Discharge procedure after birth

[crustyornommed]

Hi All,

I'm trying to sort out childcare for my DD while I'm having DC2 and I've got a slightly odd query. If you discharge yourself, or are discharged as medically fit, but they need to keep the baby in, what happens? When I had DD I was kept in a second night because there was no paediatrician to sign off her paper work and though I've got no problems with discharging myself from hospital, I wouldn't have the confidence to do that with a baby. I've googled and there's a lot of references to what happens if you discharge yourself AND the baby against medical advice, but I can't find any information on what happens if you need to be separated, if you're fit to leave but the baby can't yet, iyswim. Can your partner stay instead and the baby be transferred to a paediatric ward? Just wondered if anyone had any experience of this.

[mayhew]

In our unit, if a baby is well but there is a delay in discharge for organisational reasons, they can go home and come back for a booked appointment with paediatrician. Ie 2nd baby, want to go home same day.

[Me23]

If you are baby are well you can be discharged 6 hours after the birth mws or neonatolgists wait until the baby is at least 6 hours old before doin the examination of the newborn.
However if no one available to do this or you want to leave before this you can self discharge both of you and have baby's exam done by the GP (this is what wha happen with homebirths) if something was wrong with baby they would be in the neonatal unit and you could discharge yourself home. Where I am the neonatal unit has 24 hours visiting so the father could stay with the baby (but wouldn't get a bed or anything)
Are you and the father together? Can he not look after your dd?

[crustyornommed]

Thanks Mayhew & Me,

This is good to know- I thought for a while there that I was coming right out of left field! I'm just trying to get my ducks in a row as it were and my hospital is a bit poo at communications so I'm not sure what the situation is there. DD's dad can certainly look after her but only to a point and we've no back up other than formal nursery - with its equally formal hours! I've heard of women having to stay days with a baby on the ward when they themselves are fit to go, and in our situation it would be better if we could split the visiting and care of DD between us in that case. (I'm not worried about DD's dad frankly doesn't deserve a bed at this point, but that's a whole other story)

[VivaLeBeaver]

Where I work if the baby needed to stay in for a medical reason but isn't sick enough for scbu then they stay on the postnatal ward with the mum. A dad wouldn't be able to stay with the baby on the postnatal ward overnight.

If a mum couldn't stay then the baby would be transferred to scbu rather than a paediatric ward. Parents can visit 24/7 but don't have a bed there.

[OrlaKiely]

paperwork seems to be a big issue in this

I had ds3 in January and he was born at 1am, no complications...we sat around till 5pm waiting for permission to leave.

It was really, really boring and upsetting. Just that there was a chain of people who needed to get the paperwork completed before they could 'let' us go. And I forgot my mobile so couldn't ring up anyone to come and rescue us.

[drcharliegirl]

Different scenarios: paediatrician not available to fill in paperwork - discharge yourself and baby and return the next day/to GP to get baby check signed off (you take the risk that the baby has a significant problem that you can't detect and gets sick in that 24h period).

Second scenario: baby needs to stay in (eg for antibiotics) but you don't. Expect some eyebrow raising if you try to discharge yourself. People will be shocked you don't want to be there to feed/be close to your baby. You may have your reasons but will have to defend them robustly. It costs many hundreds of pounds a night to keep a baby on the NICU and few places will do that willingly for what they see as an unnecessary baby-sitting service. Perhaps worth discussing your reasons with your midwife in advance so a plan can be made and there is no stress on the day?

DOI: work in a NICU

[drcharliegirl]

PS a parent is expected to stay with a baby on a paediatric ward. Not the case on the NICU

[brettgirl2]

They often keep people completely unnecessarily (your paed check being one) If they say you have to stay on post natal ward ask them why. There isn't always a good reason.

For example, if there is meconium at delivery and baby is fine they made my friend stay in. It happened at my homebirth and I was told by the midwives no need to go in. Another kiddie told me someone had discharged themselves from the ward a few days ago for this.

My second daughter was admitted for weight loss. I started until all the tests had been done but when they said I needed to stay in so she could be weighed the next morning I agreed to take her to clinic in the morning and discharged us.

You can discharge a baby but obviously only if they are just being ridiculous. If they really need to be there is different.

As I understand it no one under registrar is allowed to do anything that isn't in a set procedure. When I discharged us the registrar would have probably let me go home but we were too low priority to be seen by him. The SHO couldn't authorise it.

[brettgirl2]

Another midwife

[VivaLeBeaver]

Where I work we used to be happy to discharge mec babies straight away if ok at birth. However there's now new research saying we should monitor them very closely for 12 hours. We now have a form with a list of obs that need doing at certain times.

[crustyornommed]

Crumbs ! Lots of different practices there. I guess it's going to depend on what the specifics are here. It's hard to find out any info here as I've only managed to see a midwife twice this pg- once at booking in, once just after the 20 week scan and the community midwives aren't the same as the hospital ones. Arg! I guess in terms of planning we could assume that if scbu is called for then that's one thing, if they do transfer to a paediatric ward then either if us can stay and if its postnatal then DH could look after the baby during the visiting hours - 8-8 I seem to remember - and then I could click back in for night duty. Does that sound doable? I guess I'm over thinking this its just we really need plans a and b for looking after dd and with only 2 of us, that's quite difficult. We have no family or friends here so we really do play pass the parcel with the poor kid!

[drcharliegirl]

I wouldn't risk taking my baby home before 12 hours if there had been thick meconium at delivery. (thin is different)
Weight loss is usually a readmission thing (babies are weighed at day 5) and there are some tests that need to be run, but usually babies are kept in so that mums can get extra support with breastfeeding.

Please understand that no one is trying to be "ridiculous" - they only have the safety of you and your baby in mind. In some states in the US it's expected (and I think legally binding) that you stay in hospital 5 days!

There are various cardiac abnormalities and infections which turn up during the first 24h most commonly. Not to scare you, but they can be devastating and if you're a long way from a hospital with a decent NICU your baby could be in trouble. Obviously it's a risk you take if you have a homebirth or if you have a discharge at 6 hours or before your paediatric check.

FWIW, I'm a paediatrician and I would go home at 6 hours (live round the corner from an excellent hospital, and consider myself as capable of spotting the early signs of trouble as any hospital doctor or midwife). But there is nothing that would make me take my baby home in the first 12-24 hours if there were risk factors for infection or thick meconium at delivery.

Hope that helps.

[brettgirl2]

I imagine it was thin then but they still keep them as matter of course.

Personally I think it is ridiculous to be kept in overnight just so baby can be weighed. Especially when there is noro in the next ward.

[crustyornommed]

Hi both, thanks for this. Just to clarify I'm not going to take the baby away against medical advice, if it can't be discharged then it stays period. I'm just after trying to get my head round a pattern of care that my dp and I can manage. Hopefully it won't come to any of this but I feel like I need to know how to go about sorting it all out if it does!

[VivaLeBeaver]

Can your dp not look after dd. or is he not dd's dad?

[crustyornommed]

Hi viva - yep he's responsible for both of them :-) and with this one he's bloody well doing his share of the work (lol)

[VivaLeBeaver]

So why can't he look after dd?

[bsmirched]

We're in a similar position re childcare so DS1 will go to nursery during the day so DH can visit me and DS2 then go home to collect DS1 from nursery and look after him (and our 2 dogs!) overnight. Is this not possible.?

[crustyornommed]

Of course he can and does, and if its only a few hours or whatever that's fine but if I was in for days, we'd have to find a more equitable way to sort things out than my staying permanently with a baby while he looks after dd. that's not fair on dd for a start. He already can't attend the birth of this baby because we have no childcare so we're a bit stuck!

[crustyornommed]

Hi bsmirched,

Yes on some days it might be, but dd doesn't go to nursery every day and they can't change her days without 28days notice. So it depends what day or the week we're on. Hence berserk contingency planning !

[VivaLeBeaver]

That's a shame he can't attend the birth, for both of you.

Have you thought about asking one of the workers from your dd's nursery if they fancy earning some extra money by baby sitting during the birth? I've seen people on mn do that before.

Hopefully neither of you will have to stay in ater the birth.

[ClaimedByMe]

Why can't he look after your dc1 for more than a few hours? I have read this thread a few times and can't understand it. What happens if you need to be kept in hospital for a few days who can look after her then?

[Jollyb]

What about a home birth? Could you afford an emergency nanny for a few days? It seems a shame for him to miss the birth.

I'm going to be having an elective section with DD2 and as much as I will miss being with DD1 when I'm in hospital, I've accepted that the newborn is going to have to take priority for a few days (or weeks).

[crustyornommed]

A home birth would be great if we could rely on it going to plan I guess-but then there's what do you actually do with a toddler whilst screaming your head off through contractions? i couldnt see how to avoid that possibility. That plus the fact that I cant get to see a midwife here puts me off. we've tried everything to get child care so Dp can come to the birth but no it's no dice without a date or a few dates together. dd was 40+ 14 when i gave in to an induction. this one comes when its ready but it does mean we have a potential 4-5 week window (38-43 weeks) when if could happen so we've come to get our heads round the fact it's just me.

I do worry about what happens if I'm injured or sick and have to stay in, but its rather in the same level of what happens if I get run over/seriously ill/ attacked by zombies. There's nothing I can do in that instance. I'm trying to plan for the contingencies I can. Yes I've heard the argument that newborns should take priority over older children but never understood it really. Newborns' needs are so basic if demanding and can be met by anyone. Toddlers have emotional needs rather than merely physical ones. My DP can look after a baby on a ward just as well as I can. Why shouldn't he have to prioritise his 2nd child?

[drcharliegirl]

you'll have to look up local policy. Our paediatric ward doesn't take children less than 5 days old (they go to NICU) and that would mean negotiating your special circumstances with the NICU to get the nurses there to essentially provide childcare for your new baby. I suspect you'll find some resistance there, so hopefully baby won't need to stay in over night. Obviously the NICU have to prioritise sick babies on the basis of clinical need and their services are always stretched. I would call Monday morning to your midwife as a matter of urgency - they may have better ideas about managing your childcare at short notice (this can't be the first time it has happened). Have you looked at sitters.co.uk? They do emergency nannies and babysitting...