Harvard study concludes 'drive-through deliveries' safe

BOSTON -- "Drive-through deliveries" that send new mothers home from the hospital after just one night do not seriously endanger newborns, according to a study that calls into question laws enacted around the country to restrict the practice.

Health insurance groups uttered a collective I-told-you-so.

"The political system made a judgment about what was preferred care. Now the research is showing there was probably a rush to judgment," said Karen Ignagni, president of the American Association of Health Plans.

The group represents HMOs and other managed care plans that were at the forefront of a cost-cutting movement in the early 1990s to shorten maternity stays for normal births. Eventually, such programs were widely dubbed "drive-through deliveries." Alarmed by horror stories of endangered newborns, dozens of states and Congress adopted laws mostly requiring insurance coverage for at least 48 hours of care after delivery.

However, in this study, Harvard Medical School researchers found that newborns needed the same number of later emergency room visits and hospital readmissions, regardless of whether they had longer stays or shorter ones.

The overnight stay "can be safe, if it's done carefully," said Jeanne Madden, a Harvard health policy specialist who led the study. The one-night stays examined in this study were followed quickly by home medical visits.

The researchers did not look at the health of the mothers, but all of the cases studied involved routine deliveries. The study excluded women who had Caesarean sections or serious complications.

The researchers, who published their findings in today's New England Journal of Medicine, looked at 20,366 new mothers with normal deliveries. The study was funded by government grants and the foundation arm of Harvard Pilgrim Health Care. Harvard Pilgrim's corporate predecessor insured the mothers in the study.

The researchers looked at the early 1990s, when stays were getting shorter; the mid-1990s, when they were shorter for even more women under an early-discharge program run by the HMO; and the late 1990s, when a minimum 48-hour-stay law went into effect in Massachusetts.

During the period studied, newborn visits to emergency rooms kept steady at an average of about 1 percent every three months.

Hospital readmissions held at around 1.5 percent. The same pattern held for a more vulnerable group of young, lower-income mothers with less education.