Really? Crazy HSLDA story

[bolt.]

How does 'calling in a social worker' differ from 'calling DCF' in the US system?

 

In Canada, a social worker would be called in any case where a woman may need emotional support, assistance or help figuring things out. They are also thought to be a helpful part of conflict resolution, able to help the mother understand the Dr's concerns, and also able to advocate for the mother to the Dr. I don't think people find them very threatening here... but I've never really been in that situation.

[ktgrok]

Often the social worker works for the hospital and is a staff member there. DCF is a separate entity with different powers.

[butterflymommy]

Pretty horrifying, and I believe it. I've read many similar stories on homebirth and unassisted boards.

[Anne in CA]

I believe this story because in my area hospitals have become very high handed with young mothers. One mother in my church was told her sons would not be allowed to leave the hospital until she had proven she would not try to nurse them, but go formula only because she also had a toddler and the hospital staff felt that nursing the twins would be too much. :confused:

[happyhomemaker25]

I believe this story because in my area hospitals have become very high handed with young mothers. One mother in my church was told her sons would not be allowed to leave the hospital until she had proven she would not try to nurse them, but go formula only because she also had a toddler and the hospital staff felt that nursing the twins would be too much. :confused:

 

Are you kidding me??? I would have been livid!

[Carrie12345]

I try to refrain from being lured into sensational stories, BUT... PA hospitals, particularly on the east side of the state, are notorious for "punishing" planned homebirths or any other non-mainstream medical choices.

[MinivanMom]

How does 'calling in a social worker' differ from 'calling DCF' in the US system?

 

In Canada, a social worker would be called in any case where a woman may need emotional support, assistance or help figuring things out. They are also thought to be a helpful part of conflict resolution, able to help the mother understand the Dr's concerns, and also able to advocate for the mother to the Dr. I don't think people find them very threatening here... but I've never really been in that situation.

 

"Calling in a social worker" at an American hospital means having a social worker who is privately employed by the hospital come in to provide emotional support, assistance, or help in conflict resolution. The government would not be involved in any way. The hospital social worker should theoretically do all the helpful things you describe.

 

"Calling DCF" or "calling CPS" (different states have different acronyms) means that the hospital/nurse/private social worker is filing a report accusing the family of abuse or neglect. DCF/CPS social workers are employed by the government and their purpose is to investigate accusations of abuse or neglect in order to determine whether the child/children should be removed from the custody of the parents. They have the power to immediately remove children from the custody of their parents if they believe the children are in danger. They would never engage in any of the helpful things you describe. It's not in their job description.

[readinmom]

This did happen to my close friend. At first I thought it was a joke. The issue was the fact that she was using a midwife and went into labor two weeks early. The midwife met them at the hospital but she had already given birth, assisted by the doctor on call.

 

When she and her husband wanted to leave, they were told the baby would have to stay for "further tests". The husband asked for policy in writing, was refused and security was called and he was escorted off the hall until he calmed down. They took baby home "against advice".

 

Social services came the next day for a home inspection and friend was questioned about her breastfeeding practices. They had one more visit, and worker said everything looked good. Another good use of our tax dollars.

[staceyobu]

Not the story I want to be reading very pregnant with a plan to refuse eye ointment and hepatitis b and the 'mandatory' trip to the nursery...

[SonshineLearner]

You all who have homeschooled long enough remember when children were ripped out of their homes by the government because homeschooling wasn't legal, right? There was some book about the different cases that I believe had been documented.... I can't believe that an overzealous person can start great damage ;(

[lionfamily1999]

That is what came to mind when I read the article. Were they refusing care that was considered more necessary for a preemie? And that would make more sense as to why they would want to observe the baby longer.

 

Also it may have to do with prenatal care. If she had not had standard testing for gestational diabetes, hepatitis, group B strep, there are standard guidelines for monitoring the newborn afterwards in those cases.

Our local hospital freaked out when I tried to go home after 24 hours. I didn't try to home birth, had all the regular prenatal care, and a super quick easy labor. My huge mistake was passing on the parenting class they offered and being excited to go home :glare: This was my youngest child (child number three), I felt like I knew how to change a diaper at that point and my doctor had told me that I didn't have to stay for 48 hours (which I'd done with the older two) if I didn't want to. The hospital staff gave me the worst time for that.

 

So, it doesn't suprise me to think of staff being, in general, against parents for having the audacity to think they could parent. It doesn't surprise me they would push for an extra day with no reason other than it's s.o.p.

[Kate CA]

Not only is it true, but a woman I know fairly well, locally, is a social worker and says that she is OFTEN called in on these kinds of things. That if the baby is born outside of the hospital some of the old school pediatricians insist it has to stay 48 hours, and if the mom doesn't agree they call in her, the social worker, and if she can't convince the mom to let the baby stay they call DCF.

 

Scared the living daylights out of me. I have nightmares about this kind of thing. I'm FOREVER grateful that my midwife has a good relationship with a local OB/GYN group, and is treated well at one of the local hospitals, AND that we have a homebirth friendly pediatrician who sees many babies born at birth centers and homebirths. I can't imagine him doing this. But...I suppose if he is out of town or whatever, and you get the pediatrician on call....you never know.

 

Again, SCARES the CRAP out of me. And makes me also very glad that I have a friend that is a family practice lawyer familiar with working with/against DCF. Ugh.

 

I KNOW this happens. It happened to some very dear friends of mine. It was horrible. Just because some jerk doctor or nurse doesn't like that the mother had alternate care. It is terrifying. CPS was involved for NO other reason than that she had alternate care. They even accused her of things she never did! I don't need to "hear the other side" to know that this absolutely happens. Talk about living in a police state!

 

I am so VERY glad I was able to birth at home with no complications.

[bolt.]

I have to say, this is going a long ways towards helping me understand why people get so attached to the idea of home-birthing all the way which I tend to see in Americans (online) much more than Canadians (in person). I had no idea that hospitals could be not only high-handed, but vindictive.

 

I can't imagine the catch-22: if you want a home-birth because you want to avoid the ordinary levels of high-handed-ness, so you secure alternate care, but if you have hospital-worthy complications they're going to be jerks about it??? That makes me mad.

 

(In my immediate circle IRL, some women do secure alternate care in order to have a home-birth if possible, but the idea of a swift transfer to a hospital if necessary is seen as a comforting back-up plan, not a threat. Plus, here, it is only women who really care about midwifery / home-birth as a life philosophy that go that way -- because a hospital birth is free, but you have to pay a midwife out of pocket. It's a large expense personal, compared with free care from a doctor. Some provinces are beginning to cover midwives and alternative birth options because it's often cheaper <for the province> to cover that rather than a doctor for an uncomplicated birth.)

[Kate CA]

I have to say, this is going a long ways towards helping me understand why people get so attached to the idea of home-birthing all the way which I tend to see in Americans (online) much more than Canadians (in person). I had no idea that hospitals could be not only high-handed, but vindictive.

 

I can't imagine the catch-22: if you want a home-birth because you want to avoid the ordinary levels of high-handed-ness, so you secure alternate care, but if you have hospital-worthy complications they're going to be jerks about it??? That makes me mad.

 

(In my immediate circle IRL, some women do secure alternate care in order to have a home-birth if possible, but the idea of a swift transfer to a hospital if necessary is seen as a comforting back-up plan, not a threat. Plus, here, it is only women who really care about midwifery / home-birth as a life philosophy that go that way -- because a hospital birth is free, but you have to pay a midwife out of pocket. It's a large expense personal, compared with free care from a doctor. Some provinces are beginning to cover midwives and alternative birth options because it's often cheaper <for the province> to cover that rather than a doctor for an uncomplicated birth.)

 

Yes, I am a big pro-homebirth mom, but I also really appreciate the hospitals for my friends that need/want them. I am not anti-doctor. I am anti-jerk doctors. lol Indeed, I am quite grateful for good solid medical care when it is warranted as it saved a friend's life when she had to have a true emergency C-section. She had planned a hospital birth, so there was no hospital transfer, but I will always be grateful for the care she received. I just want to be free to birth where I want to, if we are paying for it, and know that what we are doing will not result in our child being taken away if we have to transfer to the hospital!

 

:)

[justasque]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

Do you see what I mean?

 

In the HSLDA case it seems clear to me that the staff was looking for a way to hang on to the baby, perhaps in part because of concerns (accurate or not) about neglect/abuse.

 

I wonder all this because I recently listened to a Grand Rounds presentation about a child who presented with a particular complaint, but who the staff suspected was being seriously abused. (The father ultimately admitted to the abuse.) It made me wonder how a hospital goes about dealing with that - they needed to do x-rays to investigate broken bones, etc., but it didn't sound like they got parental permission to do so (or maybe they did on some pretense), and it made me wonder if there is a legitimate/legal procedure that hospital staff can go through when there are such suspicions, or if they have to figure out back-door work-arounds. The Grand Rounds was from the perspective of the doctor, and the HSLDA story sounded very similar but from the perspective of the parents. In other words, under what circumstances *can* a hospital say "we're hanging on to this child for observation and tests for 48 hours", and under what circumstances can they do tests without permission? Anyone know?

[Whereneverever]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

Do you see what I mean?

 

In the HSLDA case it seems clear to me that the staff was looking for a way to hang on to the baby, perhaps in part because of concerns (accurate or not) about neglect/abuse.

 

I wonder all this because I recently listened to a Grand Rounds presentation about a child who presented with a particular complaint, but who the staff suspected was being seriously abused. (The father ultimately admitted to the abuse.) It made me wonder how a hospital goes about dealing with that - they needed to do x-rays to investigate broken bones, etc., but it didn't sound like they got parental permission to do so (or maybe they did on some pretense), and it made me wonder if there is a legitimate/legal procedure that hospital staff can go through when there are such suspicions, or if they have to figure out back-door work-arounds. The Grand Rounds was from the perspective of the doctor, and the HSLDA story sounded very similar but from the perspective of the parents. In other words, under what circumstances *can* a hospital say "we're hanging on to this child for observation and tests for 48 hours", and under what circumstances can they do tests without permission? Anyone know?

 

I know some medical personnel flag on the no vaccination issue. Homebirthers, too. I don't think it's completely unreasonable for the reasons that you outline.

 

It's a shame when people who are not bad parents get in trouble and hassled. And scary.

[staceyobu]

I wonder all this because I recently listened to a Grand Rounds presentation about a child who presented with a particular complaint, but who the staff suspected was being seriously abused. (The father ultimately admitted to the abuse.) It made me wonder how a hospital goes about dealing with that - they needed to do x-rays to investigate broken bones, etc., but it didn't sound like they got parental permission to do so (or maybe they did on some pretense), and it made me wonder if there is a legitimate/legal procedure that hospital staff can go through when there are such suspicions, or if they have to figure out back-door work-arounds. The Grand Rounds was from the perspective of the doctor, and the HSLDA story sounded very similar but from the perspective of the parents. In other words, under what circumstances *can* a hospital say "we're hanging on to this child for observation and tests for 48 hours", and under what circumstances can they do tests without permission? Anyone know?

 

I used to work postpartum and we contacted social workers (in hospital) for patients. Social services would come evaluate and decide whether or not to contact CPS. I never directly called CPS. Typically, social services were called for positive drug screens. I'd say 90% of the time I called, it was for that reason. The other 10% was a combo of psych issues, family dynamics, and money problems (need formula, carseat, ride home, etc.). Psych issues were typically totally crazy (walking down the hall naked to get some juice) and family dynamics had to be really bad (mom telling us boyfriend beat her).

 

I think homebirth transfers were a real rarity at both places I worked. I don't think they would be lumped in with the above... but I think they are an enigma for the most part. I myself went to L&D to get stitches following an unassisted birth and I think people just didn't know what to do with me. Some nurses seemed to think I was an amazing, one cried because she was so fearful of me having a newborn since I was so irresponsible.

 

I have seen lots of refusals of hepatitis b and am surprised that would be an issue anywhere. Some peds don't want it done following birth but want to wait until the first office visit, so it's not uncommon for babies to leave without getting it.

 

Technically, they can't keep baby or do anything to baby against parents' wishes without a court order. The only time I've personally heard of court orders being obtained is for babies with parents that are Jehovah Witness and refusing blood transfusions where the baby will die without it.

 

Don't underestimate what some people will consent to. I would go in all the time and ask for urine for a drug screen from someone who knew they would test positive. 99.9% of the time they'd give it to me and not say a word.

 

Having said all that, I do think that maternity wards have very fuzzy informed consent, and I think it needs to be brought to light. I think a lot of medical personnel ignore a laboring woman's requests simply because she's in labor. However, they want her to agree/refuse procedures and not a family member since she is technically coherent. But, they don't really think she can consent since she's in labor. So, medical personnel wind up doing whatever they typically do even if it's not what the patient wants. And, of course the whole matter is complicated by the life of an infant that rides on whatever decisions are being made. Add to that the disdain some doctors have for homebirth and the lack of back up care available for homebirth emergencies... and, well, you have a huge complicated mess.

[Kate CA]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

Do you see what I mean?

 

I do see what you mean, but that goes entirely against the legal system's idea of being innocent until proven guilty. The assumption is that any homebirther is just as bad as a drug-addled mom. That makes no sense at all. It is entirely up to the staff to make that call. I don't like that at all, and I don't think it should be legal, frankly.

 

My friend almost lost her baby to the system because some nurse didn't like her choices. There was NOTHING to indicate she was anything other than a normal mom. That's wrong.

[mommaduck]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

Do you see what I mean?

 

Absolutely. Midwifery is under fire here in PA, unless you are blessed enough to live in Lancaster County and even our midwives are very cautious. There was a case where the parents went AGAINST the midwife's order to take an infant to a hospital for a particular disorder noticed after the birth (not caused by the birth). Baby died a few days later and the midwife was the one put on trial for it :glare: We've also had an issue with a CNM that was jealous of a CPM (more people were choosing the CPM over the CNM) and she caused some chaos for the CPM. My OB group with this last baby knew my midwife (a CPM) and thought highly of her. I was fortunate and given no problems. No one even questioned me about delaying my baby's vaccinations (due to our medical history). They understood that this was something that I would take up with our family physician.

[abreakfromlife]

So I super-skimmed the article and super-skimmed the comments here, lol, so this might not even be relevant, but from what I gather it is. I'm sick and don't feel like reading a bunch right now. But when I had my youngest, I refused the vit K shot, and the eyedrops stuff, and the Ped on call was thisclose to calling CPS on me. It was horrible. He was yelling at me less than an hour after I'd had the baby and was still all sore and tired and stuff. One nurse, bless her forever, talked him out of it. I wasn't super worried about CPS b/c I had gone into it knowing that was a possibility and even had paperwork with me, lol, but I totally believe something like that would happen.

[garddwr]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

I do think they re-flag all moms who come in in a non-traditional way. I have a cousin who had an unplanned homebirth--it was her second child and she thought labor would go slowly as it had with the first and simply stayed home too long. They were on their way to the car to drive to the hospital when she realized it was too late, went back indoors, and gave birth while her husband was on the phone calling 911. No complications, she and baby were transported by ambulance to the hospital--but she describes their reception and treatment there as miserable, they assumed she must be a druggy or something and put her through all kinds of unnecessary tests. She had received full prenatal care and had every intention of delivering at the hospital with her OB.

[LaxMom]

:iagree:except for your last sentence. Because of HIPA, it would be impossible for the hospital to share their side. I have never seen HSLDA misrepresent the facts.

 

As a point of reference, I was just forwarded an HSLDA "emergency" alert for Maryland, claiming the state was amending the age of compulsory attendance from 16-18, and (by the language of the alert) doing away with the <named> statute that "gives everyone the right to homeschool if they provide regular, thorough instruction in the usual subjects".

 

However, the statute they reference discusses only attendance requirements of children enrolled in public school. It's a truancy law. Further, the bills raise the mandatory age from 16 to 17, not 18, and the very first section of the bill is the exclusions including, among others, children under the age of 17 WHO ARE HOMESCHOOLED.

 

There is no emergency here, unless you really, really want your kid to drop out at 16 instead of 17 (and, really the exclusions list includes those serving in the military, leaving school to provide for family, are parents, etc, so...)

 

So, let's see: outright lie, outright lie, outright lie, misrepresentation. Yeah, it's all there.

[MinivanMom]

Curious - do you all think that part of the problem may be that the system is set up to red flag moms who come to the hospital in a non-traditional way? In other words the system/policy is lumping thoughtful, homebirth-transfer moms in with other moms for whom there might be a legitimate, serious concern about neglect, one symptom of which might be that the mom didn't do the usual prenatal visits, doctor-attended birth stuff, etc., not out of a thoughtful, informed choice but because of other issues? In other words, is hospital policy set up to say "moms who come without a doc are automatically considered high-risk for potential neglect, because we know that moms who *do* neglect often come in without a doc" (ignoring that there is another group of moms who come in without a doc, but who are part of a drastically different cohort).

 

Personally, I think the problem is much bigger than that.

 

Yes, a mother who comes into the hospital in a non-traditional way will be flagged, regardless of whether she had a planned homebirth, received prenatal care yet had a super quick labor, or didn't bother to seek any prenatal care. There is a lack of discernment there on the part of *some* medical professionals. If she then makes other non-traditional choices (no vitamin K, no immunizations, wanting to check out prior to 48 hrs, etc), then that provides the added evidence to corroborate the initial suspicions.

 

However, there is a systemic problem where *some* medical professionals working L&D/NICU genuinely believe that they are in charge of all newborns until they (the med. professionals) choose to release the child to their parents. It's not just that they disagree with declining vit-K (for example), but they genuinely believe that the parents do not have the right to make that decision for the newborn. You don't have guardianship of your child until they decide that they think you are a fit parent. The parents aren't in charge of that newborn until they choose to discharge him. Have you ever had a parent with a preemie talk openly about what it was really like to deal with the NICU, especially if it was an extended stay? The territorial issues that come up over non-medical parenting decisions (bottles, formula, paci's, frequency of visits, etc) are truly mind-boggling. There is a huge power imbalance when someone has the authority to hold your newborn and separate you from your newborn for any cause or no cause.

 

This is where L&D/NICU differ from pediatrics. If you check your older baby or child into the hospital nobody questions that as the parent it is your right to make decisions for your child. The expectation is that a parent will remain with the child at all times (except when actually in surgery) and will be consulted for all medical decisions. With a newborn, however, the mother is considered a patient herself and therefore incapable of making decisions. The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers. There is a huge power imbalance in L&D/NICU that doesn't exist anywhere else in the hospital system.

 

I truly believe that no one is treated as badly in a hospital as laboring/post-partum mothers. Nobody.

[Caraway]

Personally, I think the problem is much bigger than that.

 

Yes, a mother who comes into the hospital in a non-traditional way will be flagged, regardless of whether she had a planned homebirth, received prenatal care yet had a super quick labor, or didn't bother to seek any prenatal care. There is a lack of discernment there on the part of *some* medical professionals. If she then makes other non-traditional choices (no vitamin K, no immunizations, wanting to check out prior to 48 hrs, etc), then that provides the added evidence to corroborate the initial suspicions.

 

However, there is a systemic problem where *some* medical professionals working L&D/NICU genuinely believe that they are in charge of all newborns until they (the med. professionals) choose to release the child to their parents. It's not just that they disagree with declining vit-K (for example), but they genuinely believe that the parents do not have the right to make that decision for the newborn. You don't have guardianship of your child until they decide that they think you are a fit parent. The parents aren't in charge of that newborn until they choose to discharge him. Have you ever had a parent with a preemie talk openly about what it was really like to deal with the NICU, especially if it was an extended stay? The territorial issues that come up over non-medical parenting decisions (bottles, formula, paci's, frequency of visits, etc) are truly mind-boggling. There is a huge power imbalance when someone has the authority to hold your newborn and separate you from your newborn for any cause or no cause.

 

This is where L&D/NICU differ from pediatrics. If you check your older baby or child into the hospital nobody questions that as the parent it is your right to make decisions for your child. The expectation is that a parent will remain with the child at all times (except when actually in surgery) and will be consulted for all medical decisions. With a newborn, however, the mother is considered a patient herself and therefore incapable of making decisions. The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers. There is a huge power imbalance in L&D/NICU that doesn't exist anywhere else in the hospital system.

 

I truly believe that no one is treated as badly in a hospital as laboring/post-partum mothers. Nobody.

 

:iagree::iagree::iagree:

[Annie Laurie]

I've got to say that I'm so grateful I live in TX after reading this. (I never thought I'd say that.) I had a hospital birth here nearly 12 years ago where we declined eye ointment and many other interventions, did not let them take baby to the nursery, and asked to go home early, and none of it was met with any resistance. Dh even did the catching during delivery and my older child was allowed in too, and the staff was very respectful of our wishes. After reading this I'm thinking that was more unusual than I'd realized.

[Tarreymere]

Personally, I think the problem is much bigger than that.

 

Yes, a mother who comes into the hospital in a non-traditional way will be flagged, regardless of whether she had a planned homebirth, received prenatal care yet had a super quick labor, or didn't bother to seek any prenatal care. There is a lack of discernment there on the part of *some* medical professionals. If she then makes other non-traditional choices (no vitamin K, no immunizations, wanting to check out prior to 48 hrs, etc), then that provides the added evidence to corroborate the initial suspicions.

 

However, there is a systemic problem where *some* medical professionals working L&D/NICU genuinely believe that they are in charge of all newborns until they (the med. professionals) choose to release the child to their parents. It's not just that they disagree with declining vit-K (for example), but they genuinely believe that the parents do not have the right to make that decision for the newborn. You don't have guardianship of your child until they decide that they think you are a fit parent. The parents aren't in charge of that newborn until they choose to discharge him. Have you ever had a parent with a preemie talk openly about what it was really like to deal with the NICU, especially if it was an extended stay? The territorial issues that come up over non-medical parenting decisions (bottles, formula, paci's, frequency of visits, etc) are truly mind-boggling. There is a huge power imbalance when someone has the authority to hold your newborn and separate you from your newborn for any cause or no cause.

 

This is where L&D/NICU differ from pediatrics. If you check your older baby or child into the hospital nobody questions that as the parent it is your right to make decisions for your child. The expectation is that a parent will remain with the child at all times (except when actually in surgery) and will be consulted for all medical decisions. With a newborn, however, the mother is considered a patient herself and therefore incapable of making decisions. The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers. There is a huge power imbalance in L&D/NICU that doesn't exist anywhere else in the hospital system.

 

I truly believe that no one is treated as badly in a hospital as laboring/post-partum mothers. Nobody.

 

 

:iagree: I was an RN on an OB unit for some years and later a travel nurse. This kind of thinking is part of the mindset that encouraged me to attend midwifery school. It does exist. And no matter how wonderful YOU might think your hospital birth experience was, there are likely more than a few instances you were completely unaware of when your choices were mocked or disregarded without your knowledge or when you were manipulated into something just because the nurse or dr wanted things that way.

[chepyl]

Personally, I think the problem is much bigger than that.

 

Yes, a mother who comes into the hospital in a non-traditional way will be flagged, regardless of whether she had a planned homebirth, received prenatal care yet had a super quick labor, or didn't bother to seek any prenatal care. There is a lack of discernment there on the part of *some* medical professionals. If she then makes other non-traditional choices (no vitamin K, no immunizations, wanting to check out prior to 48 hrs, etc), then that provides the added evidence to corroborate the initial suspicions.

 

However, there is a systemic problem where *some* medical professionals working L&D/NICU genuinely believe that they are in charge of all newborns until they (the med. professionals) choose to release the child to their parents. It's not just that they disagree with declining vit-K (for example), but they genuinely believe that the parents do not have the right to make that decision for the newborn. You don't have guardianship of your child until they decide that they think you are a fit parent. The parents aren't in charge of that newborn until they choose to discharge him. Have you ever had a parent with a preemie talk openly about what it was really like to deal with the NICU, especially if it was an extended stay? The territorial issues that come up over non-medical parenting decisions (bottles, formula, paci's, frequency of visits, etc) are truly mind-boggling. There is a huge power imbalance when someone has the authority to hold your newborn and separate you from your newborn for any cause or no cause.

 

This is where L&D/NICU differ from pediatrics. If you check your older baby or child into the hospital nobody questions that as the parent it is your right to make decisions for your child. The expectation is that a parent will remain with the child at all times (except when actually in surgery) and will be consulted for all medical decisions. With a newborn, however, the mother is considered a patient herself and therefore incapable of making decisions. The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers. There is a huge power imbalance in L&D/NICU that doesn't exist anywhere else in the hospital system.

 

I truly believe that no one is treated as badly in a hospital as laboring/post-partum mothers. Nobody.

 

My bad experience was the opposite. DH went to get some food and take a.shower. etc. A few minutes after he left, DD wet her diaper and spit up everywhere. This was just after moving rooms. I called the nurse to get help getting things, I had a really bad tear and had not been out of bed yet and did not want to try that on my own with the baby...anyway she said she was not there to care for the baby, that was my job. I was to tired to be mad. She refused to do anything for the baby except the first bath and putting the kidnap monitor on her leg.

[Annie Laurie]

:iagree: I was an RN on an OB unit for some years and later a travel nurse. This kind of thinking is part of the mindset that encouraged me to attend midwifery school. It does exist. And no matter how wonderful YOU might think your hospital birth experience was, there are likely more than a few instances you were completely unaware of when your choices were mocked or disregarded without your knowledge or when you were manipulated into something just because the nurse or dr wanted things that way.

 

I agree with you. I just posted about how positive my hospital experience in TX was, but it was positive for a hospital birth experience. I still had a nurse who tried to boss me around about breastfeeding and I knew enough about it to ignore her bad advice, and there was another instance where a nurse was upset the baby was sleeping on my dh's chest instead of in the rolling plastic thing. I have had 3 home births since then.

 

I think that one reason my hospital birth experience was mostly positive, was because I had a highly respected OB who was also very into natural birth and holistic medicine, so she supported everything I was doing that was perhaps unusual in a hospital birth.

[Kate CA]

My bad experience was the opposite. DH went to get some food and take a.shower. etc. A few minutes after he left, DD wet her diaper and spit up everywhere. This was just after moving rooms. I called the nurse to get help getting things, I had a really bad tear and had not been out of bed yet and did not want to try that on my own with the baby...anyway she said she was not there to care for the baby, that was my job. I was to tired to be mad. She refused to do anything for the baby except the first bath and putting the kidnap monitor on her leg.

 

Wow, classy service. Good grief. :glare:

[swellmomma]

After giving birth in an ambulance due to a hospital kicking me out claiming I was not in labor I can see them a) doing something like this and b) trying to them CYA against medical malpractice. If this story is true there will be no comments/statements from the hospital until it is over based on their lawyer's advice.

 

HSLDA explained that though this is not a homeschooling matter they feel it is connected because it is an erosion of parental rights.

 

Living in Alberta right now with a gov't that is trying to strip parents of their rights slwoly and surely I can see how the concern is far reaching even if not specifically homeschooling connected.

[swellmomma]

Personally, I think the problem is much bigger than that.

 

Yes, a mother who comes into the hospital in a non-traditional way will be flagged, regardless of whether she had a planned homebirth, received prenatal care yet had a super quick labor, or didn't bother to seek any prenatal care. There is a lack of discernment there on the part of *some* medical professionals. If she then makes other non-traditional choices (no vitamin K, no immunizations, wanting to check out prior to 48 hrs, etc), then that provides the added evidence to corroborate the initial suspicions.

 

However, there is a systemic problem where *some* medical professionals working L&D/NICU genuinely believe that they are in charge of all newborns until they (the med. professionals) choose to release the child to their parents. It's not just that they disagree with declining vit-K (for example), but they genuinely believe that the parents do not have the right to make that decision for the newborn. You don't have guardianship of your child until they decide that they think you are a fit parent. The parents aren't in charge of that newborn until they choose to discharge him. Have you ever had a parent with a preemie talk openly about what it was really like to deal with the NICU, especially if it was an extended stay? The territorial issues that come up over non-medical parenting decisions (bottles, formula, paci's, frequency of visits, etc) are truly mind-boggling. There is a huge power imbalance when someone has the authority to hold your newborn and separate you from your newborn for any cause or no cause.

 

This is where L&D/NICU differ from pediatrics. If you check your older baby or child into the hospital nobody questions that as the parent it is your right to make decisions for your child. The expectation is that a parent will remain with the child at all times (except when actually in surgery) and will be consulted for all medical decisions. With a newborn, however, the mother is considered a patient herself and therefore incapable of making decisions. The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers. There is a huge power imbalance in L&D/NICU that doesn't exist anywhere else in the hospital system.

 

I truly believe that no one is treated as badly in a hospital as laboring/post-partum mothers. Nobody.

 

:iagree:I have lived it. Nursezilla is one I will never forget from my delivery of dd12. And you are absolutely right about the NICU. By the time I had my 4th I knew what I wanted in those first hours/days for baby. DD4 was in the NICU after being born in the hospital. As they wheeled her down the hall away from me I was yelling down to them my "orders", Then as the nurses were working to stop my hemoraging I was making them phone the NICU in front of my to repeat those orders, and as soon as they got mt hemorraging under control I had them take me to the NICU. 1 nurse tried to bar my entrance despite another nurse wheeling me in. The same one later flat out called me stupid for not letting them give her a bottle and the list goes on. Thankfully the hosptial was more worried about keeping me happy to avoid a lawsuit than in fighting me about dd.

[MinivanMom]

My bad experience was the opposite. DH went to get some food and take a.shower. etc. A few minutes after he left, DD wet her diaper and spit up everywhere. This was just after moving rooms. I called the nurse to get help getting things, I had a really bad tear and had not been out of bed yet and did not want to try that on my own with the baby...anyway she said she was not there to care for the baby, that was my job. I was to tired to be mad. She refused to do anything for the baby except the first bath and putting the kidnap monitor on her leg.

 

:grouphug:

 

Yet I'm not sure that a neglectful nurse is the opposite of an overbearing nurse. You were dealing with a nurse who had decided what you should be able to do and refused to listen and help. The opposite would be a nurse that was willing to listen when you explained that you were in pain from your tear and needed help. A good nurse would have met your needs even if it wasn't something she typically did. Many of us have experienced overbearing nurses who had decided that we were not capable of caring for our babies, nursing, rooming-in, etc. The opposite would be a nurse who is willing to listen when we say we're feeling great and want to care for own baby.

 

The overbearing nurse and the neglectful nurse are more similar than different. They are both unwilling to listen to the mother, because they are convinced that they know best.

[beaners]

I try to refrain from being lured into sensational stories, BUT... PA hospitals, particularly on the east side of the state, are notorious for "punishing" planned homebirths or any other non-mainstream medical choices.

 

And from what I've heard out this way, they aren't any better on this side of the state for homebirth.

 

Our local hospital freaked out when I tried to go home after 24 hours. I didn't try to home birth, had all the regular prenatal care, and a super quick easy labor. My huge mistake was passing on the parenting class they offered and being excited to go home :glare: This was my youngest child (child number three), I felt like I knew how to change a diaper at that point and my doctor had told me that I didn't have to stay for 48 hours (which I'd done with the older two) if I didn't want to. The hospital staff gave me the worst time for that.

 

So, it doesn't suprise me to think of staff being, in general, against parents for having the audacity to think they could parent. It doesn't surprise me they would push for an extra day with no reason other than it's s.o.p.

 

I was given similar treatment after my second was born because I wanted to leave at 24 hours. I was lied to about how serious bilirubin levels were. I was told that no one is allowed to leave at 24 hours. I was told the pediatrician didn't want to let me leave when I was already told we were fine. One nurse badgered me about HepB constantly, and I wouldn't have been surprised if she had it done without my consent. I "wasn't allowed" to go to the nursery to watch while weight checks were done because there were other babies there. I was told that I personally could check out against medical advice (although my OB cleared me? :001_huh:) but if I tried to take my daughter home they would call CPS. It was awful. I was terrified.

 

I ended up traveling an hour away to give birth for my third baby, because my experience was so horrible. I have no trouble believing this kind of horror story, and believing that it could happen through no fault of the parents.

[Quad Shot Academy]

I had something very similar happen when I was planning a home birth, but fell down and had a placental abruption so called 911. I was forced into doing many things to my baby that I would not have done otherwise. The nurse kept telling me that if I did not do x, y or z, it would be neglect. She also kept telling me that something was very wrong with my baby, that he had to be taken to NICU for X, Y and Z. She would take him for hours and refuse to return him. Every time I talked to his ped., he told me nothing was wrong and there was nothing noted in his chart. It became obvious that the nurse was trying to get me to react badly so she could report me. I believe every word of the article.

[mommaduck]

The standard of care is for newborns to be automatically separated from the mother after the birth, which places the nurse in a position of authority over the newborn with all decision-making powers.

Thankfully, this is turning around. Most of my babies that were born in the hospital never left my room or my side.

[spaceman]

I believe it. The birth of one of my children was similar, though about 10 times less intense. We caved and got shots so everyone would play nice. We just wanted to go home. We also "had" to stay at the hospital for 48 hours...in our case no one threatened about the law, but did explain that leaving against the wishes of the hospital would likely have our insurance denying claims for the birth...leaving us completely financially responsible (after we had paid in cash for a midwife).

 

 

This is a very sad story. I am happy she was returned and it didn't get worse

[ClassicalTwins]

There is now a news story

 

http://www.whptv.com/mediacenter/local.aspx?videoid=3388512

 

On the left there is a link "Hospital Violates Rights"

[swellmomma]

I find it funny this 48 hour business. When I had my 2nd (my only non-NICU baby) I was discharged with baby 12 hours after I gave birth. She was born at 1035pm, I had significant tearing, she was a vacuum extraction etc. We were in the car driving home by 11 am the next morning.

[BlsdMama]

I believe it. We refused the Hepatitis B vaccine and wanted to leave before the 24 hour mark. We were told we would have to come back to do PKU. Yes, we understand. We were told they would release me, but not the baby. The baby was full term and over eight pounds and nursing well. Hm? I said I'd sign the AMA form. APGAR scores were 9 and 9 I believe. Then the doctor said we'd have to bring her back for a bili test. Fine. I agreed to all of these things. Ultimately we even agreed to stay 'til 24 hours but steadfastly refused to stay 48.

 

However, as a parting shot, she let me know that if I did not come in over the weekend to do a bilirubin check she would call the authorities and have them come and take the baby so that they could do the bilirubin check.

 

The irritating part? Bilirubin doesn't hit it's highest points until about four days after birth, not at 48 hours so really it was just exerting control.

 

She won, of course. Like we were going to risk it. But she was certainly on a diety trip. And this in Oregon.

 

What it REALLY was was a large family bias as she had to toss a couple shots in there about her concern about me being able to handle a new baby with that many children at home. I think I managed to control myself quite well but I was beyond livid. I have often thought of going in after the fact and sitting down and speaking with her away from the heat of it all.

 

I miss MY pediatrician from home. :(

[In The Great White North]

I find it funny this 48 hour business. When I had my 2nd (my only non-NICU baby) I was discharged with baby 12 hours after I gave birth. She was born at 1035pm, I had significant tearing, she was a vacuum extraction etc. We were in the car driving home by 11 am the next morning.

 

:iagree: I was "volunteered" (without my knowledge or consent) to a trial program and sent home the next morning.

[ClassicalTwins]

the 48 hour business started with HMO's discharging moms too quickly, generally less than 24 hours and either mom or baby would get sick and have to come back. So there is some sort of mandate/law/requirement that the insurance company can not make mom leave before 48 hours. Now, I do not know if the Dr can choose to OK mom to go. The malpractice lawsuits are the highest in the OB area so my guess is the Dr is going to error on the side of "best practice" and standards as to not be sued.

 

I was a NICU nurse and that is one area where you meet many,as I called them "mothers of the year"= drugged out crack heads. But they were quite different than how I'am picturing this mother & family.

 

Now, from a personal touch. When my twins were born, one had a birth defect (unable to be detected before birth) that had we not been at a hospital with a Level 3 NICU, he may or may not have made it. But, the twin that went to the regular nursery...I'll never forget. Of all people to be nasty was the lady from the photo company. I was very ill the next morning having hemmoraged after they were born. I wanted him to have on a certain outfit for his picture and she wouldn't wait to take the picture later in the day or the next so I could have my hubby dress him, since I couldn't :crying:

 

I still to this day can not forget how hateful and nasty she was to me. I know at the time I probably looked like a teenager who didn't know anything but instead I was a very sick, scared, 27 yr old mom (a neonatal nurse) who had just had the worst 24 hours of her life, when it should have been one of the best.

Edited March 30, 2012 by ClassicalTwins

[Rbsmrter]

All of these stories make me so grateful for my positive hospital experience. With my first child I made a lot of mainstream choices, but with #2 and #3 my choices were a bit different. I was allowed to leave after 24 hours without any hassle. I don't think they would have let me do it after my first child, but I stuck with the same OB for all three pregnancies and she was more than happy to release me as soon as I felt ready.

 

I think the baby seperation thing varies among hospitals. At my hospital the baby stays in the mom's room the entire time. Only under special circumstances will a baby be allowed to leave. Even then, the baby is just wheeled to the nurses station or the NICU (there was no general nursery). Only one of my babies ever went to the nursery and they specifically asked me if it was ok to give them a bottle. I said no, and they wheeled the baby back every 2 hours, whether or not she was sleeping. They also let me cosleep without a problem. Techincally they weren't supposed to, but as long as we were sleeping and content they never bothered us.

 

A huge factor in all of my births was establishing a relationship with my OB. She's seen me through all of my deliveries and was more than happy to advocate for anything I wanted. I've never had a strict birth plan, but there were a few non negotiables for me and they've always been respected. Despite some of my more "crunchy" choices I've never had a desire for a homebirth or a birth in a facility other than a hospital, but if I ever experienced some of these situations I imagine my choices would change considerably.

[Moxie]

All of these stories make me so grateful for my positive hospital experience. With my first child I made a lot of mainstream choices, but with #2 and #3 my choices were a bit different. I was allowed to leave after 24 hours without any hassle. I don't think they would have let me do it after my first child, but I stuck with the same OB for all three pregnancies and she was more than happy to release me as soon as I felt ready.

 

I think the baby seperation thing varies among hospitals. At my hospital the baby stays in the mom's room the entire time. Only under special circumstances will a baby be allowed to leave. Even then, the baby is just wheeled to the nurses station or the NICU (there was no general nursery). Only one of my babies ever went to the nursery and they specifically asked me if it was ok to give them a bottle. I said no, and they wheeled the baby back every 2 hours, whether or not she was sleeping. They also let me cosleep without a problem. Techincally they weren't supposed to, but as long as we were sleeping and content they never bothered us.

 

A huge factor in all of my births was establishing a relationship with my OB. She's seen me through all of my deliveries and was more than happy to advocate for anything I wanted. I've never had a strict birth plan, but there were a few non negotiables for me and they've always been respected. Despite some of my more "crunchy" choices I've never had a desire for a homebirth or a birth in a facility other than a hospital, but if I ever experienced some of these situations I imagine my choices would change considerably.

 

 

It does all come back to relationships, doesn't it? My OB has 5 kids of her own; she understands that "relaxing" in the hospital after giving birth is more stressful then being at home to keep an eye on things. Were I to plan a homebirth, I think I would still try to have a good relationship with a doctor (ped or OB) as a Plan B.

[lionfamily1999]

It does all come back to relationships, doesn't it? My OB ... I think I would still try to have a good relationship with a doctor (ped or OB) as a Plan B.

I loved my OB with my oldest and my youngest dc. My middle dc's OB was not cleared for the hospital he was born in, but the doctor that delivered him was great, really nice.

 

In none of those situations did my OB have anything to do with the hospital staff. With my two older dc I was treated like carp, because I was young. With my middle dc the nurse didn't want to allow my dh in the room, because she didn't believe we were married. He brought in our marraige license (the fact that we share a last name should've made it obvious in and of itself, but :eh:) to gain admittance :glare: My youngest was nearly born before the OB arrived (the nurses were freakin' out, I was the calmest person in the room) and even though she backed me up twice on leaving within 24 hours, she told me it would not be up to her if ds could go home.

 

You could be married to your OB and it won't have so much bearing on the hospital staff. They don't answer to the OB. All the OB can do is clear you to go home. They've got nothing to do with the baby once it's born.

 

Ymmv

[Spock]

After giving birth in an ambulance due to a hospital kicking me out claiming I was not in labor I can see them a) doing something like this and b) trying to them CYA against medical malpractice. If this story is true there will be no comments/statements from the hospital until it is over based on their lawyer's advice.

 

HSLDA explained that though this is not a homeschooling matter they feel it is connected because it is an erosion of parental rights.

 

Living in Alberta right now with a gov't that is trying to strip parents of their rights slwoly and surely I can see how the concern is far reaching even if not specifically homeschooling connected.

 

I had a hospital insist I was not in labor, too (with my second). Since I had an appointment for a prenatal check-up there later that week (because he was overdue), they did an ultrasound "so I wouldn't have to come back later for that". The ultrasound indicated problems from being overdue, so they wanted to induce labor. They pressured me quite a bit for refusing to accept medications to induce labor, until my mother convinced them to check my dilation, etc. Then, they finally accepted that I was in labor. He was born about 2-3hrs later.

[Spock]

I believe it. The birth of one of my children was similar, though about 10 times less intense. We caved and got shots so everyone would play nice. We just wanted to go home. We also "had" to stay at the hospital for 48 hours...in our case no one threatened about the law, but did explain that leaving against the wishes of the hospital would likely have our insurance denying claims for the birth...leaving us completely financially responsible (after we had paid in cash for a midwife).

 

 

This is a very sad story. I am happy she was returned and it didn't get worse

 

For my first and third babies, I was told that it was mandatory to leave after 24 hours--no staying extra unless there was a medical reason. I don't remember about my second or fourth.

[MinivanMom]

I loved my OB with my oldest and my youngest dc. My middle dc's OB was not cleared for the hospital he was born in, but the doctor that delivered him was great, really nice.

 

In none of those situations did my OB have anything to do with the hospital staff. With my two older dc I was treated like carp, because I was young. With my middle dc the nurse didn't want to allow my dh in the room, because she didn't believe we were married. He brought in our marraige license (the fact that we share a last name should've made it obvious in and of itself, but :eh:) to gain admittance :glare: My youngest was nearly born before the OB arrived (the nurses were freakin' out, I was the calmest person in the room) and even though she backed me up twice on leaving within 24 hours, she told me it would not be up to her if ds could go home.

 

You could be married to your OB and it won't have so much bearing on the hospital staff. They don't answer to the OB. All the OB can do is clear you to go home. They've got nothing to do with the baby once it's born.

 

Ymmv

 

:iagree:

 

Your ob can be an advocate for you while in labor or post-partum, but they have absolutely no say over that newborn. If you have a good relationship with your pediatrician and your pediatrician has privileges at the hospital then they can help. Unfortunately, even pediatricians with privileges are only at the hospital first thing in the morning to check the babies and if they are part of a group practice then you might be dealing with a different pediatrician if it isn't your dr's turn for rounds. The other 23 hrs of the day all power resides in the nurses and/or the staff pediatrician on duty.

 

With my first I was discharged at 36 hrs after an exhausting 3-day long labor. I wanted to stay longer, but they implied (without outright lying to me) that I wasn't allowed to stay a full 48 hrs. With my second I had a very quick, easy labor (same hospital) and wanted to go home after 24 hrs. My ob okayed it and so did my pediatrician with the caveat that no problems come up with the baby. The next morning a different pediatrician from the practice was doing rounds instead of our primary doctor. He flipped out at the idea that such a young mother (I was 26) would be allowed to leave and insisted that the baby had to stay a full 48 hrs. I very politely stood my ground, so he started running every test he could come up with to try to find something wrong. He ran bili tests multiple times and even the nurses were rolling their eyes at that point. I signed ds out AMA at the 24 hr mark. It never occurred to me that medical insurance might not pay or that CPS might be called. The dr was just being a jerk. Luckily, none of those things happened.

 

The reality is there is only so much you can do in terms of choosing your provider and building good relationships. At the end of the day, you are dealing with hospital staff. You can't choose the hospital staff and they outrank any private practice ob or pediatrician who merely has hospital privileges.

[Moxie]

:iagree:

 

Your ob can be an advocate for you while in labor or post-partum, but they have absolutely no say over that newborn. If you have a good relationship with your pediatrician and your pediatrician has privileges at the hospital then they can help. Unfortunately, even pediatricians with privileges are only at the hospital first thing in the morning to check the babies and if they are part of a group practice then you might be dealing with a different pediatrician if it isn't your dr's turn for rounds. The other 23 hrs of the day all power resides in the nurses and/or the staff pediatrician on duty.

 

With my first I was discharged at 36 hrs after an exhausting 3-day long labor. I wanted to stay longer, but they implied (without outright lying to me) that I wasn't allowed to stay a full 48 hrs. With my second I had a very quick, easy labor (same hospital) and wanted to go home after 24 hrs. My ob okayed it and so did my pediatrician with the caveat that no problems come up with the baby. The next morning a different pediatrician from the practice was doing rounds instead of our primary doctor. He flipped out at the idea that such a young mother (I was 26) would be allowed to leave and insisted that the baby had to stay a full 48 hrs. I very politely stood my ground, so he started running every test he could come up with to try to find something wrong. He ran bili tests multiple times and even the nurses were rolling their eyes at that point. I signed ds out AMA at the 24 hr mark. It never occurred to me that medical insurance might not pay or that CPS might be called. The dr was just being a jerk. Luckily, none of those things happened.

 

The reality is there is only so much you can do in terms of choosing your provider and building good relationships. At the end of the day, you are dealing with hospital staff. You can't choose the hospital staff and they outrank any private practice ob or pediatrician who merely has hospital privileges.

 

This hasn't been my experience. My ped. knew I wanted to leave at 24 hours. When the visiting ped. balked at that, I informed her that my ped. okayed it and she could call him. She did call him, he said it was okay, we left with no issues. My experience is that my OB and my ped. make the call and are "on the hook" if things go bad so the hospital doesn't care.

[Alice]

I wonder all this because I recently listened to a Grand Rounds presentation about a child who presented with a particular complaint, but who the staff suspected was being seriously abused. (The father ultimately admitted to the abuse.) It made me wonder how a hospital goes about dealing with that - they needed to do x-rays to investigate broken bones, etc., but it didn't sound like they got parental permission to do so (or maybe they did on some pretense), and it made me wonder if there is a legitimate/legal procedure that hospital staff can go through when there are such suspicions, or if they have to figure out back-door work-arounds. The Grand Rounds was from the perspective of the doctor, and the HSLDA story sounded very similar but from the perspective of the parents. In other words, under what circumstances *can* a hospital say "we're hanging on to this child for observation and tests for 48 hours", and under what circumstances can they do tests without permission? Anyone know?

 

Most of the time we will tell parents what our concerns are and what tests we are doing. We wouldn't do tests without a parent's knowledge. If there is a high suspicion for abuse CPS would be contacted. CPS typically then orders further tests. Every hospital has legal and ethical committees that can aid in these kind of decisions. Legally we can't just do a test without knowledge and consent, it would be the same as assault.

 

I suppose that doctors could say "we just need to do further testing" without saying what they are testing for. However, my experience (both personally and observing other docs) is that we say something like "The kind of injury that X has is very concerning for intentional abuse. As a medical professional I am required by law to report this injury to CPS. I'm not making any judgement about how it might have occured but I am required to report it. It is also important that we do _______ testing in order to make sure there aren't other injuries typically seen in this kind of setting. This will help us take care of X better and also help us determine how likely it is that this injury was intentional." Obviously, if I was talking to a real parent I'd be more caring and less formal. My experience has been that even in situations where parents were the abusers they consent to the testing. I think partially they don't fully realize what that might mean (like a criminal who doesn't think they will be caught) and partially that they realize that if we are reporting to CPS it will be done anyway.

 

There is now a news story

 

http://www.whptv.com/mediacenter/local.aspx?videoid=3388512

 

On the left there is a link "Hospital Violates Rights"

 

Yes, but if you watch it the information is all taken completely from the HSLDA email. There is nothing new other than that the hospital says it disagrees with the description of events.

 

I find it funny this 48 hour business.

 

the 48 hour business started with HMO's discharging moms too quickly, generally less than 24 hours and either mom or baby would get sick and have to come back. So there is some sort of mandate/law/requirement that the insurance company can not make mom leave before 48 hours. Now, I do not know if the Dr can choose to OK mom to go. The malpractice lawsuits are the highest in the OB area so my guess is the Dr is going to error on the side of "best practice" and standards as to not be sued.

 

 

 

There are two reasons for the 48 hours. The first is that insurances were trying to insist that babies be discharged early. The law was made that all insurances must pay for at 48 hours for a vaginal delivery and 96 hours for a C-section. However, there is no mandate that you stay that long. They just can't make you leave before that if you want to stay. I routinely discharge people before 48 hours and it's very common at all the hospitals I go to.

 

The second reason is for GBS. GBS is a bacteria that many women carry and that cause serious illness in babies. If a Mom is GBS positive then she is typically given antibiotics during delivery which decreases the risk of the baby being infected. If she does not receive antibiotics (or even sometimes if she does) it is still recommended to somehow monitor the baby. Some hospitals/doctors will do blood counts on the baby, some will monitor the baby for 48 hours. The reason of the 48 hours is that the vast majority of GBS illness will present in the first 48 hours so if the baby is still fine at that point, you can be fairly confident that it's ok. (There is also a late onset GBS infection that occurs weeks later but that's a different animal altogether).

 

My guess is that in this case and in other homebirth planned cases that there is less of a chance that the Mom had GBS testing. She certainly did not receive antibiotics before delivery. So I'm guessing that the recommendation to watch for 48 hours came from not knowing the GBS status. The email talks about testing the baby for GBS which can't really be done so doesn't really make sense.

 

For my first and third babies, I was told that it was mandatory to leave after 24 hours--no staying extra unless there was a medical reason. I don't remember about my second or fourth.

 

This is not true and is in fact illegal. Some insurances (one in particular around here) and some hospitals (one around here will try to do it) will try and tell you that you have to leave but you do not. You can leave after 24 hours but your insurance must pay for 48.

 

The other 23 hrs of the day all power resides in the nurses and/or the staff pediatrician on duty.

 

At the end of the day, you are dealing with hospital staff. You can't choose the hospital staff and they outrank any private practice ob or pediatrician who merely has hospital privileges.

 

This should never be true and is not how hospital privileges work. As a pediatrician who is the attending for a baby everything that happens with that baby is ultimately my responsibility. My name is on the chart and I am legally responsible. Certainly I'm not there but the staff absolutely does not outrank me. The staff pediatricians should only be involved with babies under my care if I ask them to be, for example if I get a call that there is a concern and I can't get there.

 

As for the HSLDA case, I'm always a little skeptical of cases like this where we can only hear one side of the story. I can see it happening, at least in part but there are some giant holes in the story as told. I can also think of many times where a case like this comes out that sounds so obvious but then when more information comes out it sounds different. I think HSLDA does good work but I also think they have a very specific agenda and are not above making the facts fit their agenda.

[Rbsmrter]

This should never be true and is not how hospital privileges work. As a pediatrician who is the attending for a baby everything that happens with that baby is ultimately my responsibility. My name is on the chart and I am legally responsible. Certainly I'm not there but the staff absolutely does not outrank me. The staff pediatricians should only be involved with babies under my care if I ask them to be, for example if I get a call that there is a concern and I can't get there.

 

This is so reassuring to hear from a pediatrician. Some of these stories about nurses have left me completely baffled. If I ever had an issue with a nurse, my OB and the baby's pediatrician absolutely advocated for us and worked together to make things happen in a way that was best for me and my baby. The nurses never had any say over me or the baby without the doctor's consent. Both my OB and the pediatrician had privliges at the hospital and had established great relationships with the staff. They always worked together and I never experienced any disagreement or discord. It scares me to hear about situations where nurses are making decisions and calling shots without a doctor's approval, especially a doctor that has established a relationship with the patient.