Home-based versus hospital-based postnatal care: A randomised trial

University of Oxford, Oxford, England, United Kingdom
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 09/2004; 111(8):807-13. DOI: 10.1111/j.1471-0528.2004.00227.x
Source: PubMed


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.

Download full-text


Available from: Véronique Othenin-Girard, Mar 13, 2015
  • Source
    • "From the past, providing appropriate care based on sociocultural beliefs and economic status of the mother is considered a goal for standard care.[17] It is due to deep influence of many factors including the performance of service providers, enjoying social support, and the rate of adaption to the mother conditions on the effectiveness of this care.[1819202122] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Postpartum care at home is a post delivery care method that can be provided by public health nurses, trained health workers, or midwifery nurses. A study conducted to compare effect of two midwife visits at home to usual postpartum care on the healthy behaviors of low-risk Iranian mothers. A randomized controlled trial conducted on 200 mothers at a reference center for screening for infant hypothyroidism in Tehran. Mothers were randomized to either home-based (n = 100) or routine-based postpartum care (n = 100). Each mother and her neonate received two cares. Home-based cares were provided by a midwife in the intervention group. Postpartum cares in the control group were provided by care providers of primary health care system. Healthy behavior was measured using a validated and reliable researcher made instrument. The data were analyzed using independent sample t-tests, paired t-test, and χ(2)-test. The data showed that a significant number of subjects in the control group did not receive their postpartum care (P < 0.001). The mean score of maternal healthy behaviors in the intervention group increased from 120.5 (SE = 0.76) to 148.9 (SE = 1.02) (P < 0.001) and in the control group from 119.9 (SE = 1.06) to 140.9 (SE = 1.08) (P < 0.001). The mean score of maternal healthy behaviors in the intervention group had significant differences with that in the control group at the end of study (P < 0.001). Early postpartum care at home by trained midwives can be positively effective for improving maternal healthy behaviors in less developed countries.
    International journal of preventive medicine 01/2014; 5(1):61-68.
  • Source
    • "Numerous biopsychosocial interventions have been shown to significantly reduce PPD symptoms. The most popular medically-based interventions are antidepressant medication (Marcus et al, 2001), estrogen therapy (Cattel & King, 1996; Gregoire, et al., 1996; Grigoriadis & Kennedy, 2002), home health care (Appleby et al, 2003; Armstrong et al, 1999; Mauthner, 1997; Parke & Hardy, 1997, Simons et al, 2003), inpatient hospitalization (Boulvain et al, 2004), psychiatric day treatment programs (Boath et al, 1999) and educational materials provided at discharge from maternity floors (Ahn & Kim, 2004; Garg et al, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: One in seven women who have a baby will experience postpartum depression. Although there are many treatments for postpartum depression, many women do not receive assistance. When left untreated, this condition can have a deleterious affect on the woman's health/mental health, the child's cognitive, psychological, emotional and social development, the marital relationship and ability to contribute to society. This study examined 45 women's self-reported desire for PPD care and ability to obtain to these services in Erie County, New York. Results showed differences in desired care by race, differences in access to care by race and revealed the lack of PPD care in general.
    Archives of Women s Mental Health 02/2008; 11(2):81-92. DOI:10.1007/s00737-008-0001-1 · 2.16 Impact Factor
  • Source
    • "The conclusion often is that there are no significant differences in clinical outcomes and that (additional) home visits are more costly, but result in markedly higher maternal satisfaction. A research study in which early discharge combined with home midwifery support was compared with traditional postnatal hospital stay of 4-5 days found that the home-based care group reported fewer problems with breastfeeding and greater satisfaction with the help received (Boulvain et al., 2004). In a study about satisfaction with postnatal hospital care, Brown et al. (2005) found that the odds of women giving a lesser rating of their postnatal care in hospital were raised more than threefold when midwives were seen to be rushed, doctors or midwives were seen as lacking sensitivity and understanding, and advice and support was perceived as less than 'extremely helpful'. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The overall aim of postpartum care is to detect health problems of the mother and/or baby at an early stage, to encourage breastfeeding and to give families a good start. This paper presents an overview of recent literature about postpartum care in several developed countries and elaborates on the Dutch model, which consists of professional postnatal care, provided by MCAs (maternity care assistants), who are supervised by midwives. The most important tasks of the maternity care assistant are, by becoming part of the family for a number of hours each day, being able to detect possible health problems, and to instruct, observe, and support the mother (and father) in establishing a new routine in their family life and help them to become confident in their parenting. (aut.ref.)
Show more