# ? about leaving hospital AMA after birth



## danav (Jun 3, 2005)

I am planning to have our baby at a free standing birth center (where my first two babies were born), but it's 1 1/2 hrs away and given my history of fast labors we're making a back-up plan to possibly go to a local Women's Hospital if things are moving too quickly to make the trip.

The hospital just told me that they will absolutely NOT discharge the baby before 24 hrs post-partum (48 hrs if I am GBS positive or GBS status unknown...I wasn't even going to be tested but now I might just so I have the chance of having that negative result documented). The person I spoke to said that although we would not be discharged before 24 hrs, *I* could leave earlier if I wanted but the baby cannot.

I have spoken to my insurance co and they assured me that they cannot deny payment of benefits if I decide to leave the hospital AMA before the 24 hrs when they agree to discharge us.

My question is, does anyone know if the hospital can legally refuse to let me take my baby home AMA, or if I simply walk out with the baby can they do something horrible like call CPS on us?

I do NOT want to stay for 24 hrs - if the baby and I are both healthy, I fully intend to leave within just a few hours, whenever we feel ready (we were able to leave the birth center less than 12 hrs after my first two births, even after some hemmorrhage the first time and a traumatic breech birth the second time). But I also don't want to get into a nasty situation with CPS or something like that.

Hopefully it won't come to this at all - we'll either make it to the birth center in time, or things will go SO fast that there will be no choice but to birth at home...but just in case I want to be fully prepared for what my rights are.


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## SneakyPie (Jan 13, 2002)

It's usually all about their malpractice insurance. A local midwife or the birth center will probably know what the laws actually are in your state. Around here they just have to make a note in the chart like "Patient left hospital refusing recommended stay." I would hope they wouldn't call CPS but I suppose anyone CAN call them for any reason they want. Could you just not mention it to the hospital at all at the time and then stop by the nurses' station babe in arms to say "We're leaving -- run after us w/the paperwork!" ?


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## Elowyn (Nov 3, 2003)

You can always take the baby and leave AMA. Definitely an option. However, if they document you as leaving AMA, insurance is unlikely to pay for the hospital stay. Just a bit of warning for ya.


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## danav (Jun 3, 2005)

Elowyn - I've already talked to my insurance company and they assured me that they will not/cannot deny payment if I leave AMA, so that's not a concern. I just don't want the hospital trying to fight me taking my baby home with me!


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## LeosMama (Sep 6, 2005)

maybe you should call cps and ask them this question. other mamas here on MDC have done this regarding homebirth, then the CPS person laughed at them "we don't take babies b/c of homebirth!" Every state and every county is different in how CPS reacts. Here, the CPS get money to take children away, so it happens more than it should, and we live in an uptight place where doing things non-mainstream is really frowned upon and regarded with suspicion. (We're going to homebirth anyway as many women here do, it's just not mainstream.)


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## JoyofBirth (Mar 16, 2004)

I'd call the hospital anonymously. Say you justt found out t hat you're pregnant and yo're trying to decide on a hospital and you'd like to know their policies. Ask a few questions about visitation schedule, rooming-in, lactation consultants and then ask if all is well and a mama wants to leave early with her baby AMA, what is their standard way of handling this, do they just chart it and let the mom go, do they forcibly hold the baby the 24 hours or do they call CPS? If they ask if you plan to do this, say oh I don't know, I had a friend do it and I was just wonderinng if she could've gotten in trouble or something like that. If they ask your name, give them a fake and tell them you're far from due like 8 weeks or something. The reason I advise this is so you don't set off any red flags. I had a friend do this, no problems, they just charted that she refused care for her newborn. My midwife though once transported a baby who was a twin and had a little trouble breathing. Rather than wait it out, she transported. Within an hour the baby was fine, they observed him for like 6 hours and the dr said he was perfectly healthy but they wanted to watch him for 24hours. The mom tried to discharge him AMA, they called CPS while they said they were getting paperwork together. CPS showed up accused her of negligence to a newborn, she said she didn't want to take the baby, but CPS flagged her anyway, so now she has a history with CPS. So it would just be good to know up front. Hopefully, you won't even need to deal with that. Good luck!


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## janellesmommy (Jun 6, 2004)

Quote:


Originally Posted by *Elowyn*
if they document you as leaving AMA, insurance is unlikely to pay for the hospital stay. Just a bit of warning for ya.

This is an urban myth that doctors and nurses love to tell patients to get them to stay. Definitely report any doctor or nurse who tells you that to their disciplinary board.


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## Zus (Sep 21, 2005)

At my local hospitals, there is actualy a guard standing next to the door who keeps unwanted people out but also keeps 'unauthorized' babies in. He will only let you out with the baby if you have a signed discharge form.
Maybe you can talk to women who've recently given birth there and ask them about their experiences with the hospital policies? My experience is that hospitals often say X but do Y, also depending on who you talk to.


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## MrsAngelic (Sep 9, 2005)

What about the security devices some hospitals attach to the babes? I've seen it attached on the umbillical cord, they unlock it after you get your discharge papers. Might make things more difficult.


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## Zus (Sep 21, 2005)

Quote:


Originally Posted by *MrsAngelic*
What about the security devices some hospitals attach to the babes? I've seen it attached on the umbillical cord, they unlock it after you get your discharge papers. Might make things more difficult.


Kind of like those devices against shop lifting?


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## danav (Jun 3, 2005)

Quote:


Originally Posted by *Zus*
At my local hospitals, there is actualy a guard standing next to the door who keeps unwanted people out but also keeps 'unauthorized' babies in. He will only let you out with the baby if you have a signed discharge form.

GOOD LORD! How can they legally DO this??


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## Zus (Sep 21, 2005)

Quote:


Originally Posted by *danav*
GOOD LORD! How can they legally DO this??

Apparently here they can. I live in Israel.


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## Zus (Sep 21, 2005)

But I have to add that they do let you go before the 'required' 48 hours if you make a lot of noise and fill out a quadrillion papers. Most people don't know this, but you can actually sign yourself (and the baby) out.


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## LeosMama (Sep 6, 2005)

we didn't have a lock on the umbilical stump (i wouldn't have allowed that!) instead at the hospital we were at, it was an ankle band. the nurse had to cut it off when we left.
that scared the crud out of me as she had these nasty ancient dull scissors that couldn't cut paper she was using to saw at this band. i was NOT happy and let her know she needed to get some safer scissors!
but my point is that we could have cut it off ourselves.

Zus, I wouldn't think that could happen here, about having a guard to keep unauthorized babies in. Maybe that is a security measure to keep babies from being abducted, which is what our ankle bands are for here. They're not meant to keep parents from taking a baby home AMA, but to keepa baby from being stolen.


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## Zus (Sep 21, 2005)

Quote:


Originally Posted by *LeosMama*
Zus, I wouldn't think that could happen here, about having a guard to keep unauthorized babies in. Maybe that is a security measure to keep babies from being abducted, which is what our ankle bands are for here. They're not meant to keep parents from taking a baby home AMA, but to keepa baby from being stolen.

We have wrist and ankle bands too, but those are only to make sure that the babies are not being switched.
I am sure that the guards here are to prevent peoplefrom 'stealing' babies too, but the nice side-effect is that the hospital has to sign the baby out before you can take him/her home. Just adds to the general feeling of "the baby belongs to the hospital" that I've mentioned in several threads.


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## lilgsmommy (Jun 21, 2004)

The ankle bands are a minuture electronic device that sets off an alarm if abby is removed form a certain area of the hospital. Kinda like a home arrest anklet.

One of the hospitals here where I live has specially locked doors on the post partum ward that only certain nurses can unlock and the only way to leave with baby is on a special elevator with a nurse who has a special card.


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## danav (Jun 3, 2005)

Oh, this whole thing has me SO frustrated!!

I called the hospital again this afternoon to ask what they usually do when someone wants to leave before the 24 hr time frame. I was told essentially that it just doesn't happen. That if I tried to leave with my baby AMA there was a very good chance that they would call "whoever the doctor wants involved", which when I asked for clarification was explained to mean anything from an in-hospital consult (presumably with social services or someone like that) to family protective services. I was told that the only way I could take the baby early was if the doc/ped was ok with that, but that the chances of that were "slim to none". I got the whole attitude of "why in the WORLD would you want to leave early, SO MUCH CAN HAPPEN in the first 24 hours, you know!!" The nurse I spoke to also tried to tell me that my insurance would refuse to pay, which I already know is false (according to my OWN insurance company).

So I have a call in to my pediatrician - I want to ask her directly what her stand is on this, and whether she would be willing to discharge my baby earlier. Her nurse already called me back but I want to speak directly to the doc herself so I have to wait until she has time to return my call.

I'm just outraged by this all - this is MY BABY and if I don't want to stay in a freaking hospital for 24 hours for NO REASON at all, I can't believe they can make my life hell for it. Talk about a violation of rights!







:


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## Zus (Sep 21, 2005)

You are absolutely right!!! I hope your ped will have something good to say.
Are there any other hospitals in your area that you could check out?


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## LeosMama (Sep 6, 2005)

this is ridiculous, what do they think happens in homebirths? does a dr or nurse come and sit next to the baby at home for 24 hours? Whatever!


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## CarrieMF (Mar 7, 2004)

IMO since the whole hospital thing is back up for if you can't get to the birth center either stay at a hotel near the birth center or plan for a homebirth and then if a transfer was necessary go to where you would transfer to at the birth center.


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## gentlebirthmothr (Jul 13, 2005)

Quote:


Originally Posted by *JoyofBirth*
My midwife though once transported a baby who was a twin and had a little trouble breathing. Rather than wait it out, she transported. Within an hour the baby was fine, they observed him for like 6 hours and the dr said he was perfectly healthy but they wanted to watch him for 24hours. The mom tried to discharge him AMA, they called CPS while they said they were getting paperwork together. CPS showed up accused her of negligence to a newborn, she said she didn't want to take the baby, but CPS flagged her anyway, so now she has a history with CPS. So it would just be good to know up front. Hopefully, you won't even need to deal with that. Good luck!

Jessica,

WOW about your midwife on this. If I was her I would sue the hospital on calling CPS because of that incident.

Dana,

Can't believe what the hospital said to you and you peds nurse as well.

Everyone Else,

WOW about this issue.

Thank you.


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## alegna (Jan 14, 2003)

I think I'd see if I couldn't do a homebirth.

-Angela


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## danav (Jun 3, 2005)

My ped called me back this evening and was so nice! I explained the whole situation to her, and asked if she would be willing to discharge my baby a few hours post partum if everything was fine. I added that the birth center where we hope to birth (and where my first two were born) has an average stay of 6 hours. She replied "OH! Really? Wow!" and said that being my third baby, she doesn't think she would have any problem agreeing to an early discharge!!







And since she might not end up being the ped on rotation at the time of the birth, she said she'd talk to the other peds in her practice, and that she would even call the nurse manager and talk to who ever is in charge of L&D at the hospital to give them my name and let them know she is fine with an early discharge. Now, I'm not sure how much that will really help if it turns out we birth there and she's not on call...but at least she's willing to go to bat for us! I was SO relieved that there is at least a real possibility we could be "allowed" to leave early without a fight.

Carrie - I've thought about going to stay with a friend near the birth center. The issue with that is it would be me, my two kids, and probably my sister (who is coming from out of state for the birth) and that's a lot to impose upon my friend's family for an unknown length of time...staying in a hotel is an option but that's a pain, because we'd have to pack SO much stuff to entertain and take care of my two kids for however long we're there (whereas my friend's home has plenty of "kid" stuff and a full kitchen).

As for home birth...my sister, who is planning to come in time for the birth, is actually a midwife in another state, and we have been planning all along to home birth if she is here when I go into labor. However, recently DH has had a change of heart about that and is adamant that he does not want to have a home birth after all







- he's afraid something will go wrong (and believe me, I've TRIED to make him understand that my sister will have stuff like oxygen, pitocin, etc and is well trained to know when something comes up that she can't handle and warrants a transfer to the hospital). So that's why this all started with checking out the local hospital as our back-up...


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## applejuice (Oct 8, 2002)

Quote:

The hospital just told me that they will absolutely NOT discharge the baby before 24 hrs post-partum
I have posted my story many times here about my friend who was in your position. She kept insisting and was finally handed a form for the "Disposal Of A Dead Fetus"; she signed it and left with her baby.


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## Elowyn (Nov 3, 2003)

Quote:


Originally Posted by *janellesmommy*
This is an urban myth that doctors and nurses love to tell patients to get them to stay. Definitely report any doctor or nurse who tells you that to their disciplinary board.

OK, first of all, I'm a physician assistant. I've seen insurance companies deny payment on patients who left AMA, both from the ER and from the inpatient floors. I'm really not sure what "urban legend" you're talking about - the laws may vary from one state to another.

Second, I'll thank you to keep the "reporting to the disciplinary board" items for actual medical negligence. You do realize that people get their licenses pulled due to complaints, and have no end of hassles that take valuable time away from patient care, to answer complaints along these lines. Real negligence? Fine. But "they told me something about insurance companies that I think isn't true?" Frivolous. Licensing board complaints affect people's livelihoods, and ability to take care of their own children.







:

For the OP - I'm glad your ins company has to/will pay if you leave AMA. Assuming you can get out (i.e. the baby-alarms listed above) more power to you.


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## amydidit (Jan 21, 2005)

I think the suggestion to call your CPS is a great idea. Just ask them, anonymously, how they would handle a call from the hospital about a mom leaving AMA with a perfectly healthy newborn.

Any chance your sister could bring her stuff with her *just in case* things went too fast, and then just *accidently* have a homebirth? Not ideal, but neither is having to fight with the hospital. You should be able to just bond with your baby and enjoy the bliss instead of having to get on your fighting gloves.


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## gentlebirthmothr (Jul 13, 2005)

Quote:


Originally Posted by *Elowyn*
OK, first of all, I'm a physician assistant. I've seen insurance companies deny payment on patients who left AMA, both from the ER and from the inpatient floors. I'm really not sure what "urban legend" you're talking about - the laws may vary from one state to another.

Second, I'll thank you to keep the "reporting to the disciplinary board" items for actual medical negligence. You do realize that people get their licenses pulled due to complaints, and have no end of hassles that take valuable time away from patient care, to answer complaints along these lines. Real negligence? Fine. But "they told me something about insurance companies that I think isn't true?" Frivolous. Licensing board complaints affect people's livelihoods, and ability to take care of their own children.







:

For the OP - I'm glad your ins company has to/will pay if you leave AMA. Assuming you can get out (i.e. the baby-alarms listed above) more power to you.

Kate,

This definetly interesting and wish all of what you said doesn't happen in the real world because its such a shame for the whole world. Think this it.

Thank you.


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## SoCaliMommy (Jun 11, 2004)

I know my insurance company has to let me leave AMA since they arent payin a dime for my hospital birth stay .. i am payin them $200 per day for delivery.

heck if i have my way i plan to stay home as long as possible and just call the hosp after i have the baby saying the baby came to fast and we didnt have time to make it there.


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## Ruthla (Jun 2, 2004)

Please be careful. The hospital *can* call CPS while the baby is there and prevent you from taking the baby home.


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *Ruthla*
Please be careful. The hospital *can* call CPS while the baby is there and prevent you from taking the baby home.

Unfortunate, but absolutely, positively true!


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## SoCaliMommy (Jun 11, 2004)

Quote:


Originally Posted by *Ruthla*
Please be careful. The hospital *can* call CPS while the baby is there and prevent you from taking the baby home.


I dont see how they can do that when you are paying them just to stay there , the insurance company is not payin for the hosp stay so i dont see why they would get CPS involved.


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## danav (Jun 3, 2005)

Well, not only has the hospital itself told me they would call, but also the nurse practitioner at my free standing birth center told me last week that she has known hospitals in our area to call CPS and to actually attempt to ARREST AND JAIL moms who try to take their baby home without being discharged. She said she has no idea how they can legally do that but she has known it to happen!!

It just doesn't seem possible that they can get away with forcing interventions you don't want and with holding your own healthy baby literally against your will, but somehow it is happening.


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *danav*
GOOD LORD! How can they legally DO this??

Well, who owns the baby? The parents or the hospital? (the parents of course) The hospital personnell are trained to believe they do until "they" are willing to let go. Sorta like a hostage situation...it is getting very dangerous to go to a hospital for normal birth....some might not be like this but it pays to ask...


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *DustysSweety03*
I know my insurance company has to let me leave AMA since they arent payin a dime for my hospital birth stay .. i am payin them $200 per day for delivery.

heck if i have my way i plan to stay home as long as possible and just call the hosp after i have the baby saying the baby came to fast and we didnt have time to make it there.

If you can't find a mw, plan a UC, there are far less repercussions! If you can find a mw, don't bother going to a birth center, just stay home!


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## cathicog (May 7, 2005)

Quote:


Originally Posted by *danav*
Well, not only has the hospital itself told me they would call, but also the nurse practitioner at my free standing birth center told me last week that she has known hospitals in our area to call CPS and to actually attempt to ARREST AND JAIL moms who try to take their baby home without being discharged. She said she has no idea how they can legally do that but she has known it to happen!!

It just doesn't seem possible that they can get away with forcing interventions you don't want and with holding your own healthy baby literally against your will, but somehow it is happening.

I believe it! Is there a way to get your husband to get some sense? (not to be rude, but what exactly is he afraid of,) with a hospital like this you are MUCH safer at home, and if you still need a doula, pm me....(I remember our earlier conversations....is your sis still coming?)


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## Thmom (May 4, 2004)

I would call CPS and contact a family attorney.... Then call the hospital back, and tell them what you were told. I do not believe any medical establishment has the right to force treatment on you or your child for whatever reason.
OR
call the hospital and ask them for what law provides them with the right to do this. Tell them you'll hold while they get you the complete refrence number

This really is absurd, I hope you'll follow up on this even if it's not an issue for you. I'm sure many babies are being subjected to unnecessary treatments because thier mothers don't know thier rights.


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## danav (Jun 3, 2005)

Quote:


Originally Posted by *cathicog*
I believe it! Is there a way to get your husband to get some sense? (not to be rude, but what exactly is he afraid of,) with a hospital like this you are MUCH safer at home, and if you still need a doula, pm me....(I remember our earlier conversations....is your sis still coming?)

My sister is coming around the 23/24th (possibly a day or two earlier) - I'll be 38 1/2 weeks then, so hopefully that will be in time. I have also found a monitrice here in town - she has doula experience plus over 2 years experience as a midwife's apprentice/assistant!







She'll be available for any situation - whether we have time to head to the birth center (said she'd be willing to go with us even though it's 1 1/2 hrs away), to the hospital, or to assist my sister for a home birth. I think that has helped a bit with DH, to know that there would be a trained, experienced second person present for a home birth. She's coming over tomorrow night to meet with both of us, and hopefully that will ease his mind even more, then he's also going with me to the rest of my prenatal appts at the birth center and I'll make sure the midwives also stress how much better/safer it would be to stay home with my sister than to go to the hospital here.

DH is afraid because "we're two for two" as he says. I did hemmorrhage with my first birth (it was not a big deal, the midwife got it under control easily with pitocin and methergin, both of which my sister will also have with her here at home, and I was fine and home a few hours later, but at the time he literally thought he was standing there watching me die and it traumatized him deeply). Then my second birth was a surprise breech, and there was also a knot in his cord - he came out depressed and not breathing, had to be recusitated and transferred to NICU at the hosp down the street. So that was seriously traumatic as well... But the thing is, both of those were isolated problems not likely to happen again, and had we been at home rather than the birth center they would have been handled exactly the same way (we have a phone, we can call an ambulance just as quickly as the birth center can). So he really thinks that something will go wrong again this time and is just anxious about that, which I can completely understand. He also seems to think that a hospital environment/experience is similar to the birth center, rather than realizing that the birth center is MUCH more like a home birth than the hospital...he's never been to a hospital birth.

So it's not that he's being hard headed or anything...he is reacting to his own emotional memories from our first two births when he really thought he was either losing me or losing our second baby. He just wants to be sure we are both going to be safe. I'm willing to go to the hospital if it's going to be that huge an issue for him, but I'm working hard to make him feel safe with a home birth instead so hopefully that will work out.


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## gentlebirthmothr (Jul 13, 2005)

//


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## Zus (Sep 21, 2005)

If your husband has unrealistic ideas of the hospital, maybe it's a good idea to take a tour of that specific hospital so he can see with his own eyes what you're talking about.


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## saintmom (Aug 19, 2003)

Hugs to you Mamma,sounds like you have a lot to consider.
If you're babys coming so fast you don't make it to the birth center it sounds like you'd be better off at home.read up on it.Get dh to read the emergency childbirth manual www.1cascade.com carries it. in the meantime there's alot you can do nutionally to help prevent hemmorage.Egg yolks and molasses come to mind.Could you get some methregen ahead of time and find out the dose just in case?
If I were in your shoes I'd just head to the birth center early.Go shopping nearby,the walking would be good foryour labor


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## Mama2RMM (Aug 24, 2004)

We transferred from a Birthing Center to our local hospital, and I ended up with a C-Section. We picked out the pediatrician ahead of time, but my OB was just the "on-call" doctor.

We asked to be discharged less than 40 hours after my surgery. That was, of course, over the standard 24 hour wait for a healthy baby so no questions were raised about that. Insurance would've paid for a full 3-5 nights, so the hospital could've certainly put a lot of pressure on us.

They were actually really helpful, called the on-call OB at 10PM, got authorization for us to leave, and did paperwork with us until close to midnight. No red flags, no lectures, and insurance did indeed pay for two full days.

We expected the worst, but came out with great when we approached the staff with respect and honesty. I felt great, I was ready to leave, and Rachel had done everything but her hearing test (they did it that night before we left). If your pediatrician and the midwife/OB are agreeable to your plan then you really shouldn't encounter issues.


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## RockStarMom (Sep 11, 2005)

I left the hospital the day I had Hazel. They hated me and hassled me so much but there's nothing they could do. I don't know what the laws are elsewhere, but here in CA, they couldn't stop me from checking myself and baby out AMA.


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