Experiences of women discharged early following vaginal birth: a qualitative systematic review.

Abstract

The objective of this qualitative review was to evaluate the meaningfulness of early hospital discharge for women following a normal vaginal birth. A challenge for maternity services nationally and internationally is to identify what services may be restructured or reduced to enable cost savings while not compromising safe, quality care. Many different models of care have emerged across maternity services in relation to facilitating early hospital discharge. Different models of care complicate evaluation of early discharge programs because of the different staffing components, professional collaborative arrangements, and approaches to antenatal and postnatal care. Databases searched included: CINAHL, PubMed, Scopus, Embase and ProQuest Dissertations and Theses. The search was conducted between March and May 2018 and repeated again in March 2019. Only qualitative research written in English since 1970, when publications on the topic first started to appear, were considered for inclusion in this review. Critical appraisal of identified manuscripts and qualitative data extraction occurred. Findings were assembled according to their quality, and categorized on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings. A search of the literature identified seven papers for final inclusion. The meta-synthesis resulted in 22 findings, 9 categories, and the following five synthesized findings: i) Women who committed to early discharge had a positive experience; ii) Women recognized that supportive family and friends were an important resource when experiencing early discharge; iii) Women found that supportive midwives enabled a positive transition at home following early discharge; iv) Women who were ready for discharge gained control of their lives more quickly when they went home early and commenced their own routine; v) Early discharge may not be suitable for some women. Synthesized findings were used to construct a theory that comprehensively explained the women's experience. This qualitative systematic review resulted in seven moderate-quality studies that explored women's experiences of early postnatal discharge. Women who commit to, are prepared for, and have access to partner, family, and midwife support are most likely to have positive experiences when they arrive home from hospital with a new infant. Each woman, however, has a unique personality, life story, and support network that must be considered when identifying whether early discharge is appropriate. Early discharge following birth should be determined on an individual basis and in consultation with the woman. There is no agreed definition of early discharge from hospital. The different approaches to models of maternity care can complicate evaluation attempts to understand women's experiences of early discharge because of different staffing components and approaches to antenatal and postnatal care provision. There was a gap in the literature around women without partners or whose partners were unable or unwilling to provide emotional and practical support following early discharge. PROSPERO CRD42017084024.