Adequate Postnatal Care Research Articles

Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys.

BackgroundFollowing childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants.Methods and FindingsWe described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries).Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries.Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation.ConclusionsLength of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care.

Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants

BackgroundEstimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.DesignWe used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.ResultsDue to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.ConclusionsHigh in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

Características demográficas del síndrome de Down en Navarra: Evolución del diagnóstico pre y postnatal durante el periodo 1991-2009

This study describes the development of pre and postnatal diagnosis of sindrome de Down (SD) in the Autonomous Community of Navarre from 1991 to 2009 and assesses its preventive impact in the population, as well as to associated socio-demographic changes. In the absence of a prenatal diagnosis for DS, the change in maternal age from 1991 to 2009 would have caused a 50% increase in births with this disorder. However, the antenatal rate detection of DS increased from 15.8% in 1991-4 to 64.3% in 2006-9, giving rise to a decreasing incidence trend, not statistically significant, during the study period and to a higher mean age of mothers of live births with DS (32.75± 5,02 and 34.8±4,82 years during the first and second periods of the study, respectively). The proportion of young mothers (<35 years) of live births with DS was 66% in 1991-4 and 45% in 2006-9. Close to one fifth of the total population of pregnant women, however, did not want to go through a maternal screening test or amniocentesis. Seventeen per cent of all live births with DS had a positive screening test, but mothers decided to continue pregnancy. These results suggest that, despite the application of new and more sensitive prenatal screening tests, the incidence of DS may still be relatively high in our population, an important factor to be considered for future antenatal preventive programs and adequate postnatal care.

Newborn Early Discharge Revisited: Are California Newborns Receiving Recommended Postnatal Services?

In California in the early 1990s, as elsewhere in the US, pressures to limit hospital costs had the result that up to 85% of women delivering healthy singleton infants stayed in hospital only one night at the most. Because of professional and public concern about the safety of this practice, 43 states now require third-party insurers to cover a postnatal stay of at least 48 hours (96 hours after cesarean delivery). This retrospective population-based cohort study, undertaken in California in 1999, examined the postnatal management of 2828 singleton infants at low medical risk, 49% of whom were discharged early (no hospital stay or a one-night stay after vaginal delivery; no more than a 3-night stay after cesarean section). Early discharge was recorded for 44% of vaginally delivered infants and 71 % of those delivered by cesarean section. Of infants discharged early, 32.5% had a follow-up visit within 2 days of discharge and 56% within 7 days. The respective figures for infants discharged later were 32% and 55% - nearly identical to those for the early discharge group. Timely follow-up after early discharge was noted for 36% of vaginally delivered infants and 23% of those born by cesarean section. Home visits were significantly likelier than office visits to be timely, that is, to take place at home or office within 2 days of discharge. After adjusting for possibly confounding variables, the risk of untimely follow-up was relatively high for low-income families, those on Medicaid, Latinos, and families not speaking English. Professional guidelines and legislation cannot by themselves ensure adequate postnatal care, especially for socioeconomically vulnerable newborn infants.

How Health Care Is; How It Might Be

WHILE FINANCING health care adequately is essential, says the recently retired president of Johns Hopkins University's Hospital and Health System, Baltimore, Md, "just putting more money into the system isn't going to change such things as low birth weight, neonatal mortality, uncontrolled hypertension, and other treatable if not curable conditions." What the former executive, Robert Heyssel, MD, says he finds so startling is that Hopkins practices some of the most advanced medicine in the world, "yet up the street we have people dying of hypertension, going blind from cataracts or glaucoma, and on all sides there is evidence of failure to get adequate prenatal and postnatal care. These are things we can do something about, but we haven't done a very good job." A survey among young women in east Baltimore, he says, indicates that financial constraints are not what prevent them from seeking care—most of them are covered by