You're ready to go home with your new baby! Before the baby comes home, the following should have been accomplished:
- Successful feedings. Your baby should nurse or take all feedings from a bottle and should take enough to prevent dehydration. Your baby also should demonstrate coordinated sucking, swallowing, and breathing while feeding.
- Your baby urinates regularly and has passed at least one stool.
- Temperature, heart rate, breathing rate, and blood pressure are normal in an open crib.
- You (the caregiver) are comfortable with breast or bottle feeding methods.
- You and any other caretakers have learned basic infant care such as skin care, bathing, safety measures, and the signs of illness.
- Health care providers have been selected and you have the phone number to call for questions for concerns. You need a source of advice and information for breastfeeding and the general care of your baby.
- If you'd like help in selecting a doctor for your baby, please call (952) 931-3555 for a brochure about Choosing Your Child's Doctor and for a directory of pediatric clinics and doctors in the Twin Cities metropolitan area.
- Your baby's laboratory tests are normal.
- Metabolic screening tests have been performed. All states now require hospitals to test newborn babies for certain rare metabolic diseases. Doctors cannot know whether these diseases are present until the diseases have already caused irreversible brain or other injury. Early detection and treatment can prevent much of this damage. Testing the blood of all newborns most effectively identifies the affected babies. All states test for phenylketonuria (PKU) and low thyroid function. The hospital where you delivered should obtain the metabolic screening test. The hospital also usually receives the result and should transmit it to the baby's caregiver. On your baby's first check-up you should ask if the test result has been received. Occasionally, the test will have to be repeated if the baby was premature, the test was obtained in the first 24 hours after delivery, or if the result is inconclusive.
- Initial hepatitis B vaccine is administered or scheduled.
- Hearing screen completed.
- You have a car seat for transporting your baby and are familiar with how to use it.
- Primary care providers for mother and baby are aware of the discharge. Follow-up appointment for the infant should be made for two to seven days after discharge. (The length of time from discharge to the first office appointment will vary among doctors.)
If you'd like help in selecting a doctor for your baby, please call (952) 931-3555 for a brochure about Choosing Your Child's Doctor and for a directory of pediatric clinics and doctors in the Twin Cities metropolitan area.
When Is Hospital Discharge Too Early?
For parents, hospital discharge is too early any time before you feel prepared to take your baby home. Discharge also is too early any time before the mother and baby are medically ready to leave the hospital environment. Occasionally, the doctors believe you are ready before you believe you are.
Some health plans used to require discharge 24 hours after delivery. The federal Newborns' and Mothers' Health Protection Act of 1996 changed this practice. The law requires health plans to allow at least 48 hours of hospitalization after a vaginal birth and 96 hours after a cesarean section. The legislation is helpful, but what is really needed is health care tailored to each individual medical situation.
Low Risk Mothers and Infants
Your baby is at low risk of complications if you meet the following general criteria:
- Prenatal, delivery, and post-delivery course were unremarkable. If there have been no problems up to this point, it is unlikely they will start now. There are some exceptions to this, such as infection and jaundice, but not many.
- There was only a single baby (not twins, triplets), and 38 to 42 weeks gestation with normal growth. Some babies born at less than 38 weeks also can go home shortly after delivery. Some multiples born at this gestation also are ready for discharge at one to two days. However, babies born at 37 weeks or less often have feeding problems that only resolve with time. In these situations, it is better to wait a few days rather than go home and have difficulties.
- Normal Physical Exam. This is critical and should include a careful assessment by a physician or nurse practitioner -- preferably the same doctor who will see the baby as an outpatient will also see the baby in the hospital. A boy's circumcision site should be free of blood for at least one to two hours before discharge from the hospital. Jaundice should not be present in the first 24 hours and should not be prominent at discharge.
Discharge from the hospital is something best resolved between the parents and the physicians for the mother and infant. Speak directly with your doctor if you are uncomfortable with a discharge plan. Whenever you go home, you will need a source of health information and someone to call in case of problems. After you go home, you will likely think of questions to ask. This is normal, and a sign of a parent who is genuinely concerned. Write down your questions and call your clinic to get answers.