Hospital Birth Research Articles

"We don't really address the trauma": Patients' Perspectives on Postpartum Care Needs after Severe Maternal Morbidities.

This qualitative study explored experiences of 15 women in New York City who suffered physical, emotional, and socioeconomic consequences of severe maternal morbidity (SMM). This study aimed to increase our understanding of additional burdens these mothers faced during the postpartum period. Qualitative analysis of in-depth interviews (n = 15) with women who had given birth in NYC hospitals and experienced SMM. We focused on how experiences of SMM impacted postpartum recoveries. Grounded theory methodology informed analysis of participants' one-on-one interviews. To understand the comprehensive experience of postpartum recovery after SMM, we drew on theories about social stigma, reproductive equity, and quality of care to shape constant-comparative analysis and data interpretation. Three themes were generated from data analysis: 'Caring for my body' defined by challenges during physical recuperation, 'caring for my emotions' which highlighted navigation of mental health recovery, and 'caring for others' defined by care work of infants and other children. Most participants identified as Black, Latinx and/or people of color, and reported the immense impacts of SMM across aspects of their lives while receiving limited access to resources and insufficient support from family and/or healthcare providers in addressing postpartum challenges. Findings confirm the importance of developing a comprehensive trauma-informed approaches to postpartum care as a means of addressing SMM consequences.

Exploring Reasons and Perspectives Behind Decisions to Forego Hospital Births Among Remote Rural Populations in Bokeo Province, Lao PDR

Maternal mortality remains high among marginalized rural populations in Laos. Remote mountain villages in Bokeo Province typify persistent health access divides facing minor subgroups amidst infrastructure gaps and scattered habitation. This study explores complex drivers behind shunning hospital births using focused rural ethnography. Between October and November 2023, this qualitative study interviewed 40 participants including pregnant women, postpartum women, and their relatives across 5 villages in Bokeo Province regarding barriers to hospital births. Open-ended discussions aimed to elucidate motivations and barriers embedded in their decision to avoid formal delivery care, despite mortality awareness. Transcriptions from Lao were translated to Thai, maintaining cultural nuances. Thematic analysis identified patterns in women’s attitudes and barriers to hospital childbirth. A collaborative coding process revealed constraints on access, affordability, and autonomy, explaining why vulnerable groups often forego hospital births despite risks. The result founded that prohibitive transportation deficiencies including impassable roads, exorbitant driver fees and unreliable conveyance options were primary obstacles. Prohibitive direct and indirect costs compounded struggles for impoverished families. Restrictive traditions persisted among certain ethnicities. Discrimination fears and hospital foreignness also provoked wariness among a minority. Multidimensional geographical, financial and sociocultural barriers intersect to obstruct rural groups from accessible emergency obstetric care in Laos. Infrastructural strengthening, financial protection and public education can relieve these pronounced constraints denying the marginalized realization of maternal health rights.

Out-of-Hospital Birth in Medical Education: A Thematic Analysis of Question Banks for Medical Licensing Examinations in the United States.

This study assessed the content of US Medical Licensing Examination question banks with regard to out-of-hospital births and whether the questions aligned with current evidence. Three question banks were searched for key words regarding out-of-hospital births. A thematic analysis was then utilized to analyze the results. Forty-seven questions were identified, and of these, 55% indicated a lack of inadequate, limited, or irregular prenatal care in the question stem. Systematic studies comparing prenatal care in out-of-hospital births versus hospital births are nonexistent, leading to the potential for bias and adverse outcomes. Adjustments to question stems that accurately portray current evidence are recommended.

Association of childbirth experience with long–term psychological outcomes: a prospective cohort study

BackgroundThere has been limited research on the lasting impact of giving birth on both mothers and infants. This study aimed to investigate women’s memories of their childbirth experience 4 months and 4 years after giving birth. Additionally, it aimed to examine how the childbirth experience is linked to women’s mental health, sexual satisfaction, exclusive breastfeeding, and the type of subsequent birth.MethodsIn this prospective cohort study, a total of 580 women giving birth in Tabriz hospitals in 2018 were followed up for 4 years. The data were collected using a childbirth experience questionnaire, a mental health inventory, and a sexual satisfaction scale for women, and were analyzed by a Pearson correlation test, an independent samples t-test, and a general linear model.ResultsThe total scores of the childbirth experience in two short-term (4 months) and long-term (4 years) time points following the birth had a significant and strong correlation with each other (r = .51; p < .001). After adjusting for the effects of socio-demographic and obstetric characteristics, sexual satisfaction had significant relationships with childbirth experience (p < .001) and postpartum complications (p < .001). In addition, mental health had significant relationships with childbirth experience (p < .001), postpartum complications (p < .001), and low income (p = .004).ConclusionsEven 4 years after giving birth, women have a clear recall of their childbirth experience. This experience has a significant association with long-term outcomes such as sexual satisfaction, mental health, exclusive breastfeeding, and subsequent birth type.

Magnitude of preterm birth and associated factors Among mothers who gave birth in Debre Berhan comprehensive specialized hospital.

Premature deliveries are a major public health issue, with high health, economic, and productivity costs associated with lengthy hospitalizations in neonatal critical care units. The goal of this study was to determine the number of premature births in Ethiopia's Debre Berhan Comprehensive Specialized Hospital and the factors that influence them. The Debre Berhan Comprehensive Specialized Hospital conducted an institution-based cross-sectional study between February and April 2020. A total of 325 study participants were selected using systematic random sampling. Face-to-face interviews using a pre-tested semi-structured questionnaire were used to collect data. For data entry and analysis, Epi data version 3.1 and SPSS version 20 were used. At a P-value of 0.2, bivariate logistic regression analysis was used to categorize candidate variables to the next level, and variables in multivariate logistic regression models with a p-value of 0.05 were considered statistically significant. Preterm births accounted for 16.1% of all births at Debre Berhan Comprehensive Specialized Hospital. Cesarean section [AOR = 2.412; 95% CI (1.154, 5.0370)], twin pregnancy [AOR = 3.524; 95% CI (1.114, 11.150)], and maternal anemia during pregnancy [AOR = 3.124; 95% CI (1.417, 6.887)] were statistically significant associations with the outcome variable in the final logistic regression model. Preterm birth was found to be greater in the study area than in the Global Action Report for Sub-Saharan Africa and a few other countries. Efforts should be made to prevent maternal health issues that lead to caesarean section, and all pregnant mothers should be supplemented with iron and folic acid as soon as feasible. This study suggests that there is still a gap in the field in terms of health service intervention.

Neonatal morbidity and mortality in birth centers in the United States 2018-2021: An observational study of low-risk birthing individuals.

Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed. Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics. The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p-value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p-value < 0.001). Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers.

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

IntroductionIndividuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.MethodsThe National Inpatient Sample was used to identify nationwide patients with depression (n = 378,552, weighted n = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals’ gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.ResultsAmong the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.ConclusionDifferences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.

Care considerations for caesarean births in a non-obstetric hospital

Background Births in non-maternity hospitals pose significant challenges to ensure delivery of safe and effective care. Methods We conducted a retrospective chart review examining the maternal and neonatal demographics and care needs of women delivering in a non-obstetric general hospital over a 10-year period. Results Cardiac conditions and placenta accreta spectrum disorder were the most common reasons for birth in this location. All 37 births occurred on a weekday, with 29 during core working hours (8 a.m.–4 p.m.). All cases required obstetric, midwifery, anaesthesiology, neonatology and inter-hospital transfer services. Level 3 support was required for 15 women following birth. Neuraxial anaesthesia was utilised in the majority of cases (24/37, 64.8%). One in six infants were breastfed on discharge, with a mean gestational age at birth of 34 weeks. Conclusion We demonstrate the significant input of the multi-disciplinary and highlight the importance of addressing both obstetric and neonatal considerations outside of their native care setting.

Midwives' Belief in Normal Birth: The Canadian Survey of Maternity Care Providers’ Attitudes Toward Labour and Birth

Background: Midwifery has been integrated into the health care systems of over half of Canadian provinces and territories. While there are differences in legislation and payment mechanisms, the model of midwifery is fairly similar across the country. This study examined the similarities and differences among midwives' attitudestowardlabourandbirth. Inaddition,wecompareditemswhichrelatedtobeliefsaboutnormal birth between midwives and other care providers.Methods: A national cross-sectional survey was conducted comparing maternity care providers’ beliefs aboutchildbirthandintra-professionalvariationsinmidwives'attitudestowardsbirth. Therewere400 (54%) midwife respondents: 218 from Ontario, 75 from B.C, 53 from Quebec, 48 from the remaining regulated or pre-regulated provinces (six missed information for this field).Results: All midwives were critical of the routine use of interventions such as episiotomy, epidural analgesia andelectronicfetalmonitoring(EFM). Therewasstrongagreementaboutthesafetyofhomebirth,outof hospital birth centres and the importance of women's autonomy and decision-making in pregnancy and birth. However, some regional variations were identified. Quebec midwives were more opposed to epidural analgesia than BC and Ontario (p&lt;.001), and were more likely to believe that cesarean birth is more costly than vaginal birth (p=.005). Ontario midwives were most likely to believe that cesarean birth protects against urinary incontinence (p=.001), and sexual dysfunction (p=.002). Qualitative comments of midwives indicated a strong desire to reduce unnecessary medical intervention and to lower cesarean section rates.Conclusion: Canadian midwives share similar beliefs regarding place of birth, the routine use of episiotomy, EFM, and epidurals, but reported significant attitudinal differences for other issues. Regional differences may be related to midwives' primary practice settings, the historical development of midwifery in their region and the number of new midwives with less than 5 years of clinical experience. A set of core midwifery values was identified that demonstrate a strong belief in normal birth.

Intrapartum Obstetric Complications of Home Birth Versus Hospital Birth Among Sudanese Women Ad-Damar City, River Nile State January 2021 – June 2021

Intrapartum Obstetric Complications of Home Birth Versus Hospital Birth Among Sudanese Women Ad-Damar City, River Nile State January 2021 – June 2021

Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region.

Although the quality of care during childbirth is a maternity service's goal, less is known about the impact of the birth setting dimension on provision of care, defined as evidence-based intrapartum midwifery practices. This study's aim was to investigate the impact of hospital birth volume (≥1000 vs. <1000 births/year) on intrapartum midwifery care and perinatal outcomes. We conducted a population-based cohort study on healthy pregnant women who gave birth between 2018 and 2022 in Lombardy, Italy. A total of 145,224 (41.14%) women were selected from nationally linked databases. To achieve the primary aim, log-binomial regression models were constructed. More than 70% of healthy pregnant women gave birth in hospitals (≥1000 births/year) where there was lower use of nonpharmacological coping strategies, higher likelihood of epidural analgesia, episiotomy, birth companion's presence at birth, skin-to-skin contact, and first breastfeeding within 1 h (p-value < 0.001). Midwives attended almost all the births regardless of birth volume (98.80%), while gynecologists and pediatricians were more frequently present in smaller hospitals. There were no significant differences in perinatal outcomes. Our findings highlighted the impact of the birth setting dimension on the provision of care to healthy pregnant women.

Outcomes associated with planned place of birth among low-risk pregnancies in Ontario, Canada (2012-2021): A protocol for a population-based propensity score weighted cohort study.

Evidence suggests that for low-risk pregnancies, planned home births attended by a skilled health professional in settings where such services are well integrated are associated with lower risk of intrapartum interventions and no increase in adverse health outcomes. Monitoring and updating evidence on the safety of planned home births is necessary to inform ongoing clinical and policy decisions. This protocol describes a population-based retrospective cohort study which aims to compare risk of (a) neonatal morbidity and mortality, and (b) maternal outcomes and birth interventions, between people at low obstetrical risk with a planned home birth with a midwife, a planned a hospital birth with a midwife, or a planned hospital birth with a physician. The study population will include Ontario residents who gave birth in Ontario, Canada between April 1, 2012, and March 31, 2021. We will use data collected prospectively in a provincial perinatal data registry. The primary outcome will be severe neonatal morbidity or mortality, a composite binary outcome that includes one or more of the following conditions: stillbirth during the intrapartum period, neonatal death (death of a liveborn infant in the first 28 completed days of life), five-minute Apgar score <4, or infant resuscitation requiring cardiac compressions. We will conduct a stratified analysis with three strata: nulliparous, parous-no previous caesarean birth, and parous-prior caesarean birth. To reduce the impact of selection bias in estimating the effect of planned place of birth on neonatal and maternal outcomes, we will use propensity score (PS) overlap weighting (OW) and modified Poisson regression to conduct multivariate analyses.

Addressing bias in preterm birth research: The role of advanced imputation techniques for missing race and ethnicity in perinatal health data

ObjectivesTo evaluate the effectiveness of Bayesian Improved Surname Geocoding (BISG) and Bayesian Improved First Name Surname Geocoding (BIFSG) in estimating race and ethnicity, and how they influence odds ratios for preterm birth. MethodsWe analyzed hospital birth admission electronic health records (EHR) data (N = 9985). We created two simulation sets with 40 % of race and ethnicity data missing randomly or more likely for non-Hispanic black birthing people who had preterm birth. We calculated C-statistics to evaluate how accurately BISG and BIFSG estimate race and ethnicity. We examined the association between race and ethnicity and preterm birth using logistic regression and reported odds ratios (OR). ResultsBISG and BIFSG showed high accuracy for most racial and ethnic categories (C-statistics = 0.94–0.97, 95 % confidence intervals [CI] = 0.92–0.97). When race and ethnicity were not missing at random, BISG (OR = 1.25, CI = 0.97–1.62) and BIFSG (OR = 1.38, CI = 1.08–1.76) resulted in positive estimates mirroring the true association (OR = 1.68, CI = 1.34–2.09) for Non-Hispanic Black birthing people, while traditional methods showed contrasting estimates (Complete case OR = 0.62, CI = 0.41–0.94; multiple imputation OR = 0.63, CI = 0.40–0.98). ConclusionsBISG and BIFSG accurately estimate missing race and ethnicity in perinatal EHR data, decreasing bias in preterm birth research, and are recommended over traditional methods to reduce potential bias.

Homebirth and the National Health Service in Italy. A qualitative study in the Emilia- Romagna Region

Introduction: Medicalization of birth has increased all over the world in the past decades. The Italian caesarean birth rate (38%) is among the highest in the world. Could be birth at home as a public model of care a superior alternative to current practices? This paper focuses on the experience of the Emilia-Romagna region, where the National Health Service (NHS) has carried out a home birth service for more than 13 years. The aim is to discuss the strengths and weaknesses of homebirth as a public health model compared to homebirth within the private practice system. Methods: Qualitative data were collected between 2010 and 2013, as part of a wider anthropological research project on out-of-hospital birth in Italy and Spain. Seventy participants were interviewed in total. In Emilia-Romagna, in- depth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Focus groups, a field diary and participant observation were also used for data collection. Data were analyzed using ethnographic method and content analysis. Results: Main findings suggest that the added value provided by the NHS home birth service in the Emilia-Romagna region (home births attended by community- based or hospital-based midwives) compared to the private care model encompass increasing of the social legitimacy of homebirth, the transfer of best practices from homebirth to hospital birth, increasing the continuity of care when the woman is referred to the hospital, increasing the continuity of training and the autonomy of midwives in caring for normal births in the hospital and providing free services. Homebirth managed by the NHS contributes to the promotion of a physiological model of care also in the hospital.

Giving Birth Outside the Health Care System in New Brunswick: A Qualitative Investigation

Introduction: There is limited research data on unassisted childbirth (a planned out-of-hospital birth without the attendance of a regulated care provider) in Canada; this means that there is a lack of understanding of its prevalence and of the childbearing women’s motivations. This study aimed to uncover women’s reasons for planning to give birth in the absence of an attendant licensed to practice in New Brunswick, in order to create insight into mainstream maternity care practices through those who have rejected them. Methods: In-depth qualitative interviewing with women who have had planned home births in New Brunswick in the past 10 years. Results: Participants had a variety of motivations and influences that played in their decision to have an unassisted home birth, including deeply held beliefs about childbirth and the need to manifest these beliefs in their experiences of birth. Participants expressed their desire to be the locus of control in their childbirth experience and believed they could best accomplish this outside of the hospital setting. Influences included ideological stance toward birth, the attitudes of their families and friends, and birth stories they had heard. Conclusion: This study demonstrates that when women’s needs are not met by mainstream health services, some will choose to give birth in the absence of a skilled provider or independent attendant. This gives rise to the need for discussion between all care providers and parturient women to better understand unmet needs and unaddressed fears around hospital birth. This article has been peer reviewed.

Vaginal Birth After Cesarean Section: Ethical Considerations for Midwives

Vaginal birth after cesarean section (VBAC) and decisions regarding the safest mode and place of delivery can be contentious in contemporary obstetrics. The choice of birthplace adds additional layers to ethical concerns, particularly for midwives, who are often the only care providers attending birth outside the hospital setting. Current guidelines and evidence, drawing largely on obstetrical literature and the hospital environment, recommend hospital birth for anyone with a prior cesarean section. However, despite guidelines and care provider recommendations, a small proportion of women will continue to request midwife-attended homebirth. Ethical debates about VBAC have largely been inattentive to the desires of these women and the unique situation of midwives who may be presented with such requests. We will explore the ethical nuances of choice of birthplace for women planning a vaginal homebirth after cesarean section (HBAC). Analysis suggests that there may be implications to denying choice and some burden on midwives to continue to provide care for women planning HBAC, even when homebirth may not be considered the safest option.

Obstetric claims in Finland 2012-2022-A nationwide patient insurance registry study.

Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center. A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models. A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims. The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.

Childbirth experience and maternal role confidence among postpartum mothers from maternity units in Jolo

The study aims to evaluate postpartum women' birthing experiences and maternal role confidence in Jolo maternity facilities. A quantitative-descriptive cross-sectional survey methodology was used to investigate the relationship between delivery experience and maternal role confidence. The study included 100 postpartum mothers who gave birth within six weeks of delivery or in the early postpartum period. The respondents were largely young adults who were literate, earning below monthly income, had two pregnancies, gave birth in government hospitals, and were treated institutionally by qualified health professionals. They were moderately satisfied with their delivery experience and quite confident in their maternal role. There were no significant variations in the extent of delivery experience or maternal role confidence across socio-demographic groups. A positive correlation was identified between childbirth experience and maternal role confidence.

How Do Women Vote: What Women Post About Home Birth Compared With Hospital Birth on Reddit and TikTok [ID 2683436

INTRODUCTION: Rates of home birth have been increasing as has reliance on social media as a source of medical advice and support. This is the first study that directly evaluates birthing women’s beliefs about home births in the public posts and comments on two popular social media platforms. We sought to identify major themes on perceptions, attitudes, and advice offered about home birth on Reddit and TikTok. METHODS: Posts were searched using the terms “home birth” and “home versus hospital birth.” Up to five themes were collected per post or comment and were categorized as supportive, opposing, or neutral. We included posts from the United States, in English, with at least 10 comments and 10 upvotes or likes. Institutional review board approval was waived. RESULTS: A total of 777 posts and 47,452 comments were evaluated for inclusion; 257 posts and 2,408 comments met criteria for thematic content analysis. Overall in posts, 69% supported, 20% opposed, and 11% were neutral toward home birth. In comments, 53% supported, 28% opposed, and 19% were neutral. Supportive themes included concerns about safety of hospital delivery and reassurance about home birth safety, patient control with home deliveries, and advice about preparing for home birth. Opposing themes included concerns about risks of home birth, negligence of those attempting it, reassurance that hospital birth offers women control, and that medical interventions can be lifesaving. CONCLUSION: These results can help physicians recognize some of women’s concerns about hospital births and what information they may find on social media guiding them in their birth decisions.

Predictors and Outcomes of Expedited Postpartum Discharge in a National Sample [ID 2683489

INTRODUCTION: Expedited postpartum discharge (EPD), defined as less than 2 days and less than 3 days after vaginal and cesarean birth, respectively, has been postulated as a measure to improve hospital utilization. National trends regarding outcomes after EPD are lacking. This study aims to characterize national trends in EPD, identify predictors, and assess safety using 60-day postpartum readmission as a surrogate marker. METHODS: Birth hospitalizations and readmissions were extracted from the 2016–2020 Nationwide Readmissions Database. Postpartum length of stay (ppLOS) was calculated and categorized as routine, expedited, and prolonged. Annual EPD and readmission prevalence were calculated. Unadjusted and adjusted logistic regression models were fit to assess predictors of EPD and the association between EPD and readmission, adjusting for demographic, clinical, and obstetric outcomes. RESULTS: Of 17.3 million birth hospitalizations, 33% experienced EPD. Expedited postpartum discharge prevalence increased from 29.6% to 44.4% with a higher proportion of EPD in 2020 compared to 2016–2019 (P&lt;.01). Younger and older age, chronic conditions, and obstetric complications were associated with lower likelihood of EPD. The overall 60-day readmission rate after delivery hospitalization discharge was 1.4%, and when stratified by expedited, routine, and prolonged ppLOS were 1.4%, 1.6%, and 3.3%, respectively, with no change in readmission rate during the study period. Hospitalizations with expedited discharge were 14% less likely to be readmitted 60 days after discharge compared to hospitalizations with routine discharge (aOR 0.86; 95% CI: 0.85, 0.88). CONCLUSION: Nationwide rates of EPD increased during the study period with no corresponding increase in 60-day readmission rates, suggesting that EPD may be utilized more widely in appropriate-risk patients.