Early and late discharge after hospital birth. A comparative study of parental background characteristics. Does the duration of postnatal stay influence breast-feeding rates at one month in women giving birth for the first time? A randomized control trial. Postpartum early discharge: impact on maternal fatigue and functional ability. A randomized, controlled evaluation of early postpartum hospital discharge. Home-based versus hospital-based postnatal care: a randomised trial. A randomized trial of a program of early postpartum discharge with nurse visitation. Perinatal care of low-risk mothers and infants. Early discharge with home care. Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up.
When an early postnatal discharge program was introduced in Falun, Sweden in 1984, with early discharge defined as discharge 24-48 hours after birth combined with home visits on the following days, an investigation into background characteristics of parents choosing to participate and not to participate in the evaluative study of the program was initiated. 164 participants were compared with 354 non-participants. Data were collected mainly from questionnaires, 8 weeks before term. The participants were a more heterogeneous group than was expected when starting the program. Compared with the non-participants, they were characterized by: a less positive attitude to post-partum care in hospital and greater self-confidence in terms of confidence when thinking of birth and parenthood. They were more often multipara and had experienced rather less complicated pregnancies. They were a little younger and somewhat less well educated as a group, but the proportion of well educated women was the same as among non-participants. They had attended antenatal classes this pregnancy to a lesser extent, but felt better prepared for the delivery. They had a greater number of supportive persons available in case of early discharge. There was no difference between participants and non-participants as regards economy, housing conditions, distance to hospital, proportion of immigrants, paternal interest in childbirth and parenthood, equality in parental relations, social contacts, and leisure activities. The aim of the study reported in this paper was to examine the effect of postnatal stay on breast-feeding rates at one month using a randomized control trial. Participants were recruited during parent-craft classes at a large teaching hospital in the north of England. Nulliparous women in the last trimester of pregnancy were randomly allocated to a short hospital postnatal stay (6-48 hours), or a longer stay (more than 48 hours). The mothers were contacted at one month following the birth to ask about the method of feeding. The study was approved by the hospital ethical committee, and participation was voluntary. The results demonstrated no significant effect of postnatal stay on breast-feeding rates at one month. The main limitation of the study was the reluctance of the mothers in the long stay group to stay in hospital for longer than three days. This resulted in only a small difference between the lengths of hospital stay of the two interventions. The overall breast-feeding rate for the study group had increased significantly when compared with local city wide rates. This increase may be as a result of a sampling bias or a Hawthorne effect. The purpose of this study was to determine the impact of a postpartum early discharge program, with home follow-up by hospital nursing staff, on the maternal fatigue and functional ability of low-risk mothers with healthy neonates. A quasi-experimental design was used. Subjects were randomly assigned to one of two groups receiving the early-discharge program (hospital stay less than 60 hours plus home follow-up by hospital-based nurses; n = 35) or traditional hospital care (hospital stay more than 60 hours and no home follow-up by hospital staff; n = 17). A third group emerged from those originally assigned to traditional care but later transferred to early discharge due to bed shortages (n = 29). The Rhoten Fatigue Scale and the Inventory of Functional Status After Childbirth were used to collect the data at discharge and 1 and 6 weeks postpartum period. No significant differences between groups were found, suggesting that early discharge with adequate home follow-up does not affect the low-risk mother's fatigue and functional ability to any significantly greater extent than traditional care. It was also noted that, regardless of type of care, the proportion of subjects reporting severe fatigue was relatively large (25%, 31%, and 19% at discharge, 1 and 6 weeks postpartum period), highlighting the need for further study of maternal fatigue in the postpartum period. At approximately 37 weeks' gestation, 131 women were randomly assigned to one of three postpartum hospital discharge times: 12 to 24 hours, 25 to 48 hours, and 4 days. Depending on group assignment, the women received from one to five home visits by a maternity nurse clinician during the first 10 days postpartum. The results indicated the maternal and infant morbidity were low regardless of discharge time, although sample sizes were too small to detect significant differences in the outcomes. More early discharge mothers were breastfeeding without supplement at 1 month than were mothers in the long stay group. Mothers in the two early discharge groups were significantly more satisfied with their care than were those who remained longer. Those hospitalized longer scored higher on measures of depression and lower on scores of confidence at selected time periods. To compare a shortened hospital stay with midwife visits at home to usual hospital care after delivery.
                Randomised controlled trial.
                Maternity unit of a Swiss teaching hospital.
                Four hundred and fifty-nine women with a single uncomplicated pregnancy at low risk of caesarean section.
                Women were randomised to either home-based (n= 228) or hospital-based postnatal care (n= 231). Home-based postnatal care consisted of early discharge from hospital (24 to 48 hours after delivery) and home visits by a midwife; women in the hospital-based care group were hospitalised for four to five days.
                Breastfeeding 28 days postpartum, women's views of their care and readmission to hospital.
                Women in the home-based care group had shorter hospital stays (65 vs 106 hours, P < 0.001) and more midwife visits (4.8 vs 1.7, P < 0.001) than women in the hospital-based care group. Prevalence of breastfeeding at 28 days was similar between the groups (90%vs 87%, P= 0.30), but women in the home-based care group reported fewer problems with breastfeeding and greater satisfaction with the help received. There were no differences in satisfaction with care, women's hospital readmissions, postnatal depression scores and health status scores. A higher percentage of neonates in the home-based care group were readmitted to hospital during the first six months (12%vs 4.8%, P= 0.004).
                In low risk pregnancies, early discharge from hospital and midwife visits at home after delivery is an acceptable alternative to a longer duration of care in hospital. Mothers' preferences and economic considerations should be taken into account when choosing a policy of postnatal care. Our purpose was to compare an early postpartum discharge program versus standard postpartum care.
                A randomized controlled trial in a 637-bed university hospital included 175 healthy women recruited at 32 to 38 weeks gestation from physicians' offices and sonograms. Experimental intervention consisted of discharge 6 to 36 hours post partum with nursing care available by telephone or at home at 34 to 38 weeks' gestation and at < or = 48 hours and at 3, 5, and 10 days post partum. The control included a postpartum stay of 48 to 72 hours and standard follow-up.
                At 1 month no significant differences were seen in perceived maternal competence (Experimental-Control = 4.3 points [95% confidence interval-7.7 to 16.3]), infant weight gain (1.2 gm/ day [-2.8 to 5.2]); identification of significant neonatal hyperbilirubinemia (rate ratio 0.50 [0.10 to 2.51]), infant utilization of health services (rate ratio 0.88 [0.45 to 1.73]), or predominant breast-feeding (adjusted odds ratio 1.25 [0.88 to 1.75]). Program participants did have significantly less frequent infant bilirubin testing (rate ratio 0.39 [0.17 to 0.94]). The program also enhanced perceived maternal competence in recent immigrants (26.9 points [2.7 to 51.5]).
                Early postpartum discharge coupled with prenatal, postnatal, and home contacts leads to no apparent disadvantage and may yield benefits for some mothers and infants. A family-centered perinatal-care program featuring collaboration by nurse practitioners, obstetricians, pediatricians, and paramedical personnel was developed to enhance family participation and achieve a shorter but safe hospital stay. Discharge from the hospital was permitted as early as 12 hours after delivery. A perinatal nurse practitioner made daily home visits. The program's safety, feasibility, and acceptability to patients was studied by comparison of 44 patients so treated (study group) with 44 receiving traditional care (controls). Twenty-one study families, but no controls, went home within 24 hours. The study and control groups had no significant differences or trends in numbers of types of morbidity during hospitalization or the six-week post-partum period. The expense of the program is approximately equaled by hospital costs saved through early discharge. The results indicate that early discharge with home-care follow-up observation as described is safe, economically feasible, and well accepted by patients. This study was undertaken to evaluate the advantages and disadvantages of a program of early obstetric-pediatric discharge (24 hours postpartum) with domiciliary follow-up, compared with the traditional postpartum hospital stay (more than 48 hours), according to the criteria described by reviewers of the subject.
                A randomized controlled trial of early obstetric discharge for healthy mothers and term infants, with postpartum randomization, with no prenatal preparation and with observational and clinical follow-up was performed. The participants were mothers with healthy, term neonates (37-42 weeks) weighing more than 2500 g and produced via vaginal delivery and with a verified normal evolution before discharge. The sample consisted of 430 cases (213 cases with early discharge, and 217 control cases) in which the following variables were evaluated: existence of complications in the mother and/or child that required rehospitalization or a medical consultation, existence of maternal problems of fatigue or anxiety/depression after the birth, continuity of lactation and its problems, satisfaction of the mother and family, and relative costs.
                After demonstrating the homogeneity of the groups, no significant differences were found in the rates of maternal rehospitalization (1.9% in the early discharge group vs 2.3% in the control group, relative risk 0.81, 95% CI 0.21-3.03) or in the rates of rehospitalization of the neonates (1.4% in the early discharge group vs 2.3% in the control group, relative risk 0.16, 95% CI 0.15-2.56). No increases were observed in maternal or neonatal disease, puerperal fatigue, or maternal anxiety/depression. A prolongation of maternal lactation to 3 months was observed in the early discharge group (P=.016 <.05 Fisher exact test). When the cost of early discharge is compared with that of traditional discharge with a minimum of 48 hours hospital stay, we find a saving of 18% to 20%. The level of maternal satisfaction with early discharge is better than 90%.
The pooled trials have inadequate power to detect increases in rare outcomes, such as infant and maternal mortality or readmissions.
Policies of earlier postnatal discharge of healthy mothers and term infants do not appear to have adverse effects on breastfeeding or maternal depression when accompanied by a policy of offering women at least one nurse-midwife home visit post discharge.
Large well-designed trials of early discharge programs incorporating process evaluation to assess the uptake of co-interventions, and using standardized approaches to outcome assessment are needed.