Unreadiness for postpartum discharge following healthy term pregnancy: impact on health care use and outcomes

Acad Pediatr. Jan-Feb 2013;13(1):27-39. doi: 10.1016/j.acap.2012.08.005. Epub 2012 Oct 24.

Abstract

Objective: To document the association between a lack of readiness, termed "unreadiness," for postpartum discharge and the health of mothers and their term newborns.

Methods: Prospective observational cohort study of 4300 mother-infant dyads in a national, pediatric, practice-based research network. The association between unreadiness for discharge and health care use, health-related behaviors, and health outcomes was analyzed by the use of bivariate, multivariate linear, and logistic models.

Results: Sixteen percent of mother-infant dyads were unready for discharge. Unreadiness was significantly associated with maternal and infant health care use and health outcomes but not independently associated with health-related behaviors. In multivariable analyses, after we controlled for important covariates and confounders, unready dyads had more calls to health care providers than ready dyads (13.3% increase for mothers, P = .01; 18.7% increase for infants, P < .01) during the first 2 weeks after discharge. In this same time frame, unready dyads also had more symptom days (8.5% increase for mothers, P < .01; 8.7% increase for infants, P < .01). Unready mothers had lower mean physical (5.0% decrease, P < .01) and mental (4.4% decrease, P < .01) health status scores at 4 weeks after discharge.

Conclusions: Unreadiness at postpartum discharge was associated with increased health care use and poorer health outcomes in the first 2 to 4 weeks after discharge. Discharge plans should be individualized and jointly tailored to a family's needs rather than to a set timescale.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Child Health Services / statistics & numerical data*
  • Cohort Studies
  • Female
  • Health Behavior*
  • Health Status
  • Humans
  • Infant, Newborn
  • Linear Models
  • Logistic Models
  • Maternal Health Services / statistics & numerical data*
  • Mothers / psychology
  • Mothers / statistics & numerical data*
  • Multivariate Analysis
  • Patient Discharge*
  • Postpartum Period*
  • Pregnancy
  • Prospective Studies
  • Young Adult