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. 2017 Sep 6;17(1):289.
doi: 10.1186/s12884-017-1465-7.

Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review

Nadia Benahmed  1 , Lorena San Miguel  2 , Carl Devos  2 , Nicolas Fairon  2 , Wendy Christiaens  2
Affiliations

Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review

Nadia Benahmed et al. BMC Pregnancy Childbirth. .

Abstract

Background: There is an international trend to shorten the postpartum length of stay in hospitals, driven by cost containment, hospital bed availability and a movement toward the ‘demedicalization’ of birth. The aim of this systematic literature review is to determine how early postnatal discharge policies from hospitals could affect health outcomes after vaginal delivery for healthy mothers and term newborns.

Methods: A search for systematic reviews, meta-analyses, and primary studies was carried out in OVID MEDLINE, Embase, CINAHL, Econlit and the Cochrane Library (Cochrane Database of Systematic Reviews, DARE and HTA databases). The AMSTAR checklist was used for the quality appraisal of systematic reviews. The quality of the retrieved studies was assessed by the Cochrane Collaboration’s tools. The level of evidence was appraised using the GRADE system.

Results: Seven RCTs and two additional observational studies were found but no comprehensive economic evaluation. Despite variation in the definition of early discharge, the authors of the included studies, concerning early discharge and conventional length of stay, reported no statistical difference in maternal and neonatal morbidity, maternal and neonatal readmission rates, infant mortality, newborn weight gain, neonatal hyperbilirubinemia, or breastfeeding rates. The authors reported conflicting results regarding postpartum depression and competence of mothering, ranging from no difference according to length of stay to better results for early discharge. The level of evidence of the vast majority of outcomes was rated as low to very low.

Conclusions: Because of the lack of robust clinical evidence and full economic evaluations, the current data neither support nor discourage the widespread use of early postpartum discharge. Before implementing an early discharge policy, Western countries with longer length of hospital stay may benefit from testing shorter length of stay in studies with an appropriate design. The issue of cost containment in implementing early discharge and the potential impact on the current and future health of the population exemplifies the need for publicly funded clinical trials in such public health area. Finally, trials testing the range of out-patient interventions supporting early discharge are needed in Western countries which implemented early discharge policies in the past.

Keywords: Children; Delivery; Early discharge; Mother; Postpartum.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval and consent to participate were not needed because of the study design (literature review).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Pooled estimation for maternal and neonate health outcomes
See this image and copyright information in PMC

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