WHICH MOTHERS AND THEIR NEWBORNS ARE NOT READY FOR POSTPARTUM DISCHARGE? Henry Bernstein, Cathie Spino, Sarah Rieber, Stacia Finch, Alison Bocian, Richard Wasserman. 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.

BACKGROUND: As hospital lengths of stay and postpartum services have been reduced, readiness for newborn discharge remains poorly understood.

OBJECTIVE: To explore maternal, pediatrician, and family factors associated with mother/infant readiness for postpartum discharge (PPD).

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 and parental confidence in newborn care. 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". Chi-square tests were performed to identify significant (p<0.05) predictors of readiness; odds ratios with 95% confidence intervals (CI) were calculated for likeliness to be "unready".

RESULTS: 1,197 mother/infant pairs had complete readiness data at PPD; 22% were "unready". Non-whites and Hispanics/Latinos were about twice as likely to be "unready" as whites (OR 2.1; CI 1.6, 2.8 and OR 1.7; CI 1.2, 2.2, respectively). PED-related predictors of unreadiness included no visit by PED in hospital (OR 1.5; CI 1.0, 2.1) and older (>43 years) PEDs (1.3; CI 1.0, 1.7). Mothers who delivered by C-section (OR 1.5; CI 1.1, 2.0), had a neonate with problems in hospital (OR 1.9; CI 1.5, 2.5), had prolonged labor (OR 1.9; CI 1.2, 2.8), or gave birth in hospital birthing center (not the delivery room) (OR 1.4; CI 1.1, 1.9) were more likely to be "unready" for PPD. Mothers without insurance were more than twice as likely to be "unready" than those with private insurance (OR 2.6; CI 1.4, 4.9) or public insurance (OR 2.2; CI 1.1, 4.2). Mothers who felt their abilities and those of the fathers to care for newborns were less than those of other mothers/fathers, or were unsure, were more likely to be "unready" (mothers-OR 1.5; CI 1.1, 2.2; fathers-OR 1.5; CI 1.1, 2.1).

CONCLUSIONS: More than 1 in 5 mother/infant pairs are discharged postpartum against the best judgment of either the mothers or their physicians. Medical and social considerations contribute substantially to unreadiness. PEDs and OBs need to bear these factors in mind to safeguard at risk mother/infant pairs upon PPD.