Should mothers go home ASAP after delivery?

[mears]

As promised I have started a new thread on this. I am involved in the planning of a new maternity hospital. Ours is going to move to be near a general hospital for emergencies.
The plans are that there will be rooms that you deliver in then go home after 24 hours - sooner if possible, all being well. Some midwives are horrified that women will be going home too soon - especially those who have other children and perhaps need the rest.
Does anybody feel that they would have liked to stay longer? Did anyone feel 'kicked out'.
Is there a need to be in hospital after an uncomplicated birth?

Well, I was in for five days with my first daughter and less than 8 hours with my second. I LOVED being able to go home so quickly, I had a very uncomplicated birth and just couldn't wait to get home for some home cooking and a good sleep in my own lovely bed. I had a fairly helpful dp and a very unhelpful 3 year old but I really made an effort to stay in bed once I got home although physically I felt fine, a bit battered and bruised but nothing too horrendous.

I did end up with 'retained products' though, but I don't think they could have diagnosed this if I had stayed any longer in hospital.

mears, I've heard of this type of set up, and before I had ds, I was fairly cynical about it.
However, given my experience with ds, I now feel it would have been just what I wanted.
My experience was this - I arrived at hospital about 2.5 hours before ds was born. I had a very straightforward delivery kneeling on the bed. My only criticism was that the delivery room was very 'clinical' and contained no furniture/props for active labour - just a bed, which I was determined not to lie down on!!
Afterwards I was admitted to the postnatal ward - a four bed ward - at about midnight. Two more women were admitted after me at various times through the night. I had no sleep at all and I wonder who on earth thinks that it is possible to be comfortable in a shared room full of other peoples screaming newborns! I was desperate to be discharged the next day but actually had to fight to be 'allowed' home (I had the postnatal midwife from hell!) My total stay was just under 24 hours.

Next time I would prefer something more like 12 hours (depending on time of birth).

My comments are this:

1. Sharing a ward postnatally is horrible, so if this solution allows privacy that is a definite plus.
2. PArtners should be allowed to stay at all times (including overnight)
3. IMO getting back to a normal home environment as soon as possible is essential. BUT this needs to be backed up by well resourced community midwife support - especially vital for establishing breast feeding (my community midwife was fantastic, the ones in hospital gave no help whatsoever).
4. I don't think I would feel differently if I had other children at home - I'd still want to be in my own bed and with my family around me. Yes support is needed, but I'd have that from DH or others, not from being in hospital cut off from them. So in short, I think it is a good idea, but needs to be backed up by community bf support. I can certainly imagine having a few hours rest after delivery, cuddling up with dh and babe, then all going home together....wonderful! But then I hate hospitals!! Sorry for rambling, but I feel quite strongly about this - my very positive birth experience was nearly ruined by that awful postnatal ward. HTH

mears, I went home at my insistence after 4 days, post emergency c-section. I hated the noise, dry heat, crap food...
but I also worried about infection (midwife's swab at home confirmed staph infection of wound!) and also not being able to get on with being a first-time mum - even more important if you have other kids I'd imagine this time around.
one of my friends was 2 wks early and had no windows in her house so was glad she could stay for 3 nights while they sorted that out!
on balance I'd say if you're well it's good to go home but mums should have input, because they might have lots of fears about coping etc.

With my first baby, episiotomy, epidural I was in overnight. Just couldn't wait to get home and phone everyone.

With my second I was in for 4 hours after she was born. I think that is the statutory requirement. No pain relief, couple of stitches. I just wanted to get home, I was so excited I knew I wouldn't sleep in hospital, but wanted us to be home so that we could all be together.

I didn't sleep all night as I was so excited about toddler meeting baby in the morning! Weird cow - I know.

I don't like to be away from home so the quick visits to hospital suit me best. Also the with first baby, the baby stayed with me in my room and I got no sleep from all of the snuffles, and being a new mum, I didn't know if this was normal or if my baby was choking! Although a night on a ward is no quieter.

I wanted to go home earlier than the required 4 hours with the second, but paperwork took ages. I did bring baby back a couple of days later as there was no paed-n around to do the necessary checks. I felt everything was ok though, I would NOT have left if I didnt think baby was fit and well.

Mears, my mum had me at the British Nursing Home for Mothers and Babies in S London nearly 40 years ago. This specialist unit allowed all new mums to stay for up to a fortnight after delivery and after lunch all beds were wheeled out onto a verandah for fresh air and a nap. Times have changed - the babies were all in a nursery - but she said the excellence of the care from consultants and midwives was wonderful, the food was specially prepared, and every day babycare demos and activities were arranged. It seems to me so many cultures make this kind of support available for families for a period after the birth, it would be wonderful if it could happen in the UK.
I personally didn't feel kicked out but then I was there for a while! Some friends have definitely commented that at the time the ward was quiet and they would love to have stayed longer. I can envisage some kind of low-dependency post-birth unit adjacent to the Maternity facilities would be such a welcome idea for many families.

Elliott the idea of partners staying whenever is all very well. But if you are in a four bed room as you and I were it gives very little privacy to the other Mums. I gave birth to DS at lunchtime having not much sleep the previous night. Then that evening DH went home at the end of visiting but the bloke from the next bed stayed chatting away until quite late while all I wanted to do was sleep. Quite peeved about this. Then of course they were wheeling people into the other two beds through the night. So these are things to be thought about.

I had an uncomplicated birth and was in hospital for roughly 24 hours. I certainly didn't feel kicked out, if I hadn't made it pretty clear I wanted to go home I expect I could have stayed longer. But the (fantastic) midwives were supportive of my decision. Given the choice I would have gone sooner.

a few things I would have liked (not always possible I know):

• informing about what my options were regarding going home, I wasn't really sure what I was waiting for half the time
• more breastfeeding support, perhaps a visit from the breastfeeding councillor. I guess I got it right from the very beginning but no one ever let me know! (mind you everyone else was bottle feeding so perhaps it was such a shock)
• not being at the end of the queue to see the pediatrician before we could go. I had to wait AGES.

Like elliott, I went from delivery into a big room, six people both post- and antenatal. I didn't sleep at all during the night because of the movement and other babies crying. But, actually, I rather look back on that time fondly. I'm not sure how much I would have slept at home, either. I remember holding dd and quietly chatting to one of the pregnant women through the morning hours (in that intense heat of the maternity ward). It was a special time.

And there are advantages to multi-wards. One of my friends was in a single room (in the same hospital, about 2 weeks later) after a section and she felt abandoned - out of sight, out of mind.

But I did resent having dh chucked out at 8pm and not allowed back until 12 noon. I definitely would have preferred it if he could have stayed.

The final thing I was very unsure about was what to do with the baby while I went to the loo, the shower etc. When it's new and your first you feel very unsure about just leaving the cot, however safe you know it is. If dh had been there, I would have felt better. Or if I could have pushed her with me. Or something!

I stayed in for 3 days with my first baby - I knew nothing about babies, had never even held one before, so felt I needed this time to get breastfeeding established and feel (relatively!) confident that I wouldn't do ds any serious harm through my ignorance. They asked if I wanted to go home after 2 days and I opted to stay for another day.

With baby no. 2 I couldn't get out of the hospital fast enough, and went home after 7 hours, which was brilliant. I had a 2 year old at home who needed mummy as much as the new baby, I also had dh and MIL to help me so was fine.

Both situations worked exactly right for me.

I gave birth at 1am and went home at 1pm that day. In fact, my bags were packed by 9am when my hubby came to visit! It was the experience of the hospital brekkie that did it for me! Seriously though, I had an uncomplicated birth, no stitches or anything and my other half is a doctor and had about 3 weeks off so had plenty of help. It worked for me but there are those who need the support of the midwives etc so staying in could be a good thing.....

Mears - Do you're colleagues that believe women need to stay in hospital for the rest actually work in a hospital. In todays NHS with large post natal wards and people being wheeled in and out at all times, and other peoples babies screaming,I don't see how anybody will get more rest than at home, no matter how many screaming toddlers they have.
Having said that, as a first time mother I welcomed the fact I had to stay in hopital in some ways. I got wonderful bf support from one particular midwife who sat with me for about 2 hours during the night providing reassurance that I was doing it right. Always having somebody around to ask questions of was v. useful. Even if you have good community midwife services it was lovley to have the reassurance of somebody who knew what they were talking about telling me that the red rash on my 1 day old babies back was heat rash rather than meningitis - I'm not sure I would have believed anybody telling me to calm down over the phone.
If you could provide me with a private room, decent showers, good food, allow my husband/other kids to visit whenever I wanted then I'd love to stay in hospital for longer.

Bozza, I was assuming that these delivery/extended stay rooms would be private! In fact I don't think anyone should be forced to endure a postnatal stay in a shared ward partly for the reasons you outline.

I went home 48 hours after the birth of ds. I would've have went sooner, but as he was my first they wanted me there 2 nights. I couldn't wait to get out!

I had had no sleep the night before the birth (I was in hospital for a week antenatal with high BP) coz of the snoring women next to me, then I gave birth and ds would not sleep or feed properly!! The midwives wouldn't intervene.

I thought that if I went home at least dp would be able to take ds for a couple of hours and let me sleep!!!!

Next time, if all goes weel I'll be out sooner!

First time round I was in five days with DS1. I was desperate to get home after two days but feeding wasn't going well and he ended up jaundiced and they wouldn't let him out then.

This time I asked to get out after six hours, although immediately after the birth I felt I could have showered and gone home with DH, would this have been allowed? I didn't think to ask.

However they couldn't keep me on the delivery ward as they had inductions coming in in the morning and put me up to the post-natal ward, just as I was dropping off to sleep the cleaners started in the corridor outside and the tea trolley came clinking down the hall, then someone's baby started crying and before I knew it breakfast was served and the midwife was round doing checks, so no sleep! It took so long for all the paperwork and checks on myself and DS2 to be done that I did not get out until over 12 hours after delivery and still no sleep as my DH and DS1 had come to collect me and were waiting too! When we did finally get away a very grumpy midwife told me that I shouldn't be getting out anyway as I carry Group Strep B, as I had only gone into hospital (would have liked a home birth) to get IV antibiotics anyway and would have DS2 to casulty like a shot if there was anything wrong so I just ignored her.

If I have another child and if it is possible I would like to just get showered after the birth and after giving baby a feed pop him/her in their car seat and go home.

Agree with most of the points Philippat has made -had great midwives and really knew very little about babies so enjoyed my 3 night stay. Needed to be shown how to do a nappy, give a bath, when to feed (was told I should have woken her up since she had not fed for 7 hours on day 1) adn didn't feel kicked out. Plus shared can of stout with woman opposite on second night late at night and it felt magical!

I think I wouldn't stay as long if had second child since would know (a little) more about what to do.

I arrived at the hospital 2 and a half hours before dd was born, then because of losing a lot of blood during a manual removal of the placenta, had a private room for 3 days. Even if I hadn't been feeling like a wet rag I would still have wanted to stay for a few days .... it was my first and I didn't have much of an idea about feeding, nappies, bathing etc etc. In fact I would probably have stayed another day if dh hadn't pressurised me into coming home ...
I think you should be allowed to stay if you want to or feel you need to - not for 2 weeks like my mum when she had me - but as long as it takes to feel comfortable about coping with going home and being responsible for this totally helpless and dependent human being.

I had a private room and the ulimited visiting was definitely the best thing (& reasonable quiet & TV!). I was v v shocked when I went to visit a friend morning after the birth of her dd, only to find they didn't bring the food to you, it was slopped out (literally) from a trolley at the end of the room and you had to fetch it. Not nice if you have lot of stitches. I fetched hers and was roundly bollocked for visiting at an illegal time. I thought, well if anyone else was there to help her maybe I could understand it. Anyway it was 12.30 - why on earth no visitors then? Late at night I can understand.

I didn'tknow anything about babies either, but no-one was rushing to help me in hospital! I felt that the only way to learn was to get back to my normal environment and muddle through with dh. There is so much to learn anyway that you can't really be prepared by a day or two in hospital. I think it would be much better to have this kind of support at home, with intermittent visits over a longer period, so that help can be given when the need arises - I found it much easier to talk one-to-one with the community midwife when I knew her attention was focused on me, rather than trying to track down someone on a busy postnatal ward with lots of other demands.

At the Royal London, the food was served in a room which was a corridor away. I found it amazing that you were expected to get up hours after giving birth and leave your baby unattended in order to eat.

It sems to me that 24hr delivery rooms would be great, eg come in, get settled, have baby in same room, stay up to 24hrs (with bed for parner if wanted) then go home. Rather than come in, go to anti-natal ward - get no sleep as everyone is in the throws of early labour or being checked over or taken downstairs. Re-pack stuff, go to delievery room, wait for ages to be seen about induction, decide on C-section, pack up stuff, go to Theatre, have baby (bags shoved under bed in recovery) no baby. Upstairs to post-natal ward, no visitors allowed as out of hours. Try to settle as quietly as poss (difficult with new baby, catheter etc) Finally get some sleep, as next person wheeled in and baby wakes up.... etc etc.

Seriously I feel Multi-bed wards are OK to a point, but the lack of sleep is awful. If people want to stay a nice day room, where you are encouraged to go and meet the other new mums, single or perhaps double rooms. One good thing in Guys was breakfast, if you could walk it was always in the day room, so you had to meet other new mums and move about a bit. You could serve yourself cereal and do your own toast, there was always someone on hand to hold the baby, or yur wheeled them along with you. 1st time mums sometimes want a bit more time, but thee is never enough midwives to help in those first 24 hrs. Each mother should be helped to breastfeed, if wanted, and to bath/dress/change nappy if necessary. None of this was available either time I had my babies

Mears, gave birth to ds 3 years ago in Scotland - St Johns Livingston - and was so well looked after. Had him on the Friday and left on the Tuesday. Everything was provided for the baby - nappies, clothes etc.

This time nothing is provided and will be expected to leave after 6 hours - ABC Watford. Sometimes feel scared, and then I think it would be better to be at home, but then with a 3 year old stuffing Buzz or Woody in #2's face only a few hours after giving birth. Family are in Scotland so I think if I were to ask for anything it would be this idea of a low dependancy post natal ward that people have mentioned. I did like however that I was in hospital for the onset of the 3 day baby blues and my milk coming in. I know friends who were "kicked out" after 6-48 hours and had to cope with this on their own at home.

I was a bit surprised at the food being miles away too. To the point where I thought the effort wasn't worth it and missed the meal. Not a good idea really having already missed two meals during labour, expounded loads of energy in the delivery and commencing breast feeding.

At least when I got home I had DH to warm up a nice home-cooked meal I had previously frozen and carry it through for me.

Post-natal stays are an ordeal to me. I needed peace and quiet to recover and the bustle and noise of a pn ward isn't the place to get it. No one explains the 'rules', like those charts you're supposed to fill in or where to get anything, where the phone is, plus the dayroom was full of smokers. Even with my first, when I had no clue what to do with this tiny human being, I was desperate to go home. I was absolutly terrified too, but making mistakes in the privacy of my own home seemed the lesser of two evils.

I do know of one tiny 4 bed Mat Unit that offers an excellent service with lots of well trained staff who really 'Mother the Mother' and you can stay as long as you want. (Sadly, I didn't live in the area when I had my babies!). However, there have been mutterings that such provision is 'social' not medical and therefore women shouldn't be allowed to stay any longer than medically necessary.

My mum had my DB at home in the 50's and in those days new mothers had an NHS homehelp for 6 weeks post-natally. They were usually experienced mums themslves and mostly kept the household running smoothly, looking after other children, doing the shopping and preparing meals etc so the mum and baby could concentrate on each other. Sounds like heaven, and not too far away from today's modern 'doulas', to me! I wouldn't have thought that such a scheme would be too expensive to run, compared to the cost of a day's stay in hopsital - mybe you have figures on costs, Mears?

I was in for 3 days after birth of ds1 - emergency section, so I suppose I had to be there - but was climbing the walls wanting to get home! I got no sleep on the wards - if it wasn't my baby crying it was someone else's.... also, do they really have to have hospitals that hot???

Ds2 was an uncomplicated birth, so I was home later that same day - which was much nicer - it was really good to get home, & get into your own routine.

I think it may be scary to be back at home quickly with your first child - perhaps just one night in hospital would be good (as long as medically everything is OK). Certainly with your second, third etc, then I don't know of anyone who's wanted to stay in hospital!

No costs I'm afraid. There will be some but i don't have access as yet. There is talk of training health care assistants who could possibly assist the midwife by being able to help the mum with bathing, feeding etc. as it will be unlikely that there will be enough midwives to do it all in the community.
Thanks very much for all these replies - it is so helpful to get all these different insights.