Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

Abstract

BackgroundFollowing childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants.Methods and FindingsWe described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries).Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries.Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation.ConclusionsLength of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care.

Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content

“…This is well-illustrated by the alarmingly low percentage of women staying for an acceptable amount of time after birth. Egypt is one of the LMICs with the shortest length of stay for both vaginal and C-section deliveries, and the shortest length of stay for singleton vaginal deliveriesonly half a day [42]. Early discharge can have negative effects on both women and newborns.…”

Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life

“…46 In the United States, the average LOS following an uncomplicated vaginal birth had dropped from 4 days in the 1970s to 2 days by the mid 1990s, adjusting minimally since. [46][47][48] Postpartum LOS on average is currently 36 to 48 hours with some stays as short as 12 to 24 hours, which severely curtailed the time available to perform this study. 46 The above obstacles were cited as the paramount reasons that other studies on this subject matter were performed retrospectively.…”

Does Shorter Postnatal Hospital Stay Lead to Postdischarge Complications? An Instrumental Variables Approach

“…There is no such data for developing countries to compare postnatal hospital stays over time. Campbell, Cegolon, Macleod, and Benova () have mentioned only a single year's postnatal hospital stays (in days) for 30 low‐income and middle‐income countries including India. From that, it is known that India has slightly lower postnatal hospital stay than Bangladesh but much higher postnatal hospital stay than Pakistan and several African nations, but it is not known whether the postnatal hospital stay has declining trends in India or other low‐income and middle‐income countries.…”