The effect of an early postpartum discharge program on competence in mothering : a randomized controlled trial

Objective. To compare the risks and benefits of an Early Postpartum Discharge Program vs standard postpartum care. Design. Randomized controlled trial. Setting. 637-bed university-affiliated urban hospital. Participants. 175 healthy women recruited at 32-38 wks from MD and hospital ultrasound offices. Interventions. Early Postpartum Discharge Program: discharge 6-36 hours postpartum and nursing care by telephone and/or at home at 34-38 weeks gestation, $ leq$48 hours postpartum and 3, 5, and 10 days postpartum. Control. Postpartum stay of 48-72 hours and follow-up as determined by the woman's physician. Measurement/Results. At 1 month follow-up, no significant differences were seen overall in an established scale of perceived maternal competence (experimental-control = 4.3 points (95% confidence interval $-$7.7, 16.3)); infant weight gain (1.2 g/day ($-$2.8, 5.2)); identification of significant neonatal hyperbilirubinemia (rate ratio 0.50 (0.10, 2.51)); infant utilization of health services (rate ratio 0.88 (0.45, 1.73)); or predominant breastfeeding (adjusted odds ratio 1.25 (0.88, 1.75)). Early Postpartum Discharge Program participants, however, had significantly less frequent infant bilirubin testing (rate ratio 0.39 (0.17, 0.94)). The Early Postpartum Discharge Program also enhanced maternal competence in recent immigrants (26.9 points (2.7, 51.5)). Conclusion. The Early Postpartum Discharge Program leads to no apparent harm and may yield important benefits for some mothers and infants