Maternal and infant health: effects of moderate reductions in postpartum length of stay
K. D. Mandl, T. A. Brennan, P. H. Wise, E. Z. Tronick and C. J. Homer
Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
BACKGROUND: The Newborns' and Mothers' Health Protection Act of 1996
prohibits payers from restricting "benefits for any hospital length of stay
in connection with childbirth for the mother or newborn child, following a
normal vaginal delivery, to less than 48 hours." The law recognizes the
basic right of women and physicians to make decisions about aptness of
discharge timing. OBJECTIVE: To provide data as a basis for decisions about
aptness of discharge timing by studying the effect of voluntary, moderate
reductions in length of postpartum hospital stay on an array of maternal
and infant health outcomes. DESIGN: A prospective cohort study. Patients
were surveyed by telephone at 3 and 8 weeks postpartum. SETTING: A teaching
hospital where 38% of the patients are in a managed care health plan with a
noncompulsory reduced stay program offering enhanced prepartum and
postpartum services, including home visits. PATIENTS: Consecutive mothers
discharged after vaginal delivery during a 3-month period. MAIN OUTCOME
MEASURES: The outcomes were health services use within 21 days,
breast-feeding, depression, sense of competence, and satisfaction with
care. Multivariate analyses adjusted for sociodemographic factors, payer
status, services, and social support. RESULTS: Of 1364 eligible patients,
1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were
resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2
hours). Of patients going home in 30 hours or less, 60.8% belonged to a
managed care health plan. The length of stay was not related to the
outcomes, except that women hospitalized shorter than 48 hours had more
emergency department visits than those staying 40 to 48 hours (adjusted
odds ratio, 5.78; 95% confidence interval, 1.19-28.05). CONCLUSIONS: When
adequate postpartum outpatient care is accessible, a moderately shorter
length of postpartum stay after an uncomplicated vaginal delivery had no
adverse effect on an array of outcomes. Researchers and policy makers
should seek to better define the content of postpartum services necessary
for achieving optimal outcomes for women and newborns; funding should be
available to provide such services, regardless of the setting in which they
are provided.
Preventable Newborn Readmissions Since Passage of the Newborns' and Mothers' Health Protection Act
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ABSTRACT
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Maternal Postpartum Health Care Utilization and the Effect of Minnesota Early Discharge Legislation
Madlon-Kay and DeFor
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ABSTRACT
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Madlon-Kay et al.
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ABSTRACT
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Madden et al.
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Galbraith et al.
Pediatrics 2003;111:364-371.
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Madden et al.
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Feinberg et al.
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Mosen et al.
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Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants
Mandl et al.
Pediatrics 2000;106:937-941.
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A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge
Lieu et al.
Pediatrics 2000;105:1058-1065.
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Early Perinatal Hospital Discharge and Parenting During Infancy
Britton et al.
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Infant Health Care Use and Maternal Depression
Mandl et al.
Arch Pediatr Adolesc Med 1999;153:808-813.
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Early Discharge and the Neonate
Spitzer
CLIN PEDIATR 1998;37:617-619.
Postpartum Length of Stay
Johnston
Arch Pediatr Adolesc Med 1998;152:411-411.
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