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Postpartum hospital discharges -- when is the 'right time?'
August 06, 2007LEBANON, N.H. - A landmark nationwide study, published today in the journal Pediatrics, is the first ever to prospectively examine the decision-making process of over 4,000 mothers and their physicians around the readiness of mothers and their infants to leave the hospital after childbirth.
The study, led by Dr. Henry "Hank" Bernstein M.D., Professor of Pediatrics at Dartmouth Medical School, and Chief of General Academic Pediatrics at Children's Hospital at Dartmouth (CHaD), is known as the "Life Around Newborn Discharge" or LAND study. It looked specifically at postpartum decision-making, with results showing that 17 percent of all mother-infant pairs were identified as "not ready".
This study also identified those factors most related to the "unreadiness" of mother-infant pairs to leave the hospital. These included: being a first-time mother, being black and non-Hispanic, the mother's history of chronic disease, inadequate prenatal care, delivering during non-routine hours, the newborn having problems while in the hospital, the mother's intent to breastfeed, and whether or not there was adequate in-hospital education.
"Clinical decision-making regarding maternal and infant discharge is a subjective and contextual process that must take into account the perspectives of each person involved in the mothers' and infants' health care experience," Bernstein says. "This suggests that the mother and the clinicians caring for her and her infant must make the postpartum discharge decision jointly."
Hospital affiliates and offices of 451 practitioners from 112 Pediatric Research in Office Settings (PROS) practices conducted the LAND study nationwide. The aim was to address the lack of information regarding the postpartum decision-making process for healthy term newborns and its consequences during the neonatal period. Data were collected through self-administered questionnaires completed by the mother, pediatrician and obstetrician on the day of discharge. A mother-infant dyad was determined unready for postpartum discharge if at least one of the three informants perceived that either the mother or infant should stay longer.
Federal legislation - The Newborns' and Mothers' Health Protection Act of 1996 - requires insurance plans offering maternity coverage to pay for at least a 48-hour hospital stay following childbirth, or a 96-hour stay in the case of a cesarean section. While Bernstein says he understands the need for some agreed upon minimum length of stay, he cautions against a "one-size-fits-all" approach to readiness.
"A customized reflection of both the mother's and her baby's needs and concerns is required," Bernstein says. "The length of postpartum stay is not the actual determinant of outcome, and the chronological clock is not necessarily what is important. The debate regarding postpartum hospital stays must be refocused toward a broadened scope of policy and clinical care considerations."
Dartmouth Medical School
"Clinical decision-making regarding maternal and infant discharge is a subjective and contextual process that must take into account the perspectives of each person involved in the mothers' and infants' health care experience," Bernstein says. "This suggests that the mother and the clinicians caring for her and her infant must make the postpartum discharge decision jointly."
Hospital affiliates and offices of 451 practitioners from 112 Pediatric Research in Office Settings (PROS) practices conducted the LAND study nationwide. The aim was to address the lack of information regarding the postpartum decision-making process for healthy term newborns and its consequences during the neonatal period. Data were collected through self-administered questionnaires completed by the mother, pediatrician and obstetrician on the day of discharge. A mother-infant dyad was determined unready for postpartum discharge if at least one of the three informants perceived that either the mother or infant should stay longer.
Federal legislation - The Newborns' and Mothers' Health Protection Act of 1996 - requires insurance plans offering maternity coverage to pay for at least a 48-hour hospital stay following childbirth, or a 96-hour stay in the case of a cesarean section. While Bernstein says he understands the need for some agreed upon minimum length of stay, he cautions against a "one-size-fits-all" approach to readiness.
"A customized reflection of both the mother's and her baby's needs and concerns is required," Bernstein says. "The length of postpartum stay is not the actual determinant of outcome, and the chronological clock is not necessarily what is important. The debate regarding postpartum hospital stays must be refocused toward a broadened scope of policy and clinical care considerations."
Dartmouth Medical School
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