Sheila and Vernon Blackwell watched television and listened to music throughout Sheila's labor in the "sitting room" of Howard University Hospital's new birthing suite -- and then moved into the suite's "bedroom" when Sheila was ready to deliver.
Mary Alice Covington delivered her baby at Arlington Hospital at 2:30 in the afternoon and was home in time for dinner.
Nancy Granados wanted her fourth birth to be a family experience -- so her husband, Ray, and her children were present when she delivered Brian James at Washington Adventist Hospital.
College students Debi and Richard Mason were able to afford prenatal visits and childbirth by paying $115 a month for a year through a special financial program at Providence Hospital.
These examples illustrate the diverse ways couples can plan their childbirth experiences in the Washington area these days. Maternity services have become a buyer's market for the more than 50,000 women a year who are having babies in the area. Hospitals are renovating maternity wards and nurseries, offering personalized mother-child nursing care and allowing expectant couples flexibility in orchestrating the birth experience within a hospital setting.
The new approach to childbirth in the hospital is a joint effort between nursing staffs, who are becoming more aware of expectant couples' needs, and financial directors, who are seeking to attract business and reduce costly and unnecessary hospital stays or procedures.
In an informal survey of 14 of the 22 hospitals in the Washington area that offer maternity services, not one hospital has been left untouched by the new trends in childbirth. From Fairfax Hospital, which delivers more than 7,200 babies a year, to Providence Hospital, which delivers about 1,300, the nursing staffs and administration are attempting to recreate in a hospital setting the kind of environment often found in freestanding alternative birth centers (ABCs). Half of the 14 hospitals interviewed had recently finished renovating their maternity wards and nurseries, or were in the process of renovation.
Ideas that were considered innovative or radical only a few years ago are now the rule rather than the exception at most of the hospitals. For instance, many of the newly renovated maternity wards do not have a special "birthing room." Instead, all the labor and delivery rooms have been carpeted and wallpapered, and couples are allowed to labor, deliver and recover in them.
"The whole philosophy about birth has changed," said Leith Mullaly, a nurse who heads the Matters on Maternity (MOM) program at Alexandria Hospital. "Our philosophy is that it's a natural, normal process. Most people who come here do not want to turn birth into a surgical procedure. But we have the technology here to back up a birth that should suddenly present problems."
The hospitals' financial directors are also supporting these programs because they attract patients and cut costs. For instance, "short-stay" programs are increasing patient load as more mothers reduce the traditional three-day hospital stay to less than 48 hours. And the mother who labors, delivers and recovers in one room requires less staff and equipment. Also, directors hope that comprehensive programs in prenatal patient education may pay off in fewer complicated births, as well as fewer premature and high-risk infants who need hospital care.
"In the last 18 months, the average length of stay for new mothers has dropped from three days to two days," said David Vickers, supervisor of accounts receivable at Arlington Hospital. "Our special financial packages help us to increase the number of births here and to better use the labor and delivery facilities. We found that when we increased our prices that the patients went elsewhere."
Besides changes in physical facilities and financial options, hospital staffs have begun to approach maternal and child care with what is commonly known as a "family-centered" philosophy. Among the trends:
"It's the family who comes to have the baby today, rather than just the woman," said Sallie Eissler, a nurse and maternal child health clinical specialist at Greater Southeast Hospital.
Many hospitals now allow siblings or grandparents, in addition to the father, to be present during birth or to visit in the recovery room immediately after birth. Some offer classes for siblings who want to participate, or who may need help in adjusting to the new child.
New parents also are getting the opportunity to take a greater role in caring for their baby. Many hospitals allow the father to spend the night in the room with the mother and baby. And mothers are being encouraged to keep their babies with them, day and night, throughout their hospital stay.
*Primary Care Nursing
Instead of splitting the nursing staff into labor and delivery nurses, ward nurses and nursery nurses, the primary care nurse is assigned to a mother and child as soon as the mother is admitted to the hospital. At Washington Adventist Hospital, this practice is called "coupling," and at Shady Grove Hospital, the nursing staff calls it "mother-baby couple care."
"Primary care nursing decreases the number of people the mother has to deal with during her hospital stay so that she has more of a chance of developing an adequate relationship with her health-care giver," said Mary Barden, associate director of obstetics-gynecology-neotatal nursing at George Washington University Hospital. "It's also very rewarding to the nurses who feel that the patient identifies with them as their sole health-care giver."
Education has expanded to include all phases of pregnancy, childbirth and postpartum care. Many hospitals offer early pregnancy classes that focus on nutrition and general care of the mother throughout the early months of pregnancy and prepare her for the more advanced stages of pregnancy. "Thinking About Having a Baby," at Alexandria Hospital, is designed for couples -- often dual-career couples -- who want to discuss the advantages and disadvantages of having children even before getting pregnant.
In addition to traditional childbirth classes, hospitals are offering classes about Cesarean birth. Alexandria Hospital offers a class for women who have had a Cesarean birth but would like to have a vaginal birth.
During the hospital stay, nurses teach mothers how to bathe their babies and how to breastfeed. At many area hospitals, mothers can watch special educational programs on closed circuit television. At Columbia Hospital, mothers can participate in a support group to discuss the changes and challenges of new motherhood.
Mothers who want to bring their babies home as soon as possible are finding that hospitals are setting up special programs for early discharge. Most hospitals interviewed allow mother and infant to be discharged after an uncomplicated birth once the baby has been examined by a neonatologist. The minimum time in a hospital is usually six hours. However, many of the hospitals require prenatal classes, instruction by nursing staff and physician approval before discharge.
The early dischage program is a popular way to save money by reducing the number of days in the hospital. For instance, a patient at Greater Southeast Hospital can save up to $1,250 by staying one day instead of three days; a patient at Arlington is charged $675 for staying in the hospital less than 24 hours; a patient at Alexandria Hospital is charged between $800 and $1,000 for an "in and out" delivery.
At Alexandria Hospital, a 40-page booklet has been developed for short-stay mothers that serves as a self-care guide during the early days after birth. After the mother is discharged a nurse is assigned to call her at home and check up on her recovery. If there are problems, a visiting nurse is sent to the home.
Arlington Hospital recently instituted the "Special Connection" program in which the mother who leaves the hospital six to 24 hours after birth is cared for by a visiting nurse. To be eligible, the mother must be enrolled in the program and have taken childbirth classes, as well as infant skills and breastfeeding classes.
Shady Grove has a "Special Delivery Short-Stay" package that allows a mother to leave the hospital 24 hours or less after delivery. The next day, a nurse visits the home."The inclusion of a nurse's visit sets at ease a mother who may be nervous about taking the responsibility of going home so early," said Judy Thompson, Shady Grove's director of maternal child nursing.
Washington Hospital Center's short stay program allows a mother to deliver in the labor room and go home with the baby six to 12 hours later. The delivery fee is based on the number of hours that the woman stayed in the hospital.
Several hospitals offer maternity services with fees based on income for couples without insurance. "We've found that many women just do not get the prenatal care they need if they have to worry about money," said Vickers of Arlington Hospital. "These special fees give the women and babies a much better chance to be healthy."
At Providence Hospital's Center for Life, a couple can arrange to pay monthly pre- and post-natal and childbirth fees based on their income. And a new financial program offered through the hospital's obstetrics and gynecology center offers a package price for prenatal care, delivery and postnatal examination for a set fee depending on length of stay: 1 day is $1,550; 2 days is $1,750 and 3 days is $1,950. A Cesarean section is an additional fee of $500.
A package price for hospital services, excluding doctor's fees, is: 1 day for $1,200; 2 days for $1,400 and 3 days for $1,600. A Cesarean section is $1,000 extra.
Arlington Hospital offers a special obstetrics fee of $900 for a hospital stay of up to three days to patients who don't have health insurance. That fee also can be reduced by as much as 50 percent if the family qualifies for a reduced rate based on their income. In addition, the hospital charges a flat rate of $675 for couples who use the birthing room and leave the hospital within 24 hours. The woman who has an outpatient delivery but is never formally admitted to the hospital can pay as little as $250 to have a baby at Arlington Hospital, according to Vickers.
More than a dozen Blue Cross-Blue Shield programs offer incentives to reduce hospital maternity stays. Under the Maternal Infant Discharge program, a woman gets a cash bonus of between $50 and $200 if she leaves the hospital within 24 hours of the delivery.
According to Blue Cross-Blue Shield, if the average three-day stay for a normal delivery were reduced by only one-half day, it is estimated that between $40 and $50 million in hospital costs could be saved. Dinner for Two
Most hospitals offer a special candlelight dinner for new parents. At Alexandria Hospital, a tuxedoed waiter serves a full course, elegant dinner to the new mother and father in a private dining room while their newborn is cared for in the nursery. "A lot of couples linger over their dinner for hours, talking about the changes in their lives and their new experiences," said Mullaly. "It started out being sort of a 'cute' idea, but has ended up being a very profound experience."
The new approach to childbirth is not simply a way to make mother and child feel like they're at home in the hospital. It's also a way to make sure that mothers will keep having their babies in hospitals, and to ensure the optimum health and safety of mother and child. Said Vernell DeWitty, associate director for obstetrics and pediatric nursing at Howard University Hospital: "Patients want a more homelike environment, but still want the security of a hospital's modern technology if something goes wrong."