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Factors influencing maternal length of stay after giving birth in a UK hospital and the impact of those factors on bed occupancy
Abstract
On average, the length of time women remain in hospital after giving birth in the UK has deceased in recent years but most women are nevertheless admitted to a postnatal ward after childbirth. In this unique, prospective, observational study, we drew upon the expertise of caregivers on postnatal wards to reveal a wide range of obstetric, medical, neonatal and social problems that can lead to prolonged hospital stay. A woman's stay was likely to be increased by the greatest amount if her baby required specialised care but bed occupancy was more strongly influenced by the presence of obstetric complications because these were common. In this paper, we describe inpatient postnatal activity in detail and make recommendations for the safe and effective development of postnatal services.
... In the prevention of mother to child transmission (PMTCT) of HIV in tropical Africa, adoption of exclusive breastfeeding strategy becomes even more pertinent [3]. This is because breastfeeding is part and parcel of the cultures and traditions across Africa and it will take a herculean number of disincentives for a nursing mother to refuse or abandon breastfeeding her baby, especially when other people are present to ensure compliance. ...
... Agunbiyade and Ogunleye [7] in a study breastfeeding mothers in southwest Nigeria found a prevalence of 16%, citing baby's continued hunger after feeding, maternal health problem, fear that their infants could get addicted to breast milk, breast pains, and undue pressure from mothers-in-law to stop breastfeeding, as some of the barriers. Furthermore, Ugboaja, et al. [3] reported a higher but not impressive prevalence of 35.9% among urban women in southeast Nigeria. Other studies [4,5,7] have linked the persistence of these harmful breastfeeding practices to the influence of the grandmothers. ...
Background: The feeding of an infant with breast milk only, to the exclusion of all other feeds - liquids or solids, including water - except prescribed medications; within the first half year of life is referred to as exclusive breastfeeding (EBF). Despite its numerous benefits, not many mothers practiced it because of one barrier or the other. This study estimated the prevalence of EBF established the major barriers thereof and determined the link between socio-demographic characteristics and the practice of EBF among women living in the rural suburbs of Federal Capital Territory, Abuja, Nigeria. Methodology: This study was descriptive cross-sectional in design. Results: Among the 370 subjects, 49% practiced EBF. None of the respondents made PNC visit specifically for the purpose of learning or asking questions about breastfeeding. Nonetheless, 18.5% received breastfeeding education during PNC visit. A large proportion of the subjects did not practice EBF because they were not aware (21.1%) of it. Medical reasons, which included HIV positive mothers and those with breast disease constituted the least barriers (1.3%). EBF was prominently linked with maternal education, type of work, delivery place, skilled attendance at birth, husband’s education, and occupation (p<0.05). Conclusion: Capacity building for healthcare personnel on breast feeding, establishment of facilities as close to the communities as possible with their active participation in the planning, implementation and monitoring of EBF practice is recommended. Emphasis should be laid on the need for breastfeeding during antenatal period and then postnatal just before discharge.
... Consistent with the Donabedian model, 55 the existing literature examines a wide range of determinants that affect hospital LOS. 11,13,14,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] We illustrate some examples of these determinants in our conceptual framework of Figure 2, which we categorize as: (1) patient characteristics (eg, age, sex, race/ethnicity) 11,13,56-66 ; (2) hospital characteristics (eg, hospital ownership type, volume, region) 11,13,56,58,60-62,67,75 ; (3) clinical caregiver characteristics (eg, specialty, training) 14,57,59,61,66,[68][69][70][71][72][73] ; and (4) social/family environment characteristics (eg, number of people living in household, patients' family preferences). 57,61,63,65 Despite these broad and complex determinants of LOS, however, most studies include controls only for patient characteristics in their models. ...
... 11,13,14,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] We illustrate some examples of these determinants in our conceptual framework of Figure 2, which we categorize as: (1) patient characteristics (eg, age, sex, race/ethnicity) 11,13,56-66 ; (2) hospital characteristics (eg, hospital ownership type, volume, region) 11,13,56,58,60-62,67,75 ; (3) clinical caregiver characteristics (eg, specialty, training) 14,57,59,61,66,[68][69][70][71][72][73] ; and (4) social/family environment characteristics (eg, number of people living in household, patients' family preferences). 57,61,63,65 Despite these broad and complex determinants of LOS, however, most studies include controls only for patient characteristics in their models. This approach performs fairly well and explains approximately 50% of the variation. ...
Policy decisions in health care, such as hospital performance evaluation and performance-based budgeting, require an accurate prediction of hospital length of stay (LOS). This paper provides a systematic review of risk adjustment models for hospital LOS, and focuses primarily on studies that use administrative data.
MEDLINE, EMBASE, Cochrane, PubMed, and EconLit were searched for studies that tested the performance of risk adjustment models in predicting hospital LOS. We included studies that tested models developed for the general inpatient population, and excluded those that analyzed risk factors only correlated with LOS, impact analyses, or those that used disease-specific scales and indexes to predict LOS.
Our search yielded 3973 abstracts, of which 37 were included. These studies used various disease groupers and severity/morbidity indexes to predict LOS. Few models were developed specifically for explaining hospital LOS; most focused primarily on explaining resource spending and the costs associated with hospital LOS, and applied these models to hospital LOS. We found a large variation in predictive power across different LOS predictive models. The best model performance for most studies fell in the range of 0.30-0.60, approximately.
The current risk adjustment methodologies for predicting LOS are still limited in terms of models, predictors, and predictive power. One possible approach to improving the performance of LOS risk adjustment models is to include more disease-specific variables, such as disease-specific or condition-specific measures, and functional measures. For this approach, however, more comprehensive and standardized data are urgently needed. In addition, statistical methods and evaluation tools more appropriate to LOS should be tested and adopted.
... Early discharge from hospital was encouraged [29,30]. The duration of hospital stay following childbirth has decreased steadily over the last few decades to improve NHS maternity services efficiency [31,32]. However, studies have shown that shorter hospital stays following childbirth are associated with an increased risk of readmission for feeding problems and jaundice and a recent single center English study noted the number of neonates attending ED for low acuity issues has steadily increased since 2005 [26,[33][34][35]. ...
Objectives:
To examine the frequency and distribution of infant feeding-related presentations at emergency departments (EDs) before and during the SARS-CoV-2 pandemic.
Setting:
Attendances at 48 major EDs in England in two 50-week periods before and during the COVID-19 pandemic: period 1, April 2, 2019 to March 10, 2020 and period 2, April 1, 2020 to March 10, 2021.
Methods:
We estimated the change in frequency of ED presentations by age group and diagnosis before and after the start of the SARS-CoV-2 pandemic in England. We compared changes in the frequency of attendances of infant-feeding related presentations by infant age, sex, ethnicity, deprivation, rurality, arrival mode, arrival time, acuity, mother's age, gravidity and mental health, birth length of stay, attendance duration, and disposal (i.e., admission or discharge).
Results:
While total ED attendances fell by 16.7% (95% CI -16.8% to -16.6%), infant attendances increased for feeding problems (+7.5% 95% CI 2.3% to 13.0%), neonatal jaundice (+12.8%, 95% CI 3.3% to 23.3%) and gastro-esophageal reflux (+9.7%, 95% CI 4.4% to 15.2%). These increases were more pronounced amongst first babies (+22.4%, 95% CI 13.1% to 32.5%), and where the stay in hospital after birth was brief (0-1 days, +20.1%, 95% CI 14.8% to 25.7%). Our analysis suggests that many of these attendances were of low acuity.
Conclusions:
While ED attendances reduced dramatically and systematically with the COVID-19 pandemic, presentations for infant feeding issues increased, implying growth in the unmet needs of new mothers and infants.
... Nevertheless, ED of mothers and newborn has in fact increased dramatically in several high-income countries over the past 10-15 years. However, the evidence on the impact of ED on healthy mothers and term newborns (≥37 weeks) after a vaginal delivery (VD) is still inconclusive and little is known of the characteristics of those discharged early [5][6][7][8][9][10][11][12][13] . ...
Although length of stay (LoS) after childbirth has been diminishing in several high-income countries in recent decades, the evidence on the impact of early discharge (ED) on healthy mothers and term newborns after vaginal deliveries (VD) is still inconclusive and little is known on the characteristics of those discharged early. We conducted a population-based study in Friuli Venezia Giulia (FVG) during 2005–2015, to investigate the mean LoS and the percentage of LoS longer than our proposed ED benchmarks following VD: 2 days after spontaneous vaginal deliveries (SVD) and 3 days post instrumental vaginal deliveries (IVD). We employed a multivariable logistic as well as a linear regression model, adjusting for a considerable number of factors pertaining to health-care setting and timeframe, maternal health factors, newborn clinical factors, obstetric history factors, socio-demographic background and present obstetric conditions. Results were expressed as odds ratios (OR) and regression coefficients (RC) with 95% confidence interval (95%CI). The adjusted mean LoS was calculated by level of pregnancy risk (high vs. low). Due to a very high number of multiple tests performed we employed the procedure proposed by Benjamini-Hochberg (BH) as a further selection criterion to calculate the BH p-value for the respective estimates. During 2005–2015, the average LoS in FVG was 2.9 and 3.3 days after SVD and IVD respectively, and the pooled regional proportion of LoS > ED was 64.4% for SVD and 32.0% for IVD. The variation of LoS across calendar years was marginal for both vaginal delivery modes (VDM). The adjusted mean LoS was higher in IVD than SVD, and although a decline of LoS > ED and mean LoS over time was observed for both VDM, there was little variation of the adjusted mean LoS by nationality of the woman and by level of pregnancy risk (high vs. low). By contrast, the adjusted figures for hospitals with shortest (centres A and G) and longest (centre B) mean LoS were 2.3 and 3.4 days respectively, among “low risk” pregnancies. The corresponding figures for “high risk” pregnancies were 2.5 days for centre A/G and 3.6 days for centre B. Therefore, the shift from “low” to “high” risk pregnancies in all three latter centres (A, B and G) increased the mean adjusted LoS just by 0.2 days. By contrast, the discrepancy between maternity centres with highest and lowest adjusted mean LoS post SVD (hospital B vs. A/G) was 1.1 days both among “low risk” (1.1 = 3.4–2.3 days) and “high risk” (1.1 = 3.6–2.5) pregnanices. Similar patterns were obseved also for IVD. Our adjusted regression models confirmed that maternity centres were the main explanatory factor for LoS after childbirth in both VDM. Therefore, health and clinical factors were less influential than practice patterns in determining LoS after VD. Hospitalization and discharge policies following childbirth in FVG should follow standardized guidelines, to be enforced at hospital level. Any prolonged LoS post VD (LoS > ED) should be reviewed and audited if need be. Primary care services within the catchment areas of the maternity centres of FVG should be improved to implement the follow up of puerperae undergoing ED after VD.
... The women in this study described care that was centred on their babies, not them. This accords with other literature (see [47][48][49] and supports Rothman's suggestion 50 that hospital obstetrics view the woman as separate from her baby. de Cássia de Jesus Melo et al. 51 stress that mothers of preterm babies themselves need individualised care as women. ...
Problem:
There is minimal research exploring women's experiences of caring for a late preterm baby. The emphasis in the literature is mostly baby centric.
Background:
The number of babies born late preterm is rising and women's views are largely unknown.
Aim:
What are the experiences of women who are caring for a late preterm baby?
Methods:
A feminist lens was the key philosophical underpinning. Semi-structured interviews were undertaken with 14 women.
Findings:
Women who become mothers' of late preterm babies have a complex journey. It begins with separation, with babies being cared for in unfamiliar and highly technical environments where the perceived experts are healthcare professionals. Women's needs are side-lined, and they are required to care for their babies within parameters determined by others. Institutional and professional barriers to mothering/caring are numerous.
Discussion:
Some of the women who were separated from their babies immediately after birth had difficulties conceiving themselves as mothers, and others faced restrictions when trying to access their babies. Women described care that was centred on their babies. They were allowed and expected to care for their babies, but only with 'powerless responsibility'. Many women appeared to be excluded from decisions and were not always provided with full information about their babies.
Conclusion:
Women whose babies are born late preterm would benefit from greater consideration in relation to their needs, rather than the focus being almost exclusively on their babies.
... Factors with the greatest influence on maternal length of stay have been identified. 26 Notably, the mean length of stay increased in an approximately linear fashion with the number of risk factors identified. A significant increase in length of stay was noted among women whose infants required specialized neonatal care, women with certain social problems, and women with obstetric or medical complications. ...
... The reported distribution of typical discharge times for newborns in the United Kingdom are 16% on the day of birth, 35% the following day; 21% after 2 days and 28% for 3 days after delivery [21]. In the US, healthy infants are typically discharged from the hospital between 24 and 48 h after birth [22]. ...
... Factors with the greatest influence on maternal length of stay have been identified. 26 Notably, the mean length of stay increased in an approximately linear fashion with the number of risk factors identified. A significant increase in length of stay was noted among women whose infants required specialized neonatal care, women with certain social problems, and women with obstetric or medical complications. ...
Purpose/Aims: Neonatal outcomes have been used as proxy for maternal-fetal care evaluation, which do not address the unique needs of the pregnant woman. The purpose of this study is to identify the maternal risk factors that have predictive value in determining adverse maternal outcomes in order to support the development of maternal risk-appropriate care. Specific aims: a) identify patterns of high-risk factors present in cases with adverse maternal outcomes, and b) describe the relationship between age, parity, pre-pregnancy weight, history of adverse outcome in previous pregnancy, history of chronic medical conditions, presence of current medical conditions, history of obstetrical complications, current pregnancy conditions, and adverse delivery outcomes.
Background: The number of high-risk pregnancies due to maternal or neonatal complications has significantly increased over the past decade (Kuklina et al., 2009). Approximately 31.1% of pregnant females suffered complications during hospitalized labor and delivery in 2007 (USDHHS, 2010). As a result, Healthy People 2020 objectives include the reduction of maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery) by 10%. Antenatal risk assessment and transfer are key strategies to the successful provision of risk-appropriate care and prevention of maternal mortality and/or morbidity.
Methods: A descriptive, correlational design employing linked secondary data sets will be used for the study. Using probabilistic linkage techniques, data from the California Office of Statewide Health Planning (OSHPD) will be matched with the birth statistical files of the Office of Vital Statistics (OVS). OSHPD data include demographics, delivery mode, diagnoses, procedures, type of discharge, source of payment, length of stay, charges, and hospital type. Data including parity, pre-pregnancy weight, co-morbidities, and gestational age at delivery will be collected from OVS. The statistical analysis will include descriptive and inferential statistics.
Results: in progress
Implications: Health care providers are being challenged to use their knowledge and skills to identify potential factors that may cause injury or harm to the patient. The earlier these factors are recognized the better the nurse can initiate the decision making process to mitigate the risk. Information is needed about potentially modifiable versus non-modifiable risk factors. Data sources regarding maternal outcomes are limited or non-existent. The results from this study will contribute information regarding what pregnancy related complications increase the risk for poor maternal outcomes. Information gained will inform practice standards and improve the recognition of these elements of risk and subsequent requirements for care to mitigate the potential for adverse outcomes.
... L ength of hospital stay for childbirth has decreased around the developed world over recent decades. [1][2][3][4] The main driver for reducing in-hospital stay is to reduce health care costs. International studies suggest that mean length of stay has decreased for both Caesarean and vaginal deliveries, although such studies investigated overall length of stay rather than postnatal length of stay. ...
Objective: To investigate changes in maternal length of postnatal stay by mode of birth and hospital type, and examine concurrent maternal readmission rates and reasons for readmission.
Methods: Linked birth and hospital separation data were used to investigated mothers’ birth admissions (n=597,475) and readmissions (n=19,094) in the six weeks post-birth in New South Wales, 2001–2007. Outcomes were postnatal length of stay (mean days) and rate of readmission per 100 deliveries. Poisson regression was used to investigate annual readmission rates and Wilcoxon-Mann-Whitney test was used to compare length of readmission stays.
Results: The overall mean postnatal length of stay declined from 3.7 days in 2001 to 3.4 days in 2007. Private hospitals had longer stays after Caesarean and vaginal deliveries, but mean length of stay fell for both private and public hospitals, and both modes of birth. The maternal readmission rate fell from 3.4% in 2001 to 3.0% in 2007. Leading primary diagnoses at readmission following vaginal birth were postpartum haemorrhage and breast/ lactation complications and following Caesarean section were wound complications and breast/ lactation complications.
Conclusions: Despite the decrease in mean length of stay for birth admissions, there was no increase, and in fact a decrease, in the rate of postnatal readmissions.
Implications: Current practices in hospital length of stay and care for women giving birth do not appear to be having serious adverse health effects as measured by readmissions.
... Unfortunately, fathers have been shown to be significantly more dissatisfied with postpartum care compared with mothers, especially in regard to fathers' ability to influence care and to actively participate in decision making (Ellberg, Högberg, & Lindh, 2010). In answering open-ended questions, The current focus in postnatal care for parents and hospital staff is often the care of the newborn (Elattar, Selamat, Robson, & Loughney, 2008). However, care of the newborn after a complicated birth may differ from the natural focus on care of newborn infants after natural childbirth (Erlandsson, 2007); in Sweden, care on maternity wards is mainly for women who have had a complicated pregnancy and/or childbirth (Ellberg, 2008). ...
The aim of this study was to describe fathers' experiences of being present on a postnatal ward and during the first days at home following a complicated birth. Fifteen fathers were interviewed, and content analysis was used for the analysis. The theme illustrated that fathers were a resource for both mother and child through practical and emotional engagement. The categories describe how the father empowers the mother and illustrates adapting to new family roles. Following complicated birth, fathers should be invited to stay around-the-clock on postnatal wards because it gives them the opportunity to place their resources at the disposal of mother and child. In antenatal courses, fathers should be prepared for their empowering role after a complicated birth.
Objective:
To evaluate the consequences of COVID-19 pandemic restrictions on the postpartum course.
Methods:
A retrospective cross-sectional study compared women who gave birth between March and April 2020 (first wave), between July to September 2020 (second wave), and a matched historical cohort throughout 2017-2019 (groups A, B, and C, respectively). Primary outcomes were postpartum length of stay (LOS), presentations to the emergency department (ED), and readmissions 30 days or longer after discharge. Following Bonferroni correction, P<0.016 was considered statistically significant.
Results:
In total, 3377 women were included: 640, 914, and 1823 in groups A, B, and C, respectively. LOS after birth (both vaginal and cesarean) was shorter in groups A and B compared to the control group (2.28±1.01 and 2.25±0.93 vs 2.55±1.10 days, P<0.001). Rates of ED presentations 30 days after discharge were higher in groups C and B compared to group A (6.63% and 6.45% vs 3.12%, P=0.006). Rates of readmissions 30 days after discharge were 0.78%, 1.42%, and 1.09% (groups A, B, and C, respectively), demonstrating no statistical difference (P=0.408).
Conclusion:
During the COVID-19 pandemic, there was a reduction or no change in rates of ED presentations and readmissions, despite the shortened LOS after delivery. A shift in policy regarding the postpartum LOS could be considered.
Perinatal complications linked to maternal comorbidities contribute to increased healthcare utilization through an extended postpartum length of stay (LOS). Understanding factors influencing postpartum LOS may minimize the adverse effects associated with comorbidities and complications. The purpose of this study was to identify risk factors with the greatest odds of increasing postpartum LOS. Linked 2008-2009 hospital discharge and birth certificate data were used to examine comorbidities and complication codes in 1 015 424 births. The overall rate for an extended LOS (vaginal: >5 days/cesarean: >6 days) was 3.63 per 1000 live births. Complications were present in 17% of pregnancies; multiple complications were seen in 1%. Chronic hypertension was associated with an extended stay for both vaginal and cesarean births (odds ratio [OR] = 5.89 [95% CI, 4.39-7.88]; OR = 3.57 [95% CI, 3.05-4.17], respectively). Puerperal infections (OR = 6.86 [95% CI, 5.73-8.21]), eclampsia (OR = 17.07 [95% CI, 13.76-21.17]), and transfusions (OR = 11.66 [95% CI, 9.20-14.75]) occurred most frequently and conferred the highest odds of an extended stay for vaginal births. Cerebrovascular conditions (OR = 15.32 [95% CI, 11.90-19.60]) and infection (OR = 15.35 [95% CI, 10.11-23.32]) conferred the highest odds of an extended LOS for cesarean births. The earlier risk factors are recognized, the sooner processes can be initiated to optimize organizational preparation, thus decreasing adverse maternal outcomes and extended hospital stays.
Aim:
The aim of this retrospective analysis was to show the readmission rate of cases with and without early discharge following vaginal or cesarean delivery.
Methods:
After exclusion of cases with pregnancy, delivery and neonatal complications, a total of 14.460 cases who delivered at Zeynep Kamil Women and Children's Health Training and Research Hospital were retrospectively screened from hospital database. Subjects were divided into two groups as Group 1:Early discharge (n?=?6802) and Group 2:Late discharge (n?=?7658). Groups were compared in terms of readmission rates and indications for readmission.
Results:
There were 6802 cases with early discharge whereas the remaining women were discharged after 24?hours for vaginal delivery and 48?hours following cesarean delivery on regular bases. Among cases with early discharge, 205 (3%) cases readmitted to emergency service with variable indications, while there were 216 (2.8%) readmitted women who were discharged on regular bases. Most common indication for readmission was wound infection in both groups. Neonatal sex distributions were similar between groups (P > 0.05), where as there was a higher rate of cesarean deliveries in Group 2 (P < 0.05). Furthermore, cesarean rate was significantly higher in readmitted women with early discharge (P < 0.05).
Conclusion:
Similar readmission rates were observed in groups with early and late discharges following vaginal or cesarean delivery without any mortality or permanent morbidity and cost analyses revealed 68 Turkish liras lower cost with early discharge.
Objective
Most literature on length of stay (LOS) for childbirth focuses on ‘early’ discharge as opposed to ‘optimal’ time of discharge and has conflicting results due to heterogeneous definitions of ‘early’ discharge and differing eligibility criteria for these programmes. We aimed to determine the LOS associated with the lowest neonatal readmission rate following childbirth by examining the incidence pattern of neonatal readmission for different LOS using the Kitagawa decomposition.
Design
Retrospective cohort study using administrative hospitalisation data.
Setting
Canada (excluding Quebec) from 2003 to 2010.
Patients
Term, singleton live births without congenital anomalies.
Interventions
LOS for childbirth.
Main outcome measure
Neonatal readmissions within 30 days of birth.
Results
1 875 322 live births were included. Neonatal LOS peaked at day 1 (47.3%) after vaginal birth and day 3 (49.3%) following caesarean section; 4.2% of infants were readmitted following vaginal birth and 2.2% after caesarean section. In 2008–2010, most readmissions occurred among infants discharged in the first 2 days (83.8%) following a vaginal birth and among infants discharged in the first 3 days (81.7%) following a caesarean birth. Readmissions increased from 4.1% in 2003–2005 to 4.6% in 2008–2010 among vaginal births and from 2.0% to 2.4% among caesarean births and occurred mostly due to changes in the day-specific readmission rates and not due to reductions in LOS.
Conclusions
Patterns of readmission suggest that readmission rates are lowest following a 1–2-day stay following a vaginal birth and a 2–4-day stay following a caesarean birth given the outpatient support in the community.
In high-income countries welfare states play a crucial role in defining - and re-defining - what is offered as publicly provided care, and as a result shape the role of families, markets and the voluntary sector in care provision. Fiscal policies of cost containment, coupled with neoliberal policies stressing individual responsibility and reliance on market forces in recent decades, have resulted in the contraction of state provided care services in a range of sectors and states. There has also been widespread retrenchment in public health sectors across many countries resulting in policies of deinstitionalisation and early discharge from hospital that are predicated on the assumption that the family or voluntary sector will pick up the slack in the care chain. At the same time that this loosening of medicalized control has occurred, services to families with young children have become increasingly targeted on 'at risk' mothers through widespread population surveillance. To date, analyses of the implications of these important changes in care provision have primarily focused on health services and outcomes for birthing women and their newborns. In this paper, we make the case that post-birth care is a form of social care shaped not only by welfare state policies but also by cultural norms, and we suggest an analytic framework for examining some of the recent changes in the provision of postpartum care. We use examples from three developed welfare states - the Netherlands, Australia and Canada -- to illustrate how variations in welfare state policy and cultural norms and ideals shape the provision of home and community based postnatal services.
A substantive amendment to this systematic review was last made on 23 May 2002. Cochrane reviews are regularly checked and updated if necessary.
Context.
—While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established.Objective.
—To assess the risk for rehospitalization following newborn early discharge.Design.
—Population-based, case-control study.Setting.
—Washington State linked birth certificate and hospital discharge abstracts covering 310578 live births from 1991 through 1994.Patients.
—Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included.Main Outcome Measure.
—Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth).Results.
—Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR,1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1.91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis.Conclusion.
—Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.
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
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 parentcraft 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.
Thesis (M.P.H.)--University of Washington, 1997. Includes bibliographical references (leaves [27]-29).
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.
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.
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.
While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established.
To assess the risk for rehospitalization following newborn early discharge.
Population-based, case-control study.
Washington State linked birth certificate and hospital discharge abstracts covering 310578 live births from 1991 through 1994.
Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included.
Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth).
Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR,1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1.91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis.
Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.
The purpose of this study was to identify factors related to pregnancy and childbirth that might be predictive of a patient's length of stay after delivery and to model variations in length of stay.
California hospital discharge data on maternity patients (n = 499,912) were analyzed. Hierarchical linear modeling was used to adjust for patient case mix and hospital characteristics and to account for the dependence of outcome variables within hospitals.
Substantial variation in length of stay among patients was observed. The variation was mainly attributed to delivery type (vaginal or cesarean section), the patient's clinical risk factors, and severity of complications (if any). Furthermore, hospitals differed significantly in maternity lengths of stay even after adjustment for patient case mix.
Developing risk-adjusted models for length of stay is a complex process but is essential for understanding variation. The hierarchical linear model approach described here represents a more efficient and appropriate way of studying interhospital variations than the traditional regression approach.
The length of time women spend in hospital after childbirth has fallen dramatically in many countries over the past 30 years. This review of trials compared the policy of early discharge after childbirth with standard length of stay and care at the time. Early postnatal discharge of healthy mothers and term infants does not appear to have adverse effects on breastfeeding or maternal depression. However, the quality of the studies was generally poor. There are still too few participants in trials to determine the impact of early discharge on rare events, such as infant mortality. Further research is needed.
Length of postnatal hospital stay has declined dramatically since the 1970s, with ongoing controversy about potential harmful effects. Three population-based surveys of recent mothers conducted in the State of Victoria, Australia have been analysed to assess the impact of shorter length of stay on breast feeding and women's psychological well-being. Women giving birth in Victoria, Australia in 1 week in 1989, 2 weeks in 1993 and 2 weeks in 1999, excluding those who had a stillbirth or neonatal death, were mailed surveys 5–8 months postpartum. Adjusted response fractions were: 71.4% in 1989 (n = 790), 62.5% in 1994 (n = 1313), and 67% in 2000 (n = 1616). Participants were representative in terms of method of birth, parity and infant birthweight. Younger women, single women and women of non-English-speaking background (born outside Australia) were under-represented.
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.
This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents' preferences.
Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth.
Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother-child dyads.
Cost calculation of various care models and parents' preferences for postnatal care.
Because the parents' preferences with regard to postnatal care created one of the most cost-minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.
Available at: http://www.dh.gov.uk/assetRoot/04/10/70
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- Statistical
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- Government
- Statistical
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Home-based versus hospital-based postnatal care: an economic evaluation
- M Boulvain
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Boulvain M, Perneger TV, Othenin-Girard V, Petrou S, Berner M, Irion O. 2004b. Home-based versus hospital-based postnatal care: an economic evaluation. British Journal Obstetrics and Gynaecology 111:800 – 806.
Early postnatal discharge from hospital for healthy mothers and term infants. The Cochrane Database of Systematic Reviews, Issue 3. Article No. CD002958 Early discharge: no evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers, con-ducted in 1989
- S Brown
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Brown S, Small R, Faber B, Krastev A, Davis P. 2002. Early postnatal discharge from hospital for healthy mothers and term infants. The Cochrane Database of Systematic Reviews, Issue 3. Article No. CD002958. Brown S, Bruinsma F, Darcy MA, Small R, Lurnley J. 2004. Early discharge: no evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers, con-ducted in 1989, 1994 and 2000. Paediatric and Perinatal Epidemiology 18:202 – 213.
Early discharge: no evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers
- S Brown
- F Bruinsma
- M A Darcy
- R Small
- J Lurnley