Early Postpartum Discharge: Recommendations From a Preliminary Report to Congress

Nearly 4 million women give birth in the United States each year, the vast majority of them in hospitals, making childbirth the most frequent reason for hospital admission.1 According to generally accepted standards of maternity care, the health care needs of the newborn and mother in the immediate postnatal/postpartum period should be met at the delivery site. These needs include monitoring and support to ensure the infant's stabilization during the initial physiologic transition from intrauterine to extrauterine environments, performance of recommended immunizations, mandatory screening for genetic disorders, and initiation of feeding and assessment of major medical risk factors. Standard inpatient care for mothers in the immediate postpartum period has also included instruction on infant and self-care, and training in breastfeeding and lactation support. Hospital length of stay after childbirth has decreased progressively during the past 25 years, initially in response to public pressure to demedicalize childbirth but then in a more accelerated fashion in response to cost-containment pressures. The trend toward increasingly shorter hospital stays has raised concerns about the potential consequences of reducing the length of time in which necessary care can be delivered to newborns and mothers in the hospital setting. In response to these concerns, the 1992 Guidelines for Perinatal Care, jointly published by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), indicated that for otherwise uncomplicated deliveries: 1) the recommended postpartum hospital stay should range from 48 hours for vaginal delivery to 96 hours for cesarean delivery, excluding the day of delivery (most subsequent guidelines and legislation have not made the distinction “excluding the day of delivery”); and 2) discharge within 48 hours of birth is defined as early discharge and discharge in <24 hours as very early discharge.2 Despite the issuance of these guidelines, an increasing …