A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

Lieu, Tracy A.; Braveman, Paula; Escobar, Gabriel J.; Fischer, Allen F.; Jensvold, Nancy G.; Capra, Angela M.

doi:10.1542/peds.105.5.1058

Cited by 106 publications

(77 citation statements)

References 17 publications

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“…These interventions occur as an adjunct to routine preventive visits, rather than within them, and have had generally limited success. [10][11][12][13] In contrast, the results of observational studies suggest that support with breastfeeding problems and promotion of breastfeeding provided by clinicians during routine preventive visits in office settings are associated with higher rates of exclusive breastfeeding. 14 However, randomized trials testing the efficacy of interventions delivered through existing primary health care services are currently lacking.…”

mentioning

confidence: 97%

Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs

Labarère¹,

Gelbert-Baudino²,

Ayral³

et al. 2005

Pediatrics

162

117

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ABSTRACT. Background. Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health, the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal. The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks. Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed, problems with the infant latching or suckling, and lack of individualized encouragement from their clinicians in the early postdischarge period. Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practices during routine preventive visits. However, robust scientific evidence based on randomized, controlled trials is currently lacking.Objective. The purpose of this study was to determine whether attending an early, routine, preventive, outpatient visit delivered in a primary care physician's office would improve breastfeeding outcomes.Design. The study was a prospective, randomized, parallel-group, open trial.Setting. Participants were recruited at a level 3 maternity facility, with an average of 2000 births per year, in France.Participants. A total of 231 mothers who had delivered a healthy singleton infant (gestational age: >37 completed weeks) and were breastfeeding on the day of discharge were recruited and randomized (116 were assigned to the intervention group and 115 to the control group) between October 1, 2001, and May 31, 2002; 226 mother-infant pairs (112 in the intervention group and 114 in the control group) contributed data on outcomes.Intervention. Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members, a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge, provision of the telephone number of a peer support group, mandatory routine, preventive, outpatient visits at 1, 2, 3, 4, 5, and 6 months of infant age, and 10 weeks of paid maternity leave (extended to 18 weeks after the birth of the third child). In addition to the usual predischarge and postdischarge support, the mothers in the intervention group were invited to attend an individual, routine, preventive, outpatient visit in the office of 1 of the 17 participating primary care physicians (pediatricians or family physicians) within 2 weeks after the birth. The participating physicians received a 5-hour training program on breastfeeding, delivered in 2 parts in 1 month, before the beginning of the study.Outcome Measures. The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks (defined as giving maternal milk as the only food source, with no other foods or liquids, other than vitamins or medications, being given). The secondary outcomes included any breastfeeding reported at 4 weeks, breastfeeding duration, breastfeeding difficulti...

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mentioning

confidence: 97%

Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs

Labarère¹,

Gelbert-Baudino²,

Ayral³

et al. 2005

Pediatrics

162

117

View full text Add to dashboard Cite

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“…Our prospective study has similarities to those conducted by Lieu et al 62 and Escobar et al, 31 who compared HNVs with outpatient clinic visits or hospital-based group visits on the third or fourth day after delivery. Those studies did not find differences in health care utilization, breastfeeding rates, or maternal mental health outcomes, but differed from our study in that they were limited to privately insured mothers and infants born vaginally.…”

Section: Commentmentioning

confidence: 74%

A Randomized Trial of Single Home Nursing Visits vs Office-Based Care After Nursery/Maternity Discharge

Paul

Beiler

Schaefer

et al. 2012

Arch Pediatr Adolesc Med

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To compare office-based care (OBC) with a care model using a home nursing visit (HNV) as the initial postdischarge encounter for "well" breastfeeding newborns and mothers.Design: Randomized controlled trial.Setting: A single academic hospital.Participants: A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks' gestation.Interventions: Home nursing visits were scheduled no later than 2 days after discharge; OBC timing was physician determined.Outcome Measures: Mothers completed telephone surveys at 2 weeks, 2 months, and 6 months. The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery. Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration. Maternal mental health, parenting competence, and satisfaction with care outcomes were assessed. Analyses followed an intentto-treat paradigm.Results: At 2 weeks, hospital readmissions and emergency department visits were uncommon, and there were no study group differences in these outcomes or with unplanned outpatient visit frequency. Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group (85.9% vs 78.8%) (P =.002) and were more likely to be breastfeeding at 2 weeks (92.3% vs 88.6%) (P=.04) and 2 months (72.1% vs 66.4%) (P =.05) but not 6 months. No group differences were detected for maternal mental health or satisfaction with care, but HNV group mothers had a greater parenting sense of competence (P Ͻ .01 at 2 weeks and 2 months).Conclusions: Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits.

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“…The survey questions were based on questions used in a series of studies of models of postpartum care at Kaiser Permanente. [7][8][9] The survey was piloted on 28 English-speaking mothers. The interviews were done in the English, Spanish, and Hmong languages.…”

Section: Methodsmentioning

confidence: 99%

Factors That Influence the Receipt of Well Baby Care in the First 2 Weeks of Life

Madlon-Kay¹,

Asche²

2006

The Journal of the American Board of Family Medicine

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Purpose: To determine the percentage of babies born at a community hospital who received follow-up visits at home or clinic by 2 weeks of age. Also to describe the characteristics of the mothers whose newborns received visits within 2 weeks of birth.Methods Results: 84% of the infants had a home or clinic visit within 2 weeks of birth. In bivariate analyses, the likelihood of having a visit within 2 weeks was significantly lower for mothers having more children (P ‫؍‬ .002), lower maternal education level (P ‫؍‬ .002), lower income (P ‫؍‬ .02), mothers' lack of knowledge of baby's insurance (P ‫؍‬ .02), mothers of nonwhite race (P ‫؍‬ .03), and mothers' having no medical insurance (P ‫؍‬ .04). The likelihood of a visit was not significantly related to whether English was spoken in the home or marital status. In logistic regression analyses, lower maternal education, and more children were significant predictors of the lack of visits.Conclusions: Infants whose mothers had little education and had other children were a high-risk group that was less likely to receive care. When discharging newborns belonging to this group, extra effort should be made to ensure that appropriate postdischarge follow-up occurs. An additional follow-up visit at home or clinic within 2 days of discharge has been recommended by the American Academy of Pediatrics (AAP) since 1995 for newborns discharged less than 48 hours after delivery.2 A visit at this time allows an infant to be observed by a clinician at 3 to 5 days of life, which is the usual peak of serum bilirubin concentration. In addition, breastfeeding mothers discharged early do not have time for their lactation to become well-established. Therefore this visit also enables the clinician to assess the adequacy of breastfeeding. Studies indicate that providers have not consistently followed the AAP guidelines for early follow-up.

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A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge

Cited by 106 publications

References 17 publications

Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs

Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs

A Randomized Trial of Single Home Nursing Visits vs Office-Based Care After Nursery/Maternity Discharge

Factors That Influence the Receipt of Well Baby Care in the First 2 Weeks of Life

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