Postpartum Hospital Stay and the Outcomes of Mothers and their Newborns

During the 1980s and 1990s, the lengths of postpartum hospital stays declined for both vaginal and cesarean births. Health professionals and policy makers expressed concern that shorter hospital stays might jeopardize the health of both mothers and infants and the federal government and states responded by passing laws requiring insurance carriers provide coverage for longer postpartum stays. One such law was the California Newborn’s and Mother’s Health Act of 1997, which went into effect on August 26, 1997, and mandated that insurance carriers provide coverage for at least 48-hour hospital stays for normal deliveries and at least 96-hour hospital stays for cesarean deliveries. If the physician, in consultation with the mother, discharges the patient before these time limits, the law requires that insurers provide coverage for a home or office follow-up visit for these women. A similar federal law called the Newborns’ and Mothers’ Health Protection Act of 1996 went into effect on January1, 1998. In this paper, we use restricted-use data for all births in California over a six-year period to examine the effect of these early discharge laws. Using an interrupted time series design, we demonstrate these laws reduced considerably the fraction of newborns that were discharged early. In two-stage least square models using the laws as instruments for the postpartum length of stay, we find that an early discharge increases the probability of a readmission within 28 days for newborns from complicated vaginal births, and c-sections. Among newborns from uncomplicated vaginal deliveries, there is no evidence that the early discharges improved health for privately insured newborns but the laws did reduce readmission rates for Medicaid patients. These results suggest that the early discharge laws improved outcomes for those most likely to be readmitted but there is little benefit for the healthiest patients.