1A. Consider all birthplace options, recognizing that birth experiences are enhanced in home, birth center, or hospital settings that support parent's informed choices for the labor, birthing, and postpartum process.
References:
Godman-Brown, S., & Tate-Johnson, B. (1998). Enhancing early discharge with home follow-up: A pilot project. Journal of Obstetric, Gynecological, and Neonatal Nursing, 27(1), 33-38. (abstract)
Mendler, V., Scallen, C., Kovtun, L., Balesky, J., & Lewis, C. (1996). The conception, birth, and infancy of an early discharge program. American Journal of Maternal Child Nursing, 21, 241-246. (abstract)
Abstract 1:
Premise: Home follow-up care of postpartum mothers and their newborn infants has demonstrated improved health outcome for both mother and infant and an overall health care cost reduction.
Research Question: What is the effectiveness of a postpartum home follow-up project?
Subjects: Study consisted of 29 experimental mothers-infants completing the program and 29 control mothers-infants from a hospital’s delivery log serving as the control group.
Study Design: Data were obtained by nursing staff from two telephone interviews with the mother and two home visits assessing health status of mother-infant in the experimental group during the six-week postpartum period. The control dyads were contacted by telephone after the six-week period and interviewed to ascertain any health problems that may have transpired during that six-week time frame. The cost of unscheduled health care in both groups was estimated by the hospital accounting department.
Findings: Findings support the importance of offering preventive health services to mother-infant dyads during the six-week transitional period after birth. Experimental mothers kept more six-week check-up appointments (79% vs. 55%) and more experimental infants kept routine follow-up care (100% vs. 90%). Unscheduled care was less for both the experimental group mothers (3% vs. 10%) and infants (28% vs. 45%). One control group infant was hospitalized. Costs of nonscheduled health care were $646 for the experimental group versus $6,631 for the control group. Costs of the experimental group follow-up were not provided. Experimental group mothers had needs addressed in the areas of food stamps, WIC educational programs, breastfeeding support groups, pain reduction, coping with fatigue, newborn care and feeding, and care for jaundice or infection. Because one infant's hospitalization can impact the financial findings dramatically, this study needs to replicated with a large sample.
Research reviewed by Roxanne Zeto-Brennan, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 2:
Premise: Hospital development, implementation, and management of an early discharge program can offer quality comprehensive postpartum care to new mothers and their infants while utilizing nursing staff and health care funds more cost effectively.
Research Question: How can a hospital meet the needs of the community, hospital, and nursing staff?
Research Design: A multidisciplinary team at a hospital undertook a project to develop, implement, and manage an early discharge program. Program design outcome was based on both quantitative and qualitative data consisting of the following: exploratory studies to ascertain population (maternal, nursing, physician) interest and historical studies on early discharge programs and health provider reimbursement issues. Continuous quality monitoring of this program was accomplished by statistical analysis of hospital cost versus reimbursement information and by surveys to assess satisfaction of participants (maternal, nursing, physician) involved in the program.
Findings: Of the first 250 families in the program, 72% breastfed, fewer than half were primipara, no mothers needed re-hospitalization, and seven infants were re-hospitalized for hyperbilirubinemia or fever. The ensuing and ongoing data compilation demonstrated that this hospital had developed, implemented, and effectively managed a program that offered a preventive health care service while simultaneously utilizing hospital resources more cost-effectively.
Research reviewed by Roxanne Zeto-Brennan, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.