On May 2, 2015, at approximately 6 a.m. local time, the Duchess of Cambridge was admitted to the Lindo Wing of Saint Mary’s Hospital after going into labor. At 8:34 a.m., the Duke and Duchess welcomed a baby girl, Charlotte Elizabeth Diana, into the world weighing 8 lbs. 3 oz. Kensington Palace announced the arrival of the fourth royal in line to the British throne at 11 a.m. At around 1 p.m., the royal hairstylist arrived and by 3 p.m., an official declaration of the birth was placed on an easel outside Buckingham Palace. At 4 p.m., the Duke left St. Mary’s briefly to pick up his son, Prince George, at Kensington Palace before returning to introduce the 21-month-old brother and future king to his baby sister. At 6:12 p.m., the Duke and Duchess made a quick appearance to show Her Royal Highness, the Princess of Cambridge to an eager crowd. The Duke then buckled his daughter into the back of a black Land Rover before returning home to Kensington Palace at about 6:15 p.m.
So the question arises, “Why did I have to stay in the hospital for 2 or 3 days when I delivered my own prince (or princess)?” The answers are revealed in the updated American Academy of Pediatrics (AAP) policy statement “Hospital Stay for Healthy Term Newborn Infants,” published by lead author Dr. William Benitz in the May 2015 edition of Pediatrics. Contrary to what a third-party payer (i.e. insurance company) may tell you, the timing of discharge for a healthy, term baby should be evaluated by the healthcare provider after consultation with the family, other providers, and hospital staff.
The new guidelines, developed by the AAP Committee on Fetus and Newborn, outline specific criteria for determining whether a mother is ready to care for herself and her baby at home, including the mother’s health, the level of support she has at home, the health and stability of the baby, and access to follow-up care. The policy statement contains 17 minimum criteria that should be met before a newborn is discharged.
The baby should have no serious abnormalities noted on physical examination and vital signs should remain within normal ranges. At least two urinations and one spontaneous passage of stool should occur. At least two successful feedings (either by bottle or breast) should be documented. Jaundice and risk factors should be noted and an appropriate plan to monitor for jaundice should be instituted. Parents should have an appropriate car safety seat and know how to use it. Also important is assessment of possible risk factors in the home including whether parents have mental illness, untreated drug or alcohol use, a history of child abuse or neglect, or a history of domestic violence. For newborns discharged less than 48 hours after delivery, an appointment should be made for the infant to be examined by a health care provider within 48 hours of discharge.
So, in general, the hospitalization should be long enough to establish that the term newborn is healthy. With the luxury of 24/7 royal doctors and a private staff (as well as the added experience of a previous birth), the Duchess and Princess of Cambridge should be in good hands. Unfortunately, most non-royal princes and princesses are not ready to go home within 10 hours of life, nor would their parents have time to prep their own dinner.
Justin Morgan is a pediatrician who blogs at Bundoo, where this article originally appeared. He can be reached at his self-titled site, Justin Morgan, MD.
