Postpartum Early Hospital Discharge and Follow‐up Practices in Canada and the United States

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Abstract
Background: Although official guidelines and recent legislation have addressed early postpartum hospital discharge and follow‐up, little is known about the practices of obstetricians in Canada and the United States on this issue. Methods: Questionnaires were mailed to two separate random samples of 2000 Fellows of the American College of Obstetricians and Gynecologists (ACOG) in the United States and all Canadian Fellows. Practices and perceptions were compared with those recommended in the literature, recent legislation, and guidelines of ACOG and American Academy of Pediatrics (AAP). Results: In contrast to concerns expressed in the medical literature and official AAP/ACOG guidelines, many physicians considered potential psychosocial and demographic risk factors relatively unimportant in making early discharge decisions, preferring to emphasize aspects of the patient's medical condition, hospital course, and social support. Although the official guidelines encourage follow‐up for all patients discharged early, additional visits are routinely advised by only 39 percent of obstetricians after vaginal delivery and by 68 percent after cesarean section. After vaginal delivery 39 percent of obstetricians used telephone follow‐up and 37 percent after cesarean delivery. Moreover, although the official guidelines recommend follow‐up within 48 hours of discharge, only one‐half of the obstetricians surveyed advised follow‐up at this time. In contrast to the guidelines, most obstetricians defined early discharge as that occuring within 24 hours after vaginal delivery and 72 hours after cesarean delivery; most defined optimal lengths of stay within the 48‐hour (after vaginal delivery) and 96‐hour (after cesarean delivery) periods considered short by the guidelines. Conclusions: Current postpartum early discharge and follow‐up practices emphasize the physical health of the mother and place little emphasis on social risk. They appear to be influenced by perceptions of the appropriateness of the length of stay and are not in agreement with professional guidelines. (BIRTH 25:3 September 1998)