Friday, November 23, 2007

A Tourist in Medical America

Yesterday, Thanksgiving, was unseasonably warm. I took my favorite stroll and soon put my jacket into my backpack, comfortable in just a t-shirt. I saw people jogging in t-shirts and pants, and others strolling in light, open jackets. The leaves are now a darker shade of magenta and mustard-yellow, with more brown branches mixed in. It’s still beautiful and brilliant, but a different hue. It’s like gazing at a different, but marvelous, painting every week.

Today we had our 38/39 week prenatal appointment. We’re getting to the final countdown. As someone who has never spent a night in a hospital, I find the frequent medical visits and the upcoming hospital stay to be a form of cultural tourism, especially given the troubled state the U.S. medical system is currently in. We’ve chosen a strong hospital and some of the best doctors available locally. But still, some of the overall problems of the system – the following of norms that haven’t been proven as effective and the emphasis on cost over quality of care - are still easily apparent.

Everyone who gets an epidural at the local hospital has to be hooked up to a fetal heart rate monitor. I’d read that when these monitors say everything is OK, it is OK. But when it says there’s a problem, it’s often mistaken. I asked the doctor whether there was any means of verifying a problematic signal from the fetal heart rate monitor.

He said no, that various methods had been tried, but none were reliable. He said he wasn’t sure why the U.S. had signed on to this technology and these procedures, but it had.

“So what do you do if it indicates a problem?”

“We do a cesarean, but 9 times out of 10 it proves to have been unnecessary.”

I then asked about the period we could stay in the hospital. It’s generally two days for a standard delivery, 3-4 for cesarean. But the timing is based on the time one gives birth. If you give birth at 11:59 p.m., you have to leave at 10 a.m. two days later, for a stay of about 36 hours. If you give birth 10 minutes later, you get an extra 24 hours.

I’d heard that a doctor could write a note saying that the patient needed a longer stay and then they could at least stay the full day, rather than having to leave by 10. I asked him about this and he said it depended on the hospital need for beds. If they need the bed, you can’t stay longer.

“So it’s not up to the doctor?” I asked.


“Nor does it matter whether the patient needs the additional time?”

“In the past, people generally stayed in the hospital 24 hours and most of them seemed to do just fine.”

That was the first indication I’d heard that the current standard of two days is somehow generous. The mouth of a Chinese friend fell open when we told her the standard stay is two days. She worked as a pediatric nurse for 26 years in China and never heard of such a thing. There, as in many parts of the world, ten days is more the norm.

Not to say that I want to stay ten days. But it’s unfortunate to think that people are pushed out before they are ready, before their milk has come in and they’ve learned how to breastfeed, before they feel ready to take care of both themselves and the new, needy being. I wonder if more support and care early on would affect the rates of post-partum depression.

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