Hospital Discharge after Baby is Born
In the world of COVID, leaving the hospital immediately after 24 hour screenings on baby were completed became commonplace. This occurred as everyone was “staying home” in an effort to keep people home and to minimize exposure to the public. While this was the “norm” in COVID times, it is not best practice and many hospitals are transitioning back to pre-COVID discharge timelines. One of the most common questions I get in my current job when discussing discharge is…
My friend left the hospital 24 hours after her baby was born, why can’t I?
There are 15, yes, FIFTEEN, criteria recommended by the American Academy of Pediatrics (AAP) that need to be met for safe discharge of the newborn infant. As providers, we are constantly assessing all of these things to determine if discharge is safe for an infant. Early newborn discharge (prior to 48 hours of life) is associated with increased risk for readmission to the hospital per the AAP. My goal as a provider sending a baby is home is that once they go home, they get to stay home and don’t have to come back to the hospital at any point to see me again.
Also, jaundice hits its peak in a full term, healthy newborn on day 3-4 of life. When babies are monitored up to 48 hours of life, providers can get a better idea of if an infant will need treatment for jaundice than if they get a single reading at 24 hours.
Okay, so what is going to truly keep you in the hospital for more than one night after your baby is born?
First baby? Hard stop, it will be recommended you stay at least 2 nights after baby is born. The biggest reason for this is that breastfeeding is hard y’all and it is a learning curve for you and your baby. Give yourself (and your baby) a chance to learn how to eat with the professionals available to help before going home. Trust me, you do not want to endure your first night of cluster feeding alone.
Mother is Group B strep positive:
With appropriate treatment, which means you got ALL of your antibiotics in 4 hours prior to delivery. If this is your second, third, etc baby, you may be a candidate for discharge.
Without appropriate treatment. Another hard stop. Recommendations are to watch baby for signs of infection for a minimum of 36-48 hours to ensure they aren’t sick. Group B sepsis is scary and life threatening for infants.
Water was broken for more than 18 hours. Another hard stop. This is considered a prolonged rupture time. Again, babies are kept to watch for signs of infection for a minimum of 36-48 hours.
Feeding issues. If your baby loses more than 10% of their birth weight during the hospital stay, you will be asked to stay an additional night to work on feedings.
Dehydration and infection can be life-threatening to infants. Untreated jaundice can cause brain damage. Listen, I know the hospital beds are uncomfortable. I know that if this is your second baby that your kid at home misses you, and you miss them. When I had my second baby, I remember telling my husband that I felt like I had a huge hole in my heart while in the hospital because a part of our family was missing from that room. I know that the hospital is not a restful environment and no one sleeps well during an admission. I know all of these things. I also know that an additional night of discomfort is worth it to protect your infant, which is why the recommendation is made to stay. Trust me, your provider would LOVE for everyone to go home after 24 hours and have less patients to see the next day, BUT that isn’t in the best interest of every baby and the job of the medical provider is to make recommendations in your child’s best interest.
So, if you or a friend were able to be discharged after 24 hours in the past, that is great and things must have gone perfectly for that baby and parents for it to happen. Please, understand that is not the standard of care and your provider is just trying to ensure everyone’s safety.
