at the doctor's office and should be completed at the hospital before discharge. It is required for all infants. The baby will also have a hearing test before leaving. Our neighbor, who is now a speech therapist in the Fairfax schools, used to do hearing screenings and said that she came around one every morning to do the test. Also, the baby is monitored for jaundice at certain intervals. Long story short, they will probably want you to stay a minimum of 24 hours following the birth even if you are 100% ready to rock, to address infant needs.

[Anonymous]

OP here, thank you all, very helpful. I think the ordeal of moving from hospital to home within 24 hours of delivery will be too much for me anyway, so I'm not thinking of delivering and dashing or anything. 24 hours recovery time in hospital is probably going to be necessary for me as well as baby, but I'm hoping that we can get home soon after that to rest more fully. The poster advising about not having to play cruise director was especially helpful, as were all the posts about tests that need to be done and pediatric philosophies. It sounds like there are steps we can take to ensure a healthy, early checkout, so I appreciate these tips and am printing off this thread for reference later on. Thanks all and Happy New Year!

[Anonymous]

OP - I am a little confused by your post. It is very rare that moms stay in the hospital for more than 48 hours (72 for c/s). In fact, most insur. plans probably won't allow you to stay longer even if you wanted to (unless there are medical complications).

So...is 48 hours (or 72 hours) really THAT long of a stay for you?

Plus, this allows adequate time for your doc. to be convinced that you are healing ok. It also also the ped. time to monitor the baby (jaundice issues perhaps???). Depending on the case load, these doc. may not even be making their rounds until the afternoon - thus delaying any chance of early dismissal.

Plus, the 48 hours that you are there really go by fast.

One more thing, I don't know about Sibley, but at FFx Inova, ALL moms and dads have to attend a post-birth class (only about 30 min. long) before discharge. It is just a quick little session about things-to-expect when coming home with baby, what type of dirty diapers to see, how to safely give an infant a bath, when to call the pediatrician, how to care for yourself, etc. For us, that wasn't until the early evening so even if you wanted to leave early you sorta couldn't.

[Anonymous]

The metabolic screening test (PKU, etc) can be and is done at the pediatrician's office, as well as in the hospital.

[Anonymous]

As anyone who has had an out of hospital birth knows, it is both possible and quite safe to be home in your own bed within 4-6 hours after delivery. This is the standard discharge time for the birth centers in the DC metro area. Also, I would like to point out that out-of-hospital birth itself has been proven, repeatedly, to be as safe or safer than in-hospital birth for low-risk moms.

OP, leaving after 24 hours is an extremely reasonable request after a low-intervention delivery. Both the hearing test and the PKU can easily be done at the pediatricians office the next day. As another poster mentioned, the PKU is not usually accurate before the baby is 24 hours old - although I will say that it is sometimes not accurate even at 36 or 48 hours. Women who birth out-of-hospital usually take the baby in on day 3 or so to do the PKU, when the results will reflect what is really going on with the baby metabolically (baby needs to have been eating for a while to get good results). Since you don't want to leave before 24 hours anyway, this really isn't an issue. They could do the test right before you leave but you should not freak out if they ask you to come back for retesting a few days later.

Again, 24 hours is really reasonable and is very likely to be granted (barring any complications, of course). Make sure you have asked your doctor ahead of time if that is reasonable to him, as it is your doctor who discharges you. Have the same conversation with your chosen pediatrician "if I have a low-intervention delivery, everything looks great, and I want to go home at 24 hours, would you be okay with that?" because it will be the ped who discharges baby. You can decide whether or not you want the testing done before you leave the hospital, or whether you want to take baby in the next day or so to have it done. Some people who leave early do like the reassurance of taking baby into the ped's office 24-48 hours later just for a weight check if nothing else.

If everything goes as planned with your delivery, and you find yourself wanting to leave early, it is helpful to start letting the nurses know right away. They do have paperwork to complete and as someone else said, they might want you to take that silly discharge class. If you tell every nurse who comes in your room "I want to leave by 11am, what do we need to do to make that happen?" you are much more likely to get your early discharge. Good luck to you.

[Anonymous]

Anonymous wrote:The metabolic screening panel (PKU etc..) needs to be completed on the baby at least 24 hours after birth to be accurate. My pediatrician said most hospitals usually do it around 36 hours but can be pushed up to the 24 hour mark. I have been told that the metabolic screen can not be drawn at the doctor's office and should be completed at the hospital before discharge. It is required for all infants. The baby will also have a hearing test before leaving. Our neighbor, who is now a speech therapist in the Fairfax schools, used to do hearing screenings and said that she came around one every morning to do the test. Also, the baby is monitored for jaundice at certain intervals. Long story short, they will probably want you to stay a minimum of 24 hours following the birth even if you are 100% ready to rock, to address infant needs.

Actually...

I gave birth at a birth center in MD and went home after 12 hours. The pediatrician did the PKU (metabolic) test the next day. We had the hearing test done at a Children's Hospital outpatient clinic the next week. The ped monitored for jaundice at the office visits.

So all of those issues can be addressed out of the hospital, if you choose.

[Anonymous]

OP here, for the most recent few posters -- I said I would be okay with 24 hours because I thought the pain of moving, getting in a car, going home might offset the benefits of peaceful sleep at home. I just know I will be more comfortable at home -- we have an amazing comfy bed, bathroom steps from that bed, dedicated "staff" with my sister backing up my DH, and ability to hire help as needed. So just curious, since i have no idea how much post-labor pain to expect (besides "a lot,") if you personally felt it was too early to deal with the pain of getting into the car and being driven home (sounds like it wasn't), and if it was painful, if you thought it was still worth it to be at home. If that's the case, then I just might want to go home early. I'm not sure how I'll feel yet, and 24 hours post birth seems like a good number. But I guess it would also depend on the time of day I gave birth. If I delivered at midnight, I'd probably want to go home sometime the next afternoon -- not the next night at midnight. But if I gave birth at 7 AM, I could probably stick it out until then. (And yes, speaking from experience (though not birth experience) I do think 48 or 76 hours will be a very long time to me). It's one part the constant vitals checking and another part need for privacy, I'm a light sleeper and am concerned about not sleeping at all, even when the baby is sleeping, and I just want to be home.

Thanks for those very useful posts about the pediatricians, as well. We haven't begun to research pediatricians yet (will be starting that very soon) so I hope you all will still be posting on this forum when we start considering pediatricians -- would appreciate any guidance. I'm in the district. The more I hear about them the more I think that must be a very positive way to have a child, but the NICU and other benefits of a hospital reassure me, and I also really like my OB, and he has priveleges at Sibley, so that's where I'll be.

[Anonymous]

Op here again, it's late and I'm getting tired. That last sentence was supposed to refer to birthing centers, as a positive way to have a child. (Not pediatricians!) Not that they're not a positive... but I was referring to the birthing centers many of you referred to.

[Anonymous]

I had my second at Sibley a few years ago and was discharged after one night. I couldn't wait to get home, especially since I was in a semi-private (i.e., non-private) room. When I had my first, I would probably have stayed in the hospital (not Sibley) for weeks if they had let me. I had no idea what I was doing, and the maternity ward was an incredibly reassuring cocoon. But physically I could have gone home within a day. I had a quick, uneventful, unmedicated delivery (albeit with an episiotomy) and had no discomfort that Motrin and ice packs couldn't cure. Good luck!

[Anonymous]

OP, I was home in my own bed 4 hours after my first child was born at Birthcare in Alexandria. I really don't want this to turn into a hosp. vs. birth center debate, but I do want to point out that birth centers are statistically SAFER than hospitals for moms who do not have any risk issues. The NICU and/or medical care you reference wanting close by becomes MORE necessary simply as a result of being in the hospital. Maybe, just for kicks, you could interview the midwives at a local birth center (like the DC Birth Center or Special Beginnings) and ask them about any situation or eventuality you are concerned about. The only reason I suggest this is because it sounds like you would be thrilled with the type of care a birth center has to offer, and the reality is that you will have to fight for this type of care at Sibley hospital. Again, I'm not saying this to bother you or debate or anything -- it sounds like you have done your research and really know what you want, so maybe you have already taken this step. Oh, by the way, both of the birth center practices I mentioned above ALSO deliver at a hospital if that's what you want - WHC and Anne Arundal, respectively. When you deliver with a midwifery practice at a hospital, they still try to keep your experience as "birth center like" as possible by encouraging all the things that make a low-intervention birth possible, as well as early discharge. Okay, I'm sorry if I'm just frustrating you further by writing all this -- I know you said you like your doctor. Who is your doctor by the way?

Back to your question -- it was awesome to be home in my own bed so soon after the birth. I did have a 2nd degree tear, which the midwife neatly stitched, but it was not especially painful. I also had a 2 day labor, so by many standards it was a "difficult" labor. The difference of course is that at a birth center you are encouraged to eat and drink and remain mobile, walk outside, get in the hottub, etc., so I didn't feel totally wrecked after the whole experience. Basically I delivered the baby (yes, at midnight), spent 30 minutes getting sewn, then we spent two hours lying in the bed getting to know each other and nursing. Then I got up, peed, showered, ate something, they did the newborn exam, and then we packed up and left. Believe it or not, I felt great. Thrilled, empowered...on a total birth high, so to speak. It was absolutely LOVELY to be home so soon. My husband and I and baby just snuggled up in the bed and were in awe of what had happened. The next day my birth assistant came over, and then the next day my midwife came over. Both of them checked me and the baby thoroughly, in the comfort of my own bed -- not that there were any problems at all, but it was comforting to have them stop by. You could accomplish the same thing by hiring a very good doula who is willing to come by to check on you the next day. So then, the day after that I took my baby in to the ped for an exam, PKU and hearing test. For a first baby, it was all so perfect. That said, for any future babies I will just have them at home because then I won't have to drive anywhere at all after the delivery.

Hope this helps in some way.

[Anonymous]

Hi there PP, I don't mind the information about birthing centers. I have a handful of reasons that I'm shying away from this experience. The first is that I have quite a few friends who are nurses, who have told me stories about women and babies rushed to the hospital becuase the birth center / midwife at home was unable to perform certain emergency procedures they or baby ended up needing. I realize these are rare, but then a friend of mine delivered at home and had an oxygen deprived baby -- umbilical cord prolapse -- and it was very scary for her. So even though I know that statistically these types of episodes are WAY less likely to happen at a birthing center and home (and I really do believe this), it is very hard for me to move past the stories from people who have experienced it first hand. Also, my father in law is a surgeon, (not in this area, however) so my husband has a tremendous amount of faith in and respect for the medical community and, although he is not the one giving birth and ultimately he will support whatever I decide, I know that he would be fearful of a non-hospital delivery. Perception is very powerful, and I don't believe that any amount of research would be able to help me shake the perception that I'm less safe outside a hospital. The other thing is that I'm still not completely sure what kind of birth I'd like to aim for, but one thing that worries me about doulas, midwives and birth centers is that they sometimes come across as being as anti-intervention and anti-pain medication as the medical community comes across as pushing all these things. Again, probably just perception. But if I have a long, hard labor and need an epidural, I think at some point, the benefits of that can outweigh the potential drawbacks, and I wouldn't want to feel guilty about making that choice. (But your point about moving around, eating, epidurals, is well taken -- I think the birthing center option sounds so much less torturous than the hospital option with respect to enduring a long delivery, and maybe this would really offset the need for drugs). Someone said earlier, on this thread or another one, that you don't get a prize for enduring the most pain. I agree with that, but at the same time, it's still my goal to go intervention-free for as long as possible, ideally through the birth. If it doesn't work out, then that's okay too.

I've said in other places on this board, I think, that I sincerely wish that hospitals would really start to embrace the advances in the actual delivery process that so many birthing centers and midwives have already embraced. To me, an ideal situation would be the choice, flexibility and low-intervention goals of a birthing center with the reassurance of a hospital NICU and emergency procedures as well. It upsets me that I feel like I have to choose one over another when neither one offers 100 percent of what I want.

Anyway, I hope all of this doesn't make it seem like I'm closed minded about birth centers. I'd actually like to hear more about this. I don't know that it will change my mind, but you are absolutely right in noting that this sort of delivery is a much closer match to the things I believe I want than what I've been hearing about Sibley. Since you said you didn't want to reopen the birthing center debate, and I have a feeling these posts are bound to, perhaps if you have some time you might contact me at my home email address famst7 (at) gmail (dot) com and tell me who your midwife and doula was?

[Anonymous]

"I've said in other places on this board, I think, that I sincerely wish that hospitals would really start to embrace the advances in the actual delivery process that so many birthing centers and midwives have already embraced. To me, an ideal situation would be the choice, flexibility and low-intervention goals of a birthing center with the reassurance of a hospital NICU and emergency procedures as well. It upsets me that I feel like I have to choose one over another when neither one offers 100 percent of what I want. "

I completely agree. GU used to have a nurse-midwife practice at GUH back in the 90s. Everyone I knew back then used the midwives and had great natural child births in the hospital. They also loved the time the mid wives spent with them, had more focus on good nutrition and exercise, and were so much better prepared for childbirth. GU like many hospitals is now a factory with long wait times only to see a rushed practioner for a few minutes, lots of interventions, and moms really needing to bring a doula to get support to go natural.