"UNREADINESS" AT POSTPARTUM DISCHARGE PREDICTS LOWER MATERNAL HEALTH STATUS DURING THE FIRST 4 WEEKS POSTPARTUM Henry Bernstein, Cathie Spino, Stacia Finch, Rebecca Stoltz, Richard Wasserman, Marie McCormick. Division of General Pediatrics, Children?s Hospital, Boston, MA; , Ann Arbor, MI; PROS, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL; PROS, University of Vermont, Burlington, VT; Maternal and Child Health, Harvard School of Public Health, Boston, MA.

BACKGROUND: Childbirth represents a significant health event for women. It is not clear if current discharge practices allow adequate recuperation, and what implications of being unready for discharge are.

OBJECTIVE: To determine how readiness for post-partum discharge (PPD) predicts the physical and mental well being of mothers 4 weeks post-partum.

DESIGN/METHODS: Pediatric Research in Office Settings (PROS) conducted a prospective observational cohort study of mothers and healthy term infants. Upon nursery discharge, mothers, pediatricians (PED) and obstetricians (OB) completed self-administered questionnaires assessing the discharge decision-making process. Readiness for PPD was defined as mutual agreement of mother, PED and OB that mother and infant were ready. If either was perceived as not ready, then the pair was defined as "unready". Mothers also completed a daily diary for the first 2 weeks post-partum to prospectively document their experiences and completed follow-up questionnaires 4 weeks post-partum using the Short Form-12 (SF-12), a series of 12 questions that assesses physical and mental well being, which provides physical (PCS) and mental (MCS) component summaries. Higher scores on either subscale indicate better health. All comparisons were assessed using two-sample t-tests.

RESULTS: 1,635 mothers completed the SF-12 (69% response rate). Mean PCS and MCS scores were 46.6 (SD 9.1) and 49.5 (SD 9.8), respectively, as compared with published mean PCS and MCS scores of 52.3 and 46.4 for 18 - 44 year old women. The mean PCS score of 44.7 for mothers perceived as "unready" for PPD was significantly lower than the mean PCS of 47.1 for mothers perceived as ready (p<0.001). Similarly, the mean MCS score of 47.8 for mothers perceived as "unready" for PPD was also significantly lower than the mean MCS of 49.9 for mothers perceived as ready (p<0.01). "Unready" mothers reported significantly more days of concern about pain, feeling blue, incision care and other concerns in the daily diary than ready mothers (p<.001).

CONCLUSIONS: Mothers perceived as "unready" for PPD had significantly lower health status during the neonatal period than mothers perceived as ready. Health professionals should pay close attention to mothers considered "unready", which predicts poorer health outcomes in the ensuing 4 weeks.