A RANDOMIZED TRIAL OF A PROGRAM OF EARLY POSTPARTUM DISCHARGE WITH NURSE VISITATION

OBJECTIVE: Our purpose was to compare an early postpartum discharge pr ogram versus standard postpartum care. STUDY DESIGN: A randomized cont rolled trial in a 637-bed university hospital included 175 healthy wom en recruited at 32 to 38 weeks gestation from physicians' offices and sonograms. Experimental intervention consisted of discharge 6 to 36 ho urs post partum with nursing care available by telephone or at home at 34 to 38 weeks' gestation and at less than or equal to 48 hours and a t 3, 5, and 10 days post partum. The control included a postpartum sta y of 48 to 72 hours and standard follow-up. RESULTS: At 1 month no sig nificant differences were seen in perceived maternal competence (Exper imental - Control = 4.3 points [95% confidence interval -7.7 to 16.3]) , infant weight gain (1.2 gm/day [-2.8 to 5.2]); identification of sig nificant neonatal hyperbilirubinemia (rate ratio 0.50 [0.10 to 2.51]), infant utilization of health services (rate ratio 0.88 [0.45 to 1.73] ), or predominant breast-feeding (adjusted odds ratio 1.25 [0.88 to 1. 75]). Program participants did have significantly less frequent infant bilirubin testing (rate ratio 0.39 [0.17 to 0.94]). The program also enhanced perceived maternal competence in recent immigrants (26.9 poin ts [2.7 to 51.5]). CONCLUSIONS: Early postpartum discharge coupled wit h prenatal, postnatal, and home contacts leads to no apparent disadvan tage and may yield benefits for some mothers and infants.