Home‐based versus hospital‐based postnatal care: a randomised trial

Abstract

Objective To compare a shortened hospital stay with midwife visits at home to usual hospital care after delivery. Design Randomised controlled trial.Setting Maternity unit of a Swiss teaching hospital.Population Four hundred and fifty-nine women with a single uncomplicated pregnancy at low risk of caesarean section. Methods Women were randomised to either home-based (n ¼ 228) or hospital-based postnatal care (n ¼ 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. Main outcome measures Breastfeeding 28 days postpartum, women's views of their care and readmission to hospital. Results 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 ¼ 0.30), but women in the homebased 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 ¼ 0.004). Conclusions 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.

Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns

“…Of the women with problems, 42% attended health services seeking help. However, regarding hospital readmission, there was no difference between those discharged earlier or later (1,4) . Additionally, women who were discharged within 48hrs after delivery were significantly more likely to be depressed at 5-6 months postpartum (14) .…”

“…Although there is no conclusive evidence that proves infants discharged early have an increased risk of morbidity (1) , in 2000 a medical records analysis suggested that children who were discharged on the day of birth are more likely to be re-hospitalized with jaundice (p=0.01), however no difference was described in the prevalence of jaundice; also dehydration was higher in ED newborns (p=0.01) compared with those who were discharged later (12) . Furthermore, one study (4) noted that infants who were discharged early were more likely to be readmitted during the first six months postnatal compared with newborns discharged later (p= 0,004), nevertheless, the rate of neonate rehospitalization during the first month postpartum was not significantly different among the groups. A retrospective study, which included the medical records of American infants (13) , found a significant positive association between a postpartum discharge within 24hrs and newborn mortality at 28 days of birth (OR 3.65, 95% CI 1.56, 8.54).…”

“…In a randomized controlled trial undertaken in Switzerland, which aimed to compare a reduced hospital stay supplemented with home visits and hospitalbased postnatal care (4) , no significant difference between the groups was found when assessing breastfeeding initiation and duration. These results concur with the medical record analysis carried out in the USA (18) .…”

“…Despite the efforts of several researchers around the world systematically assessing and evaluating the effects of this new service on women and newborns (1,(4)(5)(6)(7)(8)(9) , there is still uncertainty about what the pros and cons of the shorter hospital postnatal stay are. In the context of a pioneer Chilean project which aims to develop an innovative modality of childbirth, including a reduction in the length of postnatal stay, we aimed to review the literature available and to examine the advantages and disadvantages of early postnatal discharge for both the healthy mother and child and the consequent repercussions for the health system which should be considered when proposing a reduction in the length of stay after childbirth.…”

Desired assistance versus care received for postpartum depression: access to care differences by race

“…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).…”