Early postnatal discharge from hospital for healthy mothers and term infants

BACKGROUND: Length of postnatal hospital stay has declined dramatically in the past thirty years. There is ongoing controversy concerning whether staying less time in hospital is harmful or beneficial. OBJECTIVES: The objective of this review was to assess the safety, impact and effectiveness of a policy of early discharge for healthy mothers and term infants, with respect to the health and well-being of mothers and babies, satisfaction with postnatal care, overall costs of health care and broader impacts on families. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to December 2007), CINAHL (1982 to December 2007) and reference lists of articles. SELECTION CRITERIA: Randomized trials comparing early discharge from hospital of healthy mothers and term infants, of greater than or equal to 2500 grams, with standard care in the settings in which trials were conducted. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were abstracted independently by at least two review authors. MAIN RESULTS: Ten trials (involving 4489 women) were identified . There was substantial variation in the definition of 'early discharge', and the extent of antenatal preparation and midwife home care following discharge offered to women in intervention and control groups. Six trials recruited and randomized women in pregnancy, four randomized women following childbirth. Post randomization exclusions were high. Non-compliance with allocated treatment was frequent. No statistically significant differences in infant or maternal readmissions were found in eight trials reporting data on these outcomes. Five trials showed either no significant difference or results favouring early discharge for the outcome of maternal depression, although only three used a well-validated standardized instrument. The results of eight trials showed that breastfeeding rates did not differ significantly between the early discharge group and the control group receiving standard care. AUTHORS' CONCLUSIONS: The pooled trials have inadequate power to detect increases in rare outcomes, such as infant and maternal mortality or readmissions. Policies of earlier postnatal discharge of healthy mothers and term infants do not appear to have adverse effects on breastfeeding or maternal depression when accompanied by a policy of offering women at least one nurse-midwife home visit post discharge. Large well-designed trials of early discharge programs incorporating process evaluation to assess the uptake of co-interventions, and using standardized approaches to outcome assessment are needed.