Your pregnancy was uncomplicated. You had a normal vaginal delivery yesterday evening, resulting in a healthy appearing baby boy. He seems to be nursing just fine. You feel great, and your obstetrician has given you the all clear for your discharge. Anxious to get home to your family, you start to pack your bag.
But WAIT—one problem. Your newborn hasn’t yet been discharged! “He looks fine, and I really need to get home to my two-year-old” is what you may be thinking. “What’s the holdup? Why can’t we go?”
In order to explore why a baby might have to stay in the hospital, it’s worth noting that infants are in a vulnerable state during the first few days of life. Even with a normal pregnancy and delivery, newborns are at increased risk for severe, sometimes life-threatening illness. For this reason, even the healthiest appearing ones undergo an initial period of observation.
But Can’t I Just Observe Her at Home?
You may be willing to hold vigil in your new little one’s room and call her provider at the first sign of illness. Perhaps you have an older child and have sought prompt medical attention whenever he complained of not feeling well. Problem is, newborn babies don’t tell us a lot when they are sick. Also, their health can deteriorate very quickly during those first few hours. For this reason, trained hospital staff will do frequent checks on the baby. While what is checked when varies from hospital to hospital, usually the following is included:
- Pulse rate
- Rate of breathing
- General physical condition, including color, alertness, and feeding
Depending on the baby’s and mother’s circumstances, the hospital staff may also frequently check:
- Blood pressure
- Oxygen in the blood
- Blood sugar
If something is off, staff and physicians can intervene much faster than if the baby has to come in from home. And, often, every moment counts!
OK, Then, When CAN We Go Home?
Hospitals generally set their infant discharge policies based on the latest research. That said, the policy can vary from hospital to hospital. The good news for most families that want to be home is that there is a tendency for newborns to have shorter hospital stays—sometimes as little as 24 hours. Most facilities, however, will agree on the following minimum criteria for discharge:
- At least one examination by a licensed health care provider (such as a physician or nurse practitioner)
- Evidence of adequate feeding
- At least one void (wet diaper) and stool (poop)
In addition, all infants in the United States undergo a blood test to screen for multiple diseases. In order to obtain a reliable test, it’s necessary that the baby feed for 24 hours before obtaining blood.
Some Special Situations
There are a few conditions where your newborn might look well—at least at the time of discharge—but might need to stay longer than 24 hours:
Suspicion for infection. Again, because babes don’t tell us much and any infection can be devastating, if there’s any sign at all that your new arrival might be infected, his provider may want to keep him in the hospital for a few days. Sometimes the mother’s condition around the time of labor will dictate this: Was there a fever? Did the membranes rupture early? Did her obstetrician tell her that she had a Group B Strep infection?
Also, because signs of infection in a baby can be very subtle, anything he does show us is taken very seriously—a sudden onset of difficulty breathing, for example. Usually if there’s an increased likelihood of infection, the newborn’s provider will run some tests for harmful bacteria (and sometimes viruses) and often start antibiotics while waiting a minimum of 48 to 72 hours for the tests to come back.
Low blood sugar. Often babies will have some symptoms with this problem. However, a mild decrease in blood sugar may not show much at all. Infants of diabetic mothers get regular blood sugar tests, and the values need to be normal before discharge.
Jaundice. Fortunately, this usually shows up as a yellow color in a newborn. While milder forms will often not delay a discharge, severe jaundice means a potentially unhealthy level of a chemical called bilirubin, which can cause brain damage if untreated. Infants are usually treated in the hospital with a special light that breaks down the bilirubin in the body.
Prematurity. Premature babies are at increased risk for all of the above issues as well as several others. For example, they may feed less slowly than term infants, and they may not be able to hold their own body temperature well. Such babies usually stay until they reach a specified weight.
Finally, your baby’s provider will want to make certain that you are comfortable taking care of the baby and that you have everything you need for a safe, nurturing home environment. It’s also important—especially in this era of earlier discharge—that early follow-up with your pediatric provider can be arranged. If there are any issues in this regard, feel free to discuss them.
It’s often helpful to put things in perspective. You spent nine months providing a secure, healthy place for a baby to grow. A few more hours or another day or two, when needed, to ensure her good health may seem like an eternity at the end of all that, but it’s time well spent!