New mothers and infants deserve better insurance

By Hillary Rodham Clinton

Before my daughter was born, I did everything I could think of to prepare for the arrival of my new baby.

I asked my doctor hundreds of questions. I read every book I could get my hands on. And my husband and I went to childbirth classes.

Even so, I was in for some surprises.

I remember lying in bed a few days after Chelsea's birth, when I was still getting accustomed to breast-feeding. Suddenly, I noticed foam in her nose. Afraid that she was convulsing, I pushed every call button within reach.

When the nurse arrived, she assured me that I was simply holding the baby at an awkward angle, making it difficult for her to swallow the milk she took in.

That wasn't the only time nurses came to my rescue during my stay at the hospital. They taught me to bathe and feed my daughter, and also gave me a chance to recover from the emotional and physical toll of a Caesarean section.

Nowadays, experiences like mine are far more common in countries like Australia, Germany, Japan, Ireland and France than here in the United States.

As insurance companies look for ways to cut costs, new mothers routinely are rushed out off the hospital 24 hours after an uncomplicated birth and three days after a Caesarean.

I have one friend who was pregnant with twins and began hemorrhaging during labor. she had to undergo an emergency Caesarean under full anesthesia. After the delivery, she was severely anemic and was placed in intensive care.

Even so, based on a "checklist" of medical factors, her insurance company said it would not pay for more than three days in the hospital. In the end, the company did cover a longer stay, but only because her doctor spent hours on the phone arguing that it was medically unsafe to send her home.

Unfortunately, some doctors won't take on such battles because they fear being dropped by the managed care companies with which they do business.

Another friend's wife was covered for seven days in the hospital after a complicated childbirth. But the insurance company wouldn't cover the child after three days, making it impossible for the mother to nurse the baby and much more difficult for mother and child to bond.

When my friend was told the child was considered independent of its mother, he asked, "Do you expect the baby to walk down the parking lot and drive himself home?"

Insurance companies insist that limiting a baby's time in the hospital is not only a money-saver but it also reduces exposure to hospital germs.

Most experts agree there is little medical risk to the majority of new mothers and babies discharged in the first 24 hours. But what happens if the baby develops an infection or other complication like jaundice that only become apparent on the second or third day after birth? What if the new mother has difficulty learning to breast-feed properly, which could result in dehydration or other serious problems for her baby?

Insurance companies say most new mothers are entitled to home visits by a nurse who can help spot problems after they leave the hospital.

But the reality is that many insurance companies only cover one home visit per patient; others simply provide a phone consultation with a nurse in the days after childbirth. And cases have been reported in which the nurse or home visitor simply didn't have time to show up or didn't even know the baby had been born.

A retired transit worker in New Jersey, Dominick A. Ruggiero Jr., told his story to the New Jersey legislature earlier this year:

His niece had an uneventful pregnancy and childbirth and was discharged after 28 hours. At home, however, her baby, Michelina, suddenly took a turn for the worse. A nurse was supposed to visit the home on the second day but never came. when the family called, they were told the visiting nurse wasn't aware the baby had been born.

Several times, the family called the pediatrician, who said the baby had a mild case of jaundice and did not need to be examined.

The baby died from a treatable infection when she was two days old.

Thanks in part to Ruggiero's testimony, New Jersey now has a law that will make sure that insurance covers mothers for a minimum of 48 hours in the hospital after uncomplicated delivery and 96 hours following Caesarean deliveries. Maryland passed similar legislation last spring, and Congress is now considering a bill.

Although a handful of critics has suggested that this is another example of government intrusion into the health care system, I think that protecting the health of new mothers and infants is a clear case of where government safeguards are needed.

No government employee should ever decide whether an infant has jaundice or a new mother is anemic. But at the same time, no insurance company accountant should make the final judgment about what is medically best for newborns and their mothers.

That decision should be left to doctors, nurses and mothers themselves.

-- Creators Syndicate