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Early Postpartum Discharges
Impact on Distress and Outpatient Problems
David A. Lane, MD;
Lynda S. Kauls, MD;
Jeannette R. Ickovics, PhD;
Frederick Naftolin, MD, PhD;
Alvan R. Feinstein, MD
Arch Fam Med. 1999;8:237-242.
Objective To determine the impact of shortened postpartum hospital stays on common clinical phenomena in a sociodemographically diverse, unselected group of general maternity patients.
Design Observational cohort study in which the preapproved hospital stay duration of either 1 or 2 nights was set by third-party payers before each mother's admission.
Setting Yale–New Haven Hospital, New Haven, Conn, from June 19 through August 10, 1995.
Patients Two hundred forty-four volunteers from among 400 eligible deliveries.
Main Outcome Measures Readmission within 1 month of hospital discharge, report of outpatient morbidity and use of outpatient health services within 1 week of discharge, status of breast-feeding during the first postdischarge week, and patient satisfaction.
Results At discharge from the hospital, the hospital stay was regarded as "too short" by 80 (47%) of 171 mothers and 19 (26%) of 73 mothers in the 1- and 2-night groups, respectively (P=.002). Although readmission rates were similar (5% vs 3%, P=.48), the 1-night group reported significantly more morbidity in the newborns (31% vs 16%, P=.03) and averaged more pediatric visits (96 vs 54 per 100 newborns, P=.002). Mothers in the 1-night group also reported more fatigue (49% vs 29%, P=.001) and more worries about their newborns' health (24% vs 11%, P=.02). They were less likely to start breast-feeding (64% vs 77%, P=.06), and, if they started, were somewhat more likely to stop prematurely (14% vs 8%, P=.43). A series of disturbing events was reported only in the 1-night group.
Conclusions In a relatively unselected group, mothers who stayed 1 night after routine vaginal delivery reported more distress and more pediatric problems and had greater use of outpatient health services than mothers who stayed 2 nights.
From the Departments of Medicine (Drs Lane, Ickovics, and Feinstein) and Obstetrics and Gynecology (Dr Naftolin), Yale University School of Medicine, New Haven, Conn. When this research was done, Dr Kauls was a third-year medical student at Yale University School of Medicine.
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