Unreadiness for Postpartum Discharge of Mothers and Their Healthy Infants: Multivariate Results of the Life Around Newborn Discharge (LAND) Study

H Bernstein¹, C Spino², S Finch³, S Bhalla¹, R Wasserman^3,4 and M McCormick⁵.  ¹ Gen Peds, Children?s Hospital, Boston, MA; ² Ann Arbor, MI; ³ PROS, Dept of Prac & Rsch; Ctr for Child Health Rsch, AAP, Elk Grove Village, IL; ⁴ PROS, Univ of Vermont, Burlington, VT and ⁵ Harvard School of Pub Health, Boston, MA.

 

Background: Postpartum discharge of mothers and/or their infants when not medically or psychosocially ready may place the family at risk for problems in the neonatal period.

 

Objective: Identify factors associated with maternal and newborn unreadiness for postpartum discharge.

 

Design/Methods: LAND, a prospective cohort study of 4,300 mother/healthy term infant dyads, was conducted by 451 practitioners (112 practices) in the PROS network. On the day of nursery discharge, 1,992 dyads had data from the mother, pediatrician (PED), and obstetrician (OB) re: the discharge decision and other pregnancy, labor, delivery, and demographic information. Unreadiness was defined as at least 1of 3 informants perceiving either the mother or infant as not ready for discharge. Sociodemographic, prenatal, perinatal, and postpartum variables were included in a multivariate logistic model to identify factors of unreadiness (p<.05). Adjusted odds ratios [95% confidence intervals] are presented.

 

Results: Mean maternal age was 28 yrs, with 41% primigravids, 37% attending prenatal classes, and 75% planning to breastfeed; 80% of infants were delivered vaginally, 23% had problems in the hospital, and 46% were discharged <48 hours. Unreadiness was found in 17% of dyads: 10% deemed unready by mother, 4% by PED, 2% by OB, and 1% by at least 2 informants. Significant factors of unreadiness in multivariate analyses were: uninsured (5.3 [2.2, 12.8]) and public (1.6 [.9, 2.7]) vs. private insurance, attending prenatal classes (1.6 [1.1, 2.4]), neonatal problems (2.9 [2.1, 4.0]), intent to breastfeed (2.0 [1.3, 3.2]), limited topics covered in hospital education (2.2 [1.4, 3.6]) vs. more than 4, and not asked in hospital to schedule 1st baby visit (1.5 [1.0, 2.1]). No other factors (e.g. parity, length of stay or maternal race/ethnicity) were significant.

 

Conclusions: The decision about postpartum discharge must be made jointly by mother, PED, and OB, as perceptions of readiness often differ. Support around breastfeeding and other factors, an emphasis on perinatal education, and initiation of well-child care should increase readiness and determine optimal timing for discharge and follow-up care.