Between 1970 and 1992, according to the Centers for Disease Control, the median length of hospital stay for expectant mothers declined from 3.9 to 2.1 days for vaginal delivery and from 7.8 to 4 days for cesarean. The post-1970 decrease in length of stay was a response to changing attitudes including viewing childbirth as a normal, healthy process; finding women to have not been rendered invalids by the delivery; discovering that healthy mothers and babies were prevented against being exposed to infections; promoting bonding between mother and baby; and the desire for cost containment. For insurers and health plans desiring to provide cost-effective services, maternity stays offer an opportunity to reduce expenditures while recognizing new concepts of practice, which call for a continuum of postpartum services directed to mothers’ and infants’ medical needs.

The American Academy of Gynecology (ACOG) and the American Academy of Pediatrics (AAP) jointly concede that the optimal length of stay in a hospital for healthy mothers and babies should be forty-eight (48) hours of inpatient care after a vaginal delivery and ninety-six (96) hours after a cesarean section. Those on both sides of the postpartum care debate agree that new mothers need rest and recuperation, support with breast- feeding initiation, education about infant care and parenting, and attention to the possibility of immediate anxiety or future postpartum depression,

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10 Guam Code Ann. HEALTH AND SAFETY
CH. 92 MATERNITY STAY ACT

infection or bleeding. In addition, infants require identification of congenital anomalies, screening for phenyl-ketonuria (PKU), congenital hypothyroidism and other time-sensitive and potentially devastating newborn conditions, arrangement for post-discharge screening or re- screening if infants are discharged within twenty-four (24) hours, attention to feeding and nutrition problems, monitoring of possibly serious neonatal jaundice, and linkage to primary services and immunizations.

Outpatient follow-up can be difficult and expensive. Statistics indicate about fourteen percent (14%) of women and eleven percent (11%) of newborns experience postpartum complications, breast feeding problems, jaundice, dehydration, fever and poor feeding problems within the first twenty-four (24) hours. Early intervention could prevent complications, and reduce infant and maternal mortality and morbidity.