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Many New Moms Feel 'Unready' at Hospital Discharge

Better prenatal and in-hospital education would help, researchers say

MONDAY, Aug. 6, 2007 (HealthDay News) -- About one in six new moms may not be ready to fully take care of their newborns at the time they're discharged from U.S. hospitals, new research suggests.

Reporting in the August issue of Pediatrics, researchers found that 17 percent of new mothers and infants were "unready" for the transition at the time of discharge. Eleven percent of mothers felt unready, while 5 percent of pediatricians felt mother-infant pairs were unready. Just 1 percent of obstetricians felt the mother-infant pairs were unready.

"We wanted to address the lack of information regarding the postpartum decision-making process for healthy term newborns and its consequences during the neonatal period, after federal legislation that went in effect in 1998 established a minimum postpartum length of stay of 48 hours after vaginal deliveries and 96 hours after Caesarean deliveries, unless a mother and physician decide otherwise," explained the study's lead author, Dr. Henry Bernstein. He is chief of general academic pediatrics at Children's Hospital at Dartmouth, in Lebanon, N.H.

To do this, Bernstein and his colleagues got more than 450 practitioners from 112 sites around the country to recruit 4,300 mother-infant pairs. Mothers, obstetricians and pediatricians are considered key partners in decisions on when to leave the hospital after delivery.

The researchers found that, at the time of discharge, almost one in six mother-infant pairs was deemed unready. In most cases, it was the mother, rather than her doctors, who felt she and/or her infant was not yet prepared to go home.

The researchers identified eight factors that seemed to correlate with feeling unready, including a maternal history of chronic disease, first-time parenthood, inadequate prenatal care, delivering during non-routine hours, neonatal problems in the hospital, a limited number of in-hospital education classes, plans to breast-feed, and the mother's race -- black women were almost 40 percent more likely to feel unready to be discharged than whites, the study found.

"The data suggests that mothers and clinicians must make the decision jointly," said Bernstein. He added that, "To increase readiness, it's critical to emphasize personalized discharge plans for that infant and his or her family."

Additionally, Bernstein said the researchers found that the length of a hospital stay was not a determinant of readiness.

"This study shows that the time in the hospital is not the issue; education is a more important issue," said Dr. Robert Welch, chairman and program director of obstetrics and gynecology at St. John Health's Providence Hospital in Southfield, Mich.

Welch pointed out that changes in society may have created this issue. In the past, when women came home from the hospital, a grandmother was often there to help out and teach newborn care.

"A lot of times now, moms are going home, and they're alone with the baby, and she may not have an appropriate support system in place, or day care if she's planning on going back to work," said Welch.

"From the time that they have the first inkling that they want to have a baby, women should start building a support system," he suggested.

Welch also believes that it might be a good idea for hospitals to provide more standardized postpartum education. Right now, individual centers design their own programs, and he said that what's included in those after-birth education programs can vary greatly from hospital to hospital.

Bernstein said his team is continuing its work to see if postpartum unreadiness had any effect on the newborns. Their next study will look at the health outcomes of these newborns at four weeks after hospital discharge.

And, he added, "We're hoping to come up with a score to be used at discharge, similar to the Apgar score just after birth, that can help clinicians predict who is ready and who is not ready, so appropriate postpartum supports or services can be put in place."

More information

The Nemours Foundation has more information on bringing baby home.

SOURCES: Henry Bernstein, D.O., professor, pediatrics, Dartmouth Medical School, and chief, general academic pediatrics, Children's Hospital at Dartmouth, Lebanon, N.H.; Robert Welch, M.D., chairman and program director of obstetrics and gynecology, St. John Health's Providence Hospital, Southfield, Mich.; August 2007, Pediatrics
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