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Home-based versus hospital-based postnatal care: a randomised trial
Michel Boulvain1, Thomas V Perneger, Véronique Othenin-Girard
1Department of Obstetrics and Gynaecology, Geneva University Hospitals, University of Geneva, Switzerland.
Summary
Early discharge with midwife home visits after childbirth is a safe alternative to standard hospital care for low-risk pregnancies. This approach offers shorter hospital stays and increased maternal satisfaction, though neonatal readmission rates require consideration.
Area of Science:
- Obstetrics and Gynecology
- Midwifery
- Public Health
Background:
- Traditional postnatal care involves extended hospital stays.
- There is a growing interest in alternative models for postpartum care.
- Evaluating the safety and efficacy of early discharge is crucial for maternal and infant well-being.
Purpose of the Study:
- To compare the outcomes of shortened hospital stays with home-based midwife care versus standard, longer hospital stays after delivery.
- To assess maternal satisfaction, breastfeeding rates, and readmission rates in both care models.
Main Methods:
- A randomized controlled trial involving 459 women with uncomplicated, low-risk pregnancies.
- Participants were assigned to either early discharge with home midwife visits or standard hospital-based postnatal care.
- Key outcomes included breastfeeding prevalence, maternal satisfaction, and hospital readmissions at 28 days and six months postpartum.
Main Results:
- Women in the home-based care group experienced significantly shorter hospital stays (65 vs. 106 hours) and received more midwife visits.
- Breastfeeding rates at 28 days were similar, but home-care mothers reported fewer breastfeeding problems and higher satisfaction with support.
- No significant differences were observed in maternal satisfaction, readmissions, depression, or health status, but neonatal readmissions were higher in the home-based group (12% vs. 4.8%).
Conclusions:
- Early discharge with home-based midwife care is an acceptable and effective alternative to prolonged hospital stays for low-risk pregnancies.
- Maternal preferences and economic factors should guide the implementation of postnatal care policies.
- While generally safe, the increased neonatal readmission rate in the early discharge group warrants further investigation and monitoring.