Perinatal Care of Low-Risk Mothers and Infants

Yanover, M; Jones, Deloras; Miller, Michael D.

doi:10.1056/nejm197603252941306

Cited by 101 publications

(48 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other studies have shown the safety of home-based follow-up after short maternity/nursery stays. 3,[63][64][65][66][67][68][69] Consistent with our group's previous retrospective study, 30 retrospective analyses of single HNVs have found benefits. Braveman et al 70 showed that acute care visits, rehospitalizations, and missed well-baby visits were less common among newborns who received a home nurse visit.…”

Section: Commentsupporting

confidence: 84%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Commentsupporting

confidence: 84%

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

View full text Add to dashboard Cite

show abstract

“…In almost all programs, these home follow-up services were provided by nurses with advanced training, from baccalaureate preparation with physical assessment skills (6) to nurse-practitioners and certified nurse-midwives, family nurse-practitioners, or perinatal nurse practitioners (1,5, 8,9). Only one program did not regularly use nurses to provide early discharge follow-up (7).…”

Section: Program Populations and Proceduresmentioning

confidence: 99%

Outcomes of Postpartum Early Discharge, 1960–1986 A Comparative Review

Norr

Nacion

1987

Birth

View full text Add to dashboard Cite

A review of all postpartum early discharge program outcomes in the United States published between 1960 and 1985 indicates that discharge under 48 hours after delivery has generally been safe for mothers and infants. The levels and types of morbidities did not appear to differ from those experienced with longer hospital stays. Infant readmissions and overall morbidity rates were consistently higher than the number of maternal readmissions and morbidity. The major infant morbidity was hyperbilirubinemia. Differences in identification and treatment of this single problem accounted for much of the variation in infant readmission rates among programs.Expansion of postpartum early discharge based on these favorable results must proceed with caution. Nearly all reported outcomes were for programs with extensive prenatal preparation and postpartum follow-up, serving relatively advantaged middle-class populations. It is not clear that equally good outcomes would result from less intensive programs or those serving disadvantaged populations. More research is needed on the effectiveness of early discharge procedures, cost savings, and patient satisfaction. (BIRTH 14:3, September 1987) Escalating health care costs and changing reimbursement policies have generated great pressure to discharge patients from the hospital as quickly as possible. In obstetric units, changes in high-risk antenatal and intrapartum care have greatly increased demand for beds. Today, postpartum early discharge is still relatively infrequent, usually an option available to self-selected parents. Over the next few years, this practice for low-risk mothers will become more common, perhaps even the prevailing standard of care, since health maintenance organizations (HMOs) and third-party payers will reimburse only the shortest possible stay. For low-income families and families in HMOs or dependent on third-party

show abstract

“…[18][19][20][21] The hypothesis of this study is that shorter postpartum stays are associated with poor health outcomes because of the decreased probability of detecting postpartum complications, as has been found in studies with other populations. 22 Little information is available in Mexico to assess the potentially negative effects of early hospital discharge on maternal health during early puerperium, defined as the period between 24 hours to 7 days postpartum.…”

Section: Introductionmentioning

confidence: 99%