Labor/Delivery Problems Nos Clinical Trial
Official title:
Early Postnatal Discharge in a French Perinatal Network
The purpose of this "before-after" study is to determine the effectiveness of a multidimensional intervention to increase the rate for early discharge of low-risk mothers and the healthy newborn in a perinatal network.
In March 2014, the French Health Authorities edited new guidelines about early discharge
after delivery. Early discharge is defined as a discharge during the 72 hours following
vaginal delivery of low-risk mothers and their healthy newborn. These guidelines defined the
conditions of eligibility for early discharge for mothers and babies, and the different
criteria of their follow-up at home by midwives .
The average length of stay following normal delivery is higher in France than in other
European countries: eg : 4.3 days in France vs 2.2 days in Sweden (OECD indicators 2011) On
the other hand, according to an investigation conducted by a patients association, 38% women
declared that they felt that their hospitalization was too long after their baby's birth,
but their request for a shorter stay had not been taken into account by hospital caregivers.
The investigators hypothesis is that the rate of early discharge could be increased by a
multi-pronged program coordinated in a perinatal network, and could improve quality of
postpartum care, and women's satisfaction.
The "Réseau Périnatal Alpes Isère" is a perinatal network located in French Alps region. Its
purpose is to coordinate 5 maternity services an organization of midwives providing pre and
postnatal home care, for about 10000 births annually. In 2010, according to the hospital
database provided by the Medical Information Systems Program, early discharge concerned only
4.1% of mothers between 0 and 48 hours after delivery . At the same time, 65% of women could
be considered as at low risk, considering they gave birth to a healthy singleton, born after
38 weeks of gestation by vaginal delivery. This rate is not precise, in view of the lack of
availability of documented rate of non-eligibility for early discharge such as non-
eutrophic babies, or adverse events during postpartum and the neonatal period.
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Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research