The pregnant, 30-year-old mother of two, lumbering 10 days past her due date, had finally entered Columbia Hospital at Medical City Dallas last week for a scheduled induced delivery. She was in labor for an exhausting 15 hours before delivering a 9-pound, 6-ounce boy. Shortly after the 10 p.m. delivery, nurses moved the fatigued mother to a shared room, even though she had asked for a private one. No private rooms were available at the time, the nurses told Butbul. Perhaps she would get one the next day.
But the next day, after a restless night with dizzy spells, the nurses told Butbul a private room was not available. Nor, for that matter, would the shared room in which she was staying be available in a few short hours, Butbul was told.
It was mid-morning when the nurses told Butbul she would be expected to pack her bags and leave the hospital at 10 p.m. that night--exactly 24 hours after she delivered her baby.
Despite Butbul's repeated requests to stay--and a change in federal laws to bar what have become known as drive-through deliveries--Butbul reluctantly headed for the hospital door in the middle of the night.
"The baby was screaming. I didn't feel good," recalls Butbul, who had a fever at the time. "But the nurses said, 'It's time to leave.'"
Butbul's tale is a cautionary one for expectant mothers and their kin. If they expect protection from the federal law President Bill Clinton signed on September 26, they'd better check again. The law is supposed to stop the fast-growing trend among hospitals, doctors, and managed medical care companies to kick women out of maternity wards shortly after they deliver babies.
But expectant mothers who think the practice has ended had better check the calendar and the hospital they plan to visit to have their baby.
The federal law doesn't go into effect until January 1998, and it is unclear whether state lawmakers will step in and pass a stopgap measure to halt drive-through deliveries until then.
When the Texas Legislature convenes next month, it will take up a bill introduced by Rep. Brian McCall, a Republican from Plano, aimed at ending the practice.
Critics of drive-through deliveries say such state laws may be necessary, because hospitals like Columbia Hospital at Medical City are waiting for some law to take effect before changing their policies.
"We will assess the situation," says Sheila Everly, the vice president and chief nurse at Columbia Hospital at Medical City. "If the physician and our staff deem the patient is medically stable, we will send them home. "
As for Butbul's experience, Everly says, "I'm not real comfortable commenting on the specifics." Everly cites concerns about the patient's privacy. But Columbia Hospital at Medical City's marketing director, Jonnie Rohrer, says that on the night Butbul delivered her baby, the 40-bed post-partum wing was not entirely full. It was busy, she admits. All the private rooms were indeed occupied.
When the federal law does take effect--and women can hold some significant sway in deciding when they leave the hospital--the hospital acknowledges that its facilities will have to be expanded. Officials are planning to add beds in time for the new law, Everly says, but they don't know exactly how many they will need.
The potential impact of the new law is uncertain in part because of what critics say is a large loophole. While the law indeed requires insurers and health maintenance organizations to provide at least 48 hours of hospital coverage after vaginal deliveries and 96 hours after cesarean sections, another clause gives an out. Shorter stays are permissible if the decision "is made by an attending provider in consultation with a mother," according to the federal statute.
At some Dallas area hospitals, however, expectant mothers don't have to wait for the federal law to become effective.
At Doctors Hospital, for instance, the well-advertised policy is to allow any woman who arrives for a regular delivery to stay for 48 hours after her baby is born. The hospital carries the cost of the extra day if the insurer or managed care company is unwilling to do so, says Doctors Hospital director of business development Steve LaGroin.
The policy has been in effect for more than a year, the Doctors Hospital spokesman says, but it has not necessarily added to the numbers of women choosing the facility. "But it has helped in our patient satisfaction surveys," LaGroin says.
At Parkland Memorial Hospital, the city's public, tax-supported facility, women delivering babies also don't get pushed out the exit door so soon. As an institutional policy, the hospital allows a woman a 48-hour stay after a vaginal delivery, although a patient may request to go home earlier. Because it is a public hospital--and not a for-profit institution--Parkland doesn't face the same cost issues as the other institutions. Oddly enough, women receiving public assistance may be getting to stay in the hospital longer than those who have private insurance.
Dawn Hallman, executive director of the nonprofit Dallas Association for Parent Education, which offers classes in childbirth, blames the doctors rather than the hospitals for the drive-through deliveries. "It happens all the time," she says. "The doctor is the one who has to stop it."
Butbul remembers the nurses telling her that in order to stay longer, her doctor must request it. But hospital administrator Everly says the nursing staff could also telephone the doctor and seek such a decision if they deemed it medically necessary.
On the evening after she had the baby--when she was being ushered out and nurses were peering in her room every few minutes to see if her bags were packed--Butbul didn't know where to turn. She had been seen by her doctor earlier that morning, and he didn't examine her for long. She had gotten a fever later in the day for which the nurses gave her medication (although they never managed to change her bedsheets during her stay, not an insubstantial complaint for a mother who just delivered a baby).
Butbul remembers that she really panicked around 8 p.m., when the nurses from the pediatrics ward told her that her baby might not be able to leave the hospital until he had a bowel movement. The baby might stay, she remembers the nurses telling her, but she would go.
Understandably appalled, Butbul, who was nursing the baby, pressed the issue. The nurses then said that they just might call the doctor and see if the mother could stay with her child. As it turned out, the baby's diapers were dirtied by 10 p.m., and he was permitted to leave with her.
But at that point, Butbul was suffering a fever. The baby was screaming. And her husband was red with anger.
"We were not out of there until 11 p.m." Butbul recalls. "We just couldn't go any faster."
As it turned out, her concerns about her fever were well-founded. She developed an infection the day after she left the hospital. Her husband took her to her doctor's office. She had to stop breastfeeding for a short time and begin taking antibiotics.
"She's lucky she knew what to do," says Hallman. "Some women wouldn't have known and could have died. So much for shaving a few pennies.