A randomized trial of a program of early postpartum discharge with nurse visitation

Abstract

OBJECTIVE: Our purpose was to compare an early postpartum discharge program versus standard postpartum care. STUDY DESIGN: A randomized controlled trial in a 637-bed university hospital included 175 healthy women recruited at 32 to 38 weeks gestation from physicians' offices and sonograms. Experimental intervention consisted of discharge 6 to 36 hours post partum with nursing care available by telephone or at home at 34 to 38 weeks' gestation and at ≤48 hours and at 3, 5, and 10 days post partum. The control included a postpartum stay of 48 to 72 hours and standard follow-up. RESULTS: At 1 month no significant differences were seen in perceived maternal competence (Experimental − Control = 4.3 points [95% confidence interval −7.7 to 16.3]), infant weight gain (1.2 gm/day [−2.8 to 5.2]); identification of significant neonatal hyperbilirubinemia (rate ratio 0.50 [0.10 to 2.51]), infant utilization of health services (rate ratio 0.88 [0.45 to 1.73]), or predominant breast-feeding (adjusted odds ratio 1.25 [0.88 to 1.75]). Program participants did have significantly less frequent infant bilirubin testing (rate ratio 0.39 [0.17 to 0.94]). The program also enhanced perceived maternal competence in recent immigrants (26.9 points [2.7 to 51.5]). CONCLUSIONS: Early postpartum discharge coupled with prenatal, postnatal, and home contacts leads to no apparent disadvantage and may yield benefits for some mothers and infants. (Am J Obstet Gynecol 1997;176:205-11.)