Document Detail


Decision-making for postpartum discharge of 4300 mothers and their healthy infants: the Life Around Newborn Discharge study.
MedLine Citation:
PMID:  17636111     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Postpartum discharge of mothers and infants who are not medically or psychosocially ready may place the family at risk. Most studies of postpartum length of stay, however, do not reflect the necessary complexity of decision-making. With this study we aimed to characterize decision-making on the day of postpartum discharge from the perspective of multiple key informants and identify correlates of maternal and newborn unreadiness for discharge. PATIENTS AND METHODS: This was a prospective observational cohort study of healthy term infants with mothers, pediatric providers, and obstetricians as key informants to assess the decision-making process regarding mother-infant dyad unreadiness for discharge. A mother-infant dyad was defined as unready for postpartum hospital discharge if > or = 1 of 3 informants perceived that either the mother or infant should stay longer at time of nursery discharge. Data were collected through self-administered questionnaires on the day of discharge. RESULTS: Of 4300 mother-infant dyads, unreadiness was identified in 17% as determined by the mother (11%), pediatrician (5%), obstetrician (1%), and > or = 2 informants (< 1%). Significant correlates of unreadiness were as follows: black non-Hispanic maternal race/ethnicity, maternal history of chronic disease, primigravid status, inadequate prenatal care as determined by the Kotelchuck Adequacy of Prenatal Care Utilization Index, delivering during nonroutine hours, in-hospital neonatal problems, receiving a limited number of in-hospital classes, and intent to breastfeed. CONCLUSIONS: Mothers, pediatricians, and obstetricians must make decisions about postpartum discharge jointly, because perceptions of unreadiness often differ. Sensitivity toward specific maternal vulnerabilities and an emphasis on perinatal education to insure individualized discharge plans may increase readiness and determine optimal timing for discharge and follow-up care.
Authors:
Henry H Bernstein; Cathie Spino; Stacia Finch; Richard Wasserman; Eric Slora; Christina Lalama; Carol Litten Touloukian; Harris Lilienfeld; Marie C McCormick
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2007-07-16
Journal Detail:
Title:  Pediatrics     Volume:  120     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-02     Completed Date:  2007-08-28     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e391-400     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Dartmouth Medical School, Children's Hospital at Dartmouth, Lebanon, New Hampshire 03756-0001, USA. henry.bernstein@hitchcock.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Decision Making*
Female
Humans
Infant, Newborn
Male
Patient Discharge*
Perinatal Care / methods
Physicians / psychology
Postpartum Period / psychology*
Prospective Studies
Grant Support
ID/Acronym/Agency:
2R60 MC 00107-09//PHS HHS; 5 R40 MC00117//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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