DMS study examines hospital discharge readiness of mothers and
newborns
A landmark nationwide study, published in the August issue of Pediatrics, is the
first ever to prospectively examine the decision-making process of over 4,000
mothers and their physicians around the readiness of mothers and their infants
to leave the hospital after childbirth.
 Henry Bernstein (Photo courtesy AAP News)
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The study, known as the Life Around Newborn Discharge (LAND) study, was led
by Henry (Hank) Bernstein, professor of pediatrics at Dartmouth Medical School, and chief of
general academic pediatrics at Children's
Hospital at Dartmouth (CHaD). It looked specifically at postpartum
decision-making, with results showing that 17 percent of all mother-infant
pairs were identified as "not ready."
This study also identified those factors most related to the unreadiness of
mother-infant pairs to leave the hospital. These included: being a first-time
mother, being African American and non-Hispanic, the mother's history of
chronic disease, inadequate prenatal care, delivering during non-routine hours,
the newborn having problems while in the hospital, the mother's intent to
breast feed, and whether or not there was adequate in-hospital education.
"Clinical decision-making regarding maternal and infant discharge is a
subjective and contextual process that must take into account the perspectives
of each person involved in the mothers' and infants' health care experience,"
Bernstein says. "This suggests that the mother and the clinicians caring for
her and her infant must make the postpartum discharge decision jointly."
Federal legislation—
The Newborns' and Mothers' Health Protection Act of 1996—requires insurance
plans offering maternity coverage to pay for at least a 48-hour hospital stay
following childbirth, or a 96-hour stay in the case of a cesarean section.
While Bernstein says he understands the need for some agreed upon minimum
length of stay, he cautions against a "one-size-fits-all" approach to
readiness.
"A customized reflection of both the mother's and her baby's needs and
concerns is required," Bernstein says. "The length of postpartum stay is not
the actual determinant of outcome, and the chronological clock is not
necessarily what is important. The debate regarding postpartum hospital stays
must be refocused toward a broadened scope of policy and clinical care
considerations."
Hospital affiliates and offices of 451 practitioners from 112 pediatric
research centers in office settings practices conducted the LAND study
nationwide. The aim was to address the lack of information regarding the
postpartum decision-making process for healthy term newborns and its
consequences during the neonatal period. Data were collected through
self-administered questionnaires completed by the mother, pediatrician, and
obstetrician on the day of discharge. A mother-infant dyad was determined
unready for postpartum discharge if at least one of the three informants
perceived that either the mother or infant should stay longer.
By JASON ALDOUS
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