The main purpose of this essay is to discuss the peculiarities of discharging plan, in particular, after the Cesarean section. It is of crucial importance for us to identify the major steps or probably, it is better to say evaluation criteria, on which medical workers base their judgment. Our task is to assess the advantages and disadvantages of early discharge, or the release after seventy-two hours, to be more exact. To do it, we need to focus on the consequences (physiological and psychological), which this operation may entail for the mother and her child. In addition to that, it is necessary to determine the major conditions for the discharge, and the views of obstetricians on this issue. Furthermore, this research should examine the precautions, which should be taken to avoid any possible complications.
Overall, it would not be an exaggeration to say that even now medical workers have not come to a consensus as to the discharge after C-section birth because it may have far-reaching effects, which may sometimes be almost unpredictable. We will try to summarize major parameters or characteristics that should be considered by obstetricians when they decide on hospitalization or release of the patients; moreover, in this work, we will draw certain evidence-based examples, showing positive and sides of early discharge. Before that, it is worth noting, that midwives usually warn against early discharge after the Caesarian section, they suggest that the mother and the newborn must be hospitalized for at least four or even five days (Lumley, 2004).
Their argument is primarily based on the belief that the consequences may be too sudden, therefore, during this period the patient should be under constant surveillance. In this regard, we may mention that medical researches do not provide sufficient evidence, indicating that early discharge is not advisable, at least if there are no overt complications. But according to psychologists, it may give rise to some mental disorders, namely postnatal depression (Hickey, 1997). Thus, we should weigh up the pros and cons of this issue, utilizing recent research findings of obstetricians and psychologists.
It seems that while deciding on the release of a woman after a Cesarean birth, a medical worker should take into consideration such factors as 1) the degree of complication, which necessitated the surgery, 2) the condition of the mother and newborn (Costa, 1999). Besides, one cannot overlook the number of C-sections the mother has already had, because according to recent research findings, the risk of complications is much higher in second pregnancy if such surgery has already been made (Taylor, 2005).
The main problem, which obstetricians have to face, is the suddenness of some after-effects, they may not be noticeable at first glance, and readmissions are mostly due to this feature of the Cesarean section. In this respect we should say that Anthea R Hickey takes a somewhat different approach to this problem, in her opinion, there are three types of characteristics or criteria for assessing the state of patients health after the Caesarian section; the scholar marks out 1) physiological, 2) psychological and 3) socioeconomic criteria for evaluation. She suggests that early discharge may be advisable only if the patient meets the requirement for the release (Hickey, 1997).
Probably, it is necessary to elaborate this argument: for instance, the mother must have no overt complications, additionally; she must possess obligatory child care skills. Moreover, the family must be ready to accept the child, which means all sanitary conditions must be observed. Yet the scholar argues that under some circumstances the early release can lead to postnatal depression, and it may subsequently result in readmission to the hospital (Hickey, 1997). Thus, we may conclude that in terms of psychology the discharge after seventy-two hours is not the best possible option. Yet, we may object to this statement because postnatal depression may occur to every woman, irrespective of the delivery type. It may be either Cesarean section or vaginal birth (Henderson, 2005). Probably, this mental disorder is mostly connected with the personal traits of the woman, but not with the operation, itself. Yet, we cannot deny the fact that C-section has a strong emotional impact on the mother’s feelings and her self-perception.
As far as physiological criteria are concerned, we need to point out that there are various types of this operation and the choice mostly depends upon the physical condition of the parturient woman, especially, when vaginal birth may endanger her life or her baby’s. We can single out the most widespread reasons for performing C-sections: for instance dystocia or slow labor, which is usually caused by disordered contractions of the uterus. In such cases, obstetricians usually recommend that the woman and the newborn stay in the hospital for at least four days (Buist, 2004).
However, if there are no complications to be detected the mother may be discharged earlier. On whole, the medical institutions try to adhere to the following pattern; they usually insist that the patient stays under their control for at least four or five days. But if there is an inrush of patients and the C-section has not entailed any adverse effects for the mother or child, they may be discharged within three days.
Another reason, why obstetricians may resort to this form of surgery is the so-called fetal distress, which means that the baby may have some breathing problems and his life is imperiled. On some occasions, doctors have to employ such method mostly due to the mother’s fatigue. Again, we should mention that there is no distinct pattern of the discharging plan. If we are speaking about the fetal distress, early discharge is strictly forbidden, even if the operation has been quite successful (Donovan, 2004).
Probably, we must draw some parallels between Cesarean section and normal delivery. As a rule, the hospitalization period after vaginal labor lasts one or two days, in this case, there is no necessity to detain the mother and newborn, and they are discharged after twenty-four hours. But the situation is drastically different if we are speaking about cesarean section, because this procedure may pose larger risks to the health of both mother and child. In this respect, we need to say that medical researches, conducted recently, suggest that the effects of C-sections are very difficult to determine because very often they bear striking resemblance to those of vaginal birth (Costa, 2004).
Some obstetricians even claim that the danger of Cesarean sections is often very much exaggerated, because, the aftermaths may not necessarily be caused by the surgical operation, it is often claimed that at the beginning of the twenty-first century, C-section is almost safe, especially, if the procedure is performed in accordance with the established standards.
Nonetheless, we may speak about the increasing risk of mortality, excessive after-labor bleeding, adhesions, placenta per via, and so forth. Therefore, the woman, who has undergone this surgery, should remain hospitalized, even if there are no overt complications because they may manifest themselves only after a considerable of time. The major problem, which midwives usually have to resolve, is how to decide on the appropriateness of early discharge, especially, if the hospital, itself, is overcrowded and there is hardly any room for arriving patients. It should be taken into account that there are numerous cases of readmission after such early discharges and in the vast majority of cases, the hospital administration only has to incur additional expenses. Thus, it is not prudent even in terms of sheer economics (Buist, 2004). Naturally, the financial aspect is the least important, but it also indicates that the release within three days is not the most prudent decision.
Cesarean section may also pose threat to the health of the child, namely, various fetal injuries, or neonatal depression, which may sometimes be caused by the ineffective use of anesthesia (Stright, 2004). Another possible danger is the risk of infection; it is of paramount importance to conduct HIV tests. Certainly, statistical data indicates that such an outcome is extremely improbable at least in Australia, but it is impermissible to disregard this possibility.
In theory, the patients may be discharged if the state of the child is normal and there are no deviations, but obstetricians urge not to forget about the possibility of apnea or asphyxia that may occur within five days after Cesarean section. It stands to reason that such an outcome is very rare; nevertheless, it cannot be ruled out (Bryan, 2005). The discharge after three days may sometimes be very dangerous to the life of the newborn, partly; this is one of the reasons, why midwives object to such practice.
Thus, we can say that hospitalization period may range from four days to almost a month or even more, and it is impermissible to make any generalizations because, the situation may drastically change, and there is a great likelihood of readmission or repeated operation. Yet, they are not the only ones, there are some other parameters or characteristics, to which obstetricians and psychologists also attach primary importance, namely the emotional state of the mother.
Before discharging the obstetrician need to check the following points: first and foremost, the age of the baby: he or she must be at least a nine-month and one weak after gestation. In case, the child does meet this time requirement, the mother and the newborn should still be hospitalized. Secondly, it is necessary to pay extra attention to the feeding, the mother and the child should be well adjusted to each other, in theory, there should be practical problems connected with this particular issue, however, sometimes after cesarean birth, the mother is too weak to breastfeed the baby.
Additionally, a great number of recent research findings suggest that the minimum period of hospitalization should be at least five days; the main reason for it is the above-mentioned apnea or unconscious suspension of breathing, which may occur within five days. Apart from that, there are some other characteristics such as weight, temperature. The discharge after three days may be permissible only if all the parameters are normal. But still, the medical workers are reluctant to discharge the patient after seventy-two hours because urgent medical intervention may be needed within five days (Stright, 2004).
Furthermore, we should mention psychological complications, which may arise from C-section, for instance the alienation between the mother and newborn. Several researchers presume that occasionally the woman, who has been subjected to this surgery experiences difficulties while interacting with the baby. At this moment, the origins of such behavior have not been ascertained, yet obstetricians and psychologists try to design guidelines, which may help to overcome this problem, before releasing the patient from the hospital. Occasionally, the nurses assistance is necessary, and during this time, the woman and her child should be hospitalized.
A medical worker should not forget about the mother’s mental state, because sometimes she is reluctant to communicate with other members of the family, the thing is that her temporary disability makes her feel very weak and vulnerable, besides, sometimes she has a very low esteem of her physical appearance.
As for the second pregnancy, we may refer to the research article by Lee Taylor, who argues that a woman, who has given birth with the help of a C-section, is more likely to incur some side effects in the future, in particular, the scholar mentions the preterm delivery, respiratory distress syndrome, rupture of membranes and so forth (Lee K Taylor, 2005).
In his opinion, while developing a (discharging) plan, the obstetrician should bear in mind the previous pregnancy of the mother. Although at some moment there might be no apparent disorders, they might appear later even at the very end of the treatment period. Hence, we may say that the previous experience also plays a very important role. We should note that a woman, who has once endured Cesarean section, may not be released from hospital within three days. In this particular case, an early discharge is not permissible. Additionally, we should not overlook vaginal birth that follows C-section, traditionally; obstetricians suggest that the mother and the child stay under their surveillance for four or five days, even if there are no complications.
The main problem is that with time passing the risk of complication increases and at a certain moment, it may reach some critical point. Midwives should always pay extra attention to the history of the patient. Certainly, at first glance, this statement may seem rather commonplace, but according to several research articles, dedicated to this issue, thirty percent of all unwanted aftermaths are closely intertwined with the previous experience of the patient. Unfortunately, under some conditions, would-be mothers tend to conceal the fact that they have already been pregnant, and it presents additional difficulties to the obstetricians. It is hardly possible to develop any certain strategy, but the woman has been pregnant more than once and if she has previously undergone C-section, it is not advisable to discharge her after three days, even if all characteristics are normal. The thing is that possible after-effects may manifest themselves within five or six days.
Another important issue is the attitude of the mother towards her physical condition in the future. The thing is that sometimes women are not fully aware of the possible consequences of Cesarean section. For instance, they may be firmly convinced that bleeding must cease in a very short time, and the pain in the incision must not reappear again. While assessing the woman, the obstetricians must not overlook this aspect, because sometimes the mental state of the patient is the root cause of her problems with the child and relatives. According to many scholars, it is impermissible to discharge such patients, because their behavior is utterly unpredictable and poses dangers to other people (Priest, 2005).
The above-mentioned illusion or perceived self-image creates the so-called postnatal depression, which is rather widespread among mothers, who have undergone C-sections. There is a widely held opinion among scholars, medical workers, and psychologists that it may last for two weeks or even to month. Besides, this depression may create some problems in communication between the woman and the child. It should be borne in mind that the consequences of this temporary mental disorder still require thorough examination, especially if we are speaking about long-term effects and future relations between parents and their offspring. Naturally, it does not mean that the woman should be hospitalized for a month, but if the depression is very deep and there is no evidence that it is alleviated, the medical institution must not discharge such woman, it is much better for her and the child to be within the reach of medical workers (Bisson, 2003).
As regards the health of a baby, it should be mentioned that there are several parameters for assessing his or her child: as a rule midwives focus on the tempo of growth, and gaining weight. In this regard, one has to admit that a C-section increases the risk of infection. If there are no abnormalities the early discharge is quite permissible.
Some scholars suggest that when deciding on the discharging of the mother and child, the practitioners should also study the reaction, which the baby produces in his or her mother. The thing is that sometimes, the woman may not be ready to accept the newborn as a member of the family. Such behavior is typical of both vaginal and cesarean labors, but in the second case, it is much more frequent (Hickey, 1997).
Therefore, we can arrive at the conclusion that obstetricians must take into accounts the following factors or parameters while making decisions on the postpartum care and discharge plan: first, we need to mention the outcome of the surgical operation and possible risks to the mother and child. These risks or complications can be subdivided into two groups: physiological and psychological, and it is unacceptable to overlook any of them. As for the health of the child, we need should first mostly speak about the pace of growth, and weight. We need to say that in the majority of cases, a patient is discharged after four or five days, but the period of hospitalization may last even for a month or more, depending upon the outcome of the surgery (Judith M Lumley, 2004).
As far as the early discharge is concerned, we may say that the overwhelming majority of obstetricians do not recommend it after the Caesarian section. There are various reasons for such policy, first, the consequences of this surgical operation may appear after seventy-two hours and the medical intervention must be immediate. Secondly, as it has been mentioned the early discharge increases the risk of post-natal depression, and readmission is quite probably. Apart from that if the C-section has been previously made, the obstetrician object to the early discharge. Yet, we cannot say that a woman cannot be released after three days. If all her physiological and psychological characteristics are normal, it is more prudent not to detain her.
Bibliography
- Adele Pillitteri (2006) “Maternal & child health nursing: care of the childbearing & childrearing family” Lippincott Williams & Wilkins.
- Anne E Buist (2004). “Counting the costs of early discharge after childbirth” The Medical Journal of Australia 167: 236-237
- Anthea R Hickey, Philip M Boyce, David Ellwood, and Allen D Morris-Yates (1997). “Early discharge and risk for postnatal depression”. MJA, 167: 244-247.
- Audrey A. Mattson Bryan (2005). “Birth to Three Early Intervention: Nursing’s Role on the Interdisciplinary Team” Journal of Community Health Nursing. (12), 2, p 73.
- Barbara R. Stright (2004) “Maternal newborn nursing” Lippincott Williams & Wilkins.
- Bonnie Donovan (2004). “The Cesarean Birth Experience: A Practical, Comprehensive, and Reassuring Guide for Parents and Professionals” Beacon Press.
- Caroline M de Costa (1999). “Caesarean section: a matter of choice?” The Medical Journal of Australia 170: 572-573.
- Dr Carolinem M De Costa (2004). “Cesarean Section: Understanding and Celebrating Your Baby’s Birth” The Johns Hopkins University Press.
- Judith M Lumley (2004). “Evaluating policy and practice: what are the effects of early hospital discharge after childbirth?” Medical Journal of Australia 172: 524-525.
- Laucht M, Esser G, Schmidt MH (2003). Differential development of infants at risk of psychopathology: the moderating role of maternal responsivity. Dev Med Child Neurol; 43: 292-300
- Laura Elizabeth Ettinger (2004). “Nurse-midwifery: the birth of a new American profession” Ohio State University Press.
- Lee K Taylor (2005). “Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study” The Medical Journal of Australia. 183 (10): 515-519.
- Kathleen Rice Simpson (2007) “Perinatal nursing” Lippincott Williams & Wilkins
- Keller MB, Lavori PW, Friedman B, et al (2004). The longitudinal interval follow-up evaluation. Arch Gen Psychiatry ; 44: 540-548.
- Rose S, Bisson J (2003). Brief early psychological interventions following trauma: a systematic review of the literature. J Traumatic Stress ; 11: 697-710.
- Susan R Priest, Jenni Henderson (2005). “Stress debriefing after childbirth: a randomised controlled trial” The Medical Journal of Australia, 178 (11): 542-545.