Life Around Newborn Discharge (LAND)

Aims

Insurers, managed care companies, and hospitals operating under capitation have sought to reduce costs through initiatives to shorten hospital stays, including the length of postpartum hospitalizations for mothers and newborns. Between 1970 and 1992, the average length of stay for all deliveries decreased from 4.1 to 2.6 days, and for vaginal deliveries from 3.9 to 2.1 days [CDC, 1995]. Health care practitioners, families, and public officials raised concern about medical, behavioral, and emotional consequences of shortened postpartum length of stay. A majority of newborns were being discharged earlier than recommended by the American Academy of Pediatrics [AAP, 1995].

In response to public perceptions that pressure to shorten postpartum stays had become excessive, a majority of states enacted legislation mandating insurance coverage for a minimum length of postpartum stay when requested by the mother or the attending physician. In a follow-up report of four New Jersey hospitals after enactment of such state legislation, the average postpartum length of stay for uncomplicated deliveries increased by 10-12 hours [CDC, 1996]. The Newborns’ and Mothers’ Health Protection Act of 1996 was then passed to establish federal requirements for minimum hospital length of stay following birth for both mother and infant. The intent of the legislation was to return the discharge timing decision-making process to the practitioner and to the family.

This study has two principal specific aims:

Describe readiness of mother and newborn for postpartum hospital discharge based upon maternal, pediatric and obstetrical perceptions and clinical judgments, and explore determinants of readiness.

Examine the relationship between maternal, pediatric, and obstetrical perceptions and clinical judgments of mother/infant readiness for postpartum hospital discharge on health care utilization, health-related behaviors, and infant and maternal health status during the first four weeks after discharge.

Additionally, we have the following three secondary aims:

1. Measure concordance between maternal, pediatric and obstetrical perceptions and clinical judgments of mother/infant readiness at the time of postpartum hospital discharge, and determine how well this concordance predicts health care utilization, health-related behaviors, and infant and maternal health status during the first four weeks after discharge.

2. Distinguish any subsequent change in maternal and pediatric perceptions and clinical judgments of mother/infant readiness between the time of postpartum hospital discharge and four weeks after discharge, and explore characteristics of those individuals who change their perceptions.

3. Obtain more specific, exploratory descriptive data on the issues facing mothers in the first two weeks after discharge.