A randomized trial of two public health nurse follow-up programs after early obstetric discharge

Objectives: To determine whether the outcomes of routine home visiting by public health nurses (PHN) after early obstetrical discharge differ from those of a screening telephone call designed to identify mothers who need further intervention. Methods: Primiparas delivering a singleton infant and eligible for postpartum follow-up were randomized to a home visit or screening telephone call. Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario. Outcomes included maternal confidence at two weeks, health problems of the infants between discharge and four weeks postpartum, breastfeeding rates at six months and costs of the two models. Results: Differences between the samples at the two sites necessitated stratified analyses. No differences were detected between the groups in maternal confidence (p=0.96), health problems of infants (p=0.87), or rates of breastfeeding at six months (p=0.22). However, at both sites the cost of routine home visits was found to be higher than that of screening by telephone. Conclusion: Although universal access to postpartum support is important, the results suggest that a routine home visit is not always necessary to identify the women who need it. These results can be generalized only to low-risk women and infants. The need for follow-up after earlydischarge has been recognized bythe American Academy o