When to Leave Hospital After Childbirth

Study Shows Many New Moms Not Ready to Be Discharged

Reviewed by Louise Chang, MD on August 06, 2007
From the WebMD Archives

Aug. 6, 2007 -- About one of every six new mothers is not ready to leave the hospital with their newborn when it comes time for discharge, according to a new study.

Researchers polled 4,300 new mothers, along with their pediatricians and obstetricians. "Seventeen percent of the time, the mother was not ready," says researcher Henry H. Bernstein, DO, professor of pediatrics at Dartmouth Medical School and chief of general academic pediatrics at Children's Hospital at Dartmouth, Lebanon, N.H.

Eleven percent of the time, the mother was the one feeling she or the baby was not ready to go home. In 5% of cases, the pediatrician thought the mother and newborn should stay, and in just 1% of cases it was the obstetrician who felt the mom and newborn weren't ready to leave the hospital.

The study is in the August issue of the journal Pediatrics.

"I thought 17% was a large number," Bernstein tells WebMD, especially when the number of annual births in the U.S -- 4 million -- is taken into account.

The remedy, Bernstein says, is not necessarily longer hospital stays, but better evaluation of which mothers feel unready, along with more individualized education and support to help them to become more confident parents.

Study Details

For the study, Bernstein's team asked 4,300 mothers, along with their pediatricians and obstetricians, how ready they were to leave the hospital on the day of discharge. The participants were drawn from pediatric practices from 49 states, the District of Columbia, Puerto Rico, and Canada between September 1999 and August 2002; the participants were women who delivered healthy full-term babies.

The researchers termed a mother-baby pair "unready" if one or more of the three people questioned said they thought they should stay longer than the recommended discharge day. They described them as ready if all three thought the mother and the baby were ready to go home on the recommended discharge day.

Almost two-thirds of the mothers who described themselves as not ready to go home said they needed a longer stay for their own physical concerns. When pediatricians or obstetricians termed a woman unready, it was usually due to the mother needing more maternal education or having comfort needs.

When babies were perceived as not ready, it was often because of a mother's need to address feeding or parenting issues, or to provide further medical care for the baby.

Bernstein's group identified eight factors that made a new mother more likely to feel unready to go home at the recommended time of discharge. These included being a first-time mother, receiving "inadequate" prenatal care, the mother having a chronic disease, delivering during the "nonroutine" hours between 7 p.m. and 7 a.m., receiving only a modest amount of parenting education while in the hospital, intending to breastfeed, having a newborn with health problems in the nursery, and being African-American.

Back Story

The discharge of mothers and newborns, especially the length of hospital stays, became an issue in the U.S. particularly in the early 1990s, when hospital stays were reduced due to cost containment measures put in place by managed care companies and hospitals, the researchers note in the paper.

Concerns were raised about the medical, emotional, and behavioral consequences of these shorter stays, leading to the passage of the Newborns and Mothers Health Protection Act of 1996. It established the federal requirement allowing for minimal hospital stays of 48 hours after a vaginal delivery and 96 hours after Cesarean deliveries.

Solutions for Discharge of Mothers and Newborns

Increasing the length of stay isn't the solution, Bernstein tells WebMD. "What we are hoping to do now is, create a score and be able to look at what a mother and her family need on the day of discharge," he says.

"The score would be similar to an Apgar score [that assesses a baby's health status at birth], that can predict who is ready and who is not, so appropriate services can be ordered," he says. For instance, a woman needing help with breastfeeding might get in-hospital help and also be visited by a lactation consultant once she and the baby arrive home.

Bernstein's team is following the same group of mothers now, looking at how they fared the first four weeks at home and trying to correlate whether those who were termed unready to go had more problems than those who were deemed ready.

Until more is known, Bernstein encourages new mothers to speak up and voice their opinion about their discharge date and to ask for help in the specific parenting areas they feel uncomfortable with.

Second Opinions on Discharge of Mothers and Newborns

The study results don't surprise a pediatrician and an obstetrician familiar with the study but not involved in it. "The study is right that there are mothers who aren't ready to go home," says Dennis Woo, MD, associate professor of pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles and chair of pediatrics at Santa Monica-UCLA Medical Center and Orthopaedic Hospital, Santa Monica, Calif.

"Being a parent is overwhelming," he adds. Like Bernstein, he agrees that increasing the length of stay is not the issue. "I'm not sure another day would help."

If a new mother is not ready, she should ask for more help while still in the hospital, Woo says. One good idea, he says, is to be sure the newborn will be seen by the pediatrician within the first few days of discharge. At that meeting, the new mom can bring a list of questions and concerns and get additional help.

"Most women [who are new moms] have issues about going home," adds Richard Frieder, MD, assistant professor of obstetrics and gynecology at the David Geffen School of Medicine, UCLA, and a staff ob-gyn at Santa Monica-UCLA Medical Center and Orthopaedic Hospital, Santa Monica, Calif.

Becoming a new parent isn't easy, he says. "It's like standing on the edge of the diving board. No one's ready."

Assessing outcomes -- to see if there is a difference in parenting among mothers who were ready and those who were not -- is the next logical step, Frieder says.

  • How long are you planning to stay in the hospital after baby is born? Tell us about it on WebMD's Pregnancy: 3rd Trimester message board.

Show Sources

SOURCES: Henry H. Bernstein, DO, professor of pediatrics, Dartmouth Medical School and chief of general academic pediatrics, Children's Hospital at Dartmouth, Lebanon, N.H. Richard Frieder, MD, assistant professor of obstetrics and gynecology, David Geffen School of Medicine, University of California, Los Angeles; staff obstetrician-gynecologist, Santa Monica--UCLA Medical Center ospita Hoand Orthopaedic Hospital, Santa Monica, Calif. Dennis Woo, MD, chair of pediatrics, Santa Monica--UCLA Medical Center and Orthopaedic osHospital, Santa Monica, Calif.; associate professor of pediatrics, David Geffen School of Medicine, University of California, Los Angeles. Bernstein, H. Pediatrics, August 2007; vol 120: pp 391-400.

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