Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature

Women utilisation, needs and satisfaction with postnatal follow-up care in Oman: A cross-sectional survey

BACKGROUND

In Oman, there is a lack of data on utilisation, needs and women's satisfaction with care and information provided during postnatal follow-up period.

AIM

To investigate postnatal follow-up care utilisation and women's needs; level of postnatal information received and satisfaction with services.

METHODS

A purposive sample of women (n = 500), recruited in the immediate postnatal period at one metropolitan and one regional birthing hospital in Oman. An electronic survey link was sent to participants at 6-8 weeks postnatally. Quantitative variables were analysed as frequencies and chi-squared test.

RESULTS

A total of 328 completed surveys were received; a response rate of 66 %. Most respondents were located in the metropolitan area (n = 250) and between 20 and 39 years (n = 308). Utilisation was low as women reported no need or no benefit in attending. Women's information needs were not sufficiently met by HCPs, requiring women to seek information from family and the internet to meet their needs. Satisfaction with services was mostly neither satisfied nor dissatisfied (30 %) or satisfied (30 %).

CONCLUSION

Postnatal follow-up care utilisation in both metropolitan and regional areas is less than optimal and not utilised as there was no advice to attend or no appointment date/time given, no benefit experienced previously, no need and information needed sourced from family or the internet. The information provided by postnatal follow-up care consumers can be used to enhance service delivery, inform future updates to the national maternity care guidelines, and provides a baseline for future evaluation and research.

Status and predictors of readiness for hospital discharge in women with caesarean section: A latent profile analysis

BACKGROUND

Women undergoing caesarean section (CS) experience difficulties when preparing for discharge, and readiness for hospital discharge (RHD) may depend on individual characteristics.

OBJECTIVE

To explore the status of RHD in women with CS, identify the latent classes of RHD, and analyse predictors from a bio-psycho-social perspective.

METHODS

A sample of 410 women with CS completed the following questionnaires on demographic and obstetric characteristics: Readiness for Hospital Discharge Study-New Mother Form (RHDS-NMF), Parents' Postnatal Sense of Security (PPSS), Quality of Discharge Teaching Scale (OB-QDTS), and Postpartum Support Questionnaire (PSQ). Latent profile analysis was used to identify the latent classes of RHD. Multiple logistic regression analysis was used to analyse the predictors.

RESULTS

In total, 96.6 % of women with CS reported discharge ready, and the score of RHDS-NMF was 136.09 ± 25.59. Three latent classes were identified as Low RHD (16.1 %), Moderate RHD (41.7 %), and High RHD (42.2 %). Primiparas (OR = 2.867 / 1.773; P = 0.012 / 0.033), emergency CS (OR = 3.134 / 2.470; P = 0.006 / 0.002), lower levels of PPSS (OR = 0.909 / 0.942; P = 0.009 / 0.013) and OB-ODTS (OR = 0.948 / 0.975; P < 0.001) were associated with Moderate and Low RHD. Lower PSQ predicted a higher probability of Low RHD (OR = 0.955; P = 0.038).

CONCLUSIONS

The perception of RHD by women in the study was inaccurate, with more than half not being classified as High RHD. Healthcare professionals can anticipate interventions for maternal well-being based on the characteristics of the different RHD classes.

Postnatal Care: A Comparative Review of Guidelines

Importance

Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.

Objective

The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.

Evidence Acquisition

A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.

Results

There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.

Conclusions

Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.

Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period

BACKGROUND

Women who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority. This scoping review aimed to (1) map clinical guidelines, treatment protocols and good practice guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within guidance.

METHODS

We followed the Joanna Briggs International (JBI) guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories.

RESULTS

Of 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base. Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies. Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care.

CONCLUSIONS

This synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.

Postpartum Hospital Discharge: Birthing Parent Perspectives on Supportive Practices and Areas for Improvement

BACKGROUND

Postpartum hospital care and individualized discharge preparedness should be part of person-focused health services. Yet, there are limited descriptions of birthing parents' experiences to identify clinical practice strengths and opportunities to improve systems of care.

OBJECTIVE

To explore birthing parents' perspectives on supportive healthcare practices and areas for improvement around postpartum hospital discharge.

METHODS

In this mixed-methods study, participants completed an online questionnaire and a semistructured, telephone interview at 2 to 3 weeks postpartum. Researchers summarized responses to 2 quantitative questions and conducted a thematic content analysis of interview data.

RESULTS

Forty birthing parents participated (90% non-White). According to quantitative responses, most birthing parents were prepared to be discharged (82.5%). Responses to the interview generated 6 broad factors related to postpartum hospital discharge preparedness: inpatient postpartum support, physical and emotional health, patient priorities and agency, clear and relevant information, holistic care, and scheduling and continuity of care. Researchers further identified themes around specific healthcare practices participants described to be supportive and opportunities for improvement.

CONCLUSION

Birthing parents articulated multiple contributors to their preparation for postpartum hospital discharge. These perspectives offer insights for strengthening systems of perinatal care and inform measures of quality postpartum care.

Effects of an online family-focused parenting support intervention on preterm infants' physical development and parents' sense of competence and care ability: A randomized controlled trial

BACKGROUND

Parenting of preterm infants presents unique challenges, particularly during their transition from hospital to home. Early discharge programs can assist parents during this critical period. However, the feasibility of delivering a family-focused online discharge program remains understudied.

OBJECTIVES

This study was conducted to investigate the impact of a family-focused online parenting support intervention on parents' sense of competence, depression, caregiving, social support, family functioning, and the weight and length of preterm infants.

METHODS

We conducted a single-blind, two-arm randomized controlled trial with a repeated-measures design. Participants were recruited from a specialized tertiary hospital in China between May and December 2022. Forty-five families were randomly assigned to the intervention group and 44 to the control group. The intervention included three components: (1) two one-hour group sessions and three 30-minute individual sessions of online parenting support; (2) two follow-up telephone calls (15-30 min each) post-discharge; and (3) access to online parenting resources. Primary outcomes included parenting sense of competence, parental care ability, and preterm infants' weight and length. Secondary outcomes included depression, social support, and family functioning. Measurements were taken at baseline, preterm infant discharge, one month post-discharge, and three months post-discharge. A generalized estimating equation model was employed based on the intention-to-treat principle for outcome comparison.

RESULTS

Parents in the intervention group showed significant improvements in parenting sense of competence (P < 0.001), parental care ability (P < 0.001), depression (P < 0.001), and social support (P = 0.002). However, no statistically significant differences were observed in preterm infants' weight and length, or in family functioning (P > 0.05).

CONCLUSIONS

Although the intervention did not affect preterm infants' outcomes, the positive enhancements in parenting sense of competence, care ability, depression, and social support indicate that online family-focused parenting support can effectively prepare parents for hospital discharge and the early transition period.

Stakeholder's perspectives of postnatal discharge: a qualitative evidence synthesis

INTRODUCTION

Discharge preparation prior to leaving a health facility after childbirth offers a critical window of opportunity for women, parents and newborns to receive support for the transition to care at home. However, research suggests that the quality of discharge preparation following childbirth is variable. This review synthesises qualitative evidence on stakeholder perspectives of postnatal discharge.

METHODS

We conducted a thematic synthesis of qualitative studies included in a larger published scoping review on discharge preparedness and readiness (reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews). For inclusion, in the qualitative evidence synthesis, studies had to have used qualitative methods for data collection and analysis to capture the perspectives of women, parents and health workers. Key characteristics and findings were extracted, and thematic analysis was used to inductively develop a conceptual coding framework.

RESULTS

Of a total of 130 research documents (published research articles and grey literature), six studies met the inclusion criteria; five were conducted in high-income countries, five were published in English and one was published in Swedish. Studies reported on the experiences of women, fathers and midwives with the number of participants ranging from 12 to 324. Nine descriptive themes (findings) were identified. From these, three high-level analytical themes were generated: (1) health workers need support to optimise the postnatal discharge process; (2) the allocated time for, and timing of, discharge is rushed; (3) overlooking women's and fathers'/partners' needs leads to feelings of exclusion.

CONCLUSIONS

Findings suggest an overall feeling of dissatisfaction among women, parents and midwives with the current provision of discharge preparation. In particular, women and midwives expressed frustration at the lack of time and resources available for ensuring adequate quality of care prior to discharge. The perspectives of included stakeholders indicate a demand for increased focus on the emotional and social needs of women and families during discharge preparation as well as better engagement of fathers and other family members. The qualitative evidence available indicates the likely positive impact of adequate discharge preparation if the identified service and system barriers can be overcome. As the updated WHO recommendations on postnatal care become embedded in country health systems and policies, there may be renewed interest on values, preferences and perspectives at system, service and end-user level.

Women report better experiences from maternity care after postnatal consultations: A cross sectional study

OBJECTIVE

To determine if the patient reported experiences (PREMs) of women in maternity care differ by whether or not they had a postnatal consultation before leaving the birth institution.

METHODS

Secondary analysis of cross-sectional data to compare PREMs of women who had received an individual consultation (86 %), a group consultation (3 %), and women who had received no consultation (11 %). PREMs were collected using a self-administered questionnaire. Eight summated scales were constructed from 29 single items, pertaining to different parts of the received care. Scores ranged between 0 and 100, with high scores representing positive experiences.

RESULTS

Among the 8156 sampled women, 3387 (42 %) responded. There were statistically significant (p ≤ 0.002) differences (from 3.7 to 16.3 points) on all eight scales. The scores from women who had an individual postnatal consultation were consistently higher than the scores from the other groups. The largest difference was in the scale with the worst score: information about women's health during the postnatal stay.

CONCLUSION

Women who participated in individual postnatal consultations reported more positive experiences compared to those who did not.

PRACTICE IMPLICATION

The consistent differences found in this study provide support for administering individual postnatal consultations.

Healthcare Providers' Views of Information, Support, and Services Offered to Women in the Postnatal Follow-up Care Period in Oman: A Qualitative Study

Background

Postnatal care is a component of the maternity care continuum, which is often under-valued and under-offered. The aim of this study was to explore healthcare providers' (HCPs) views about postnatal follow-up care (PNFC) offered to women in Oman.

Methods

This qualitative study was performed from May 2021 to January 2022; 29 individual participated in semi-structured telephone interviews with staff nurses (N=20), nurse/midwives (N=5), and doctors (N=4) from Khoula and Ibra hospitals and Al Amerat, Muttrah and Al Qabil health centers in Oman. Conventional content analysis was guided by Erlingsson and Brysiewicz.

Results

Seventeen sub-categories and four categories emerged from the data; they included communication and timing of PNFC, provision of PNFC with various components, challenges and needs for providing PNFC, and the impact of COVID-19 on PNFC.

Conclusion

Providing postnatal follow-up care in Oman is challenging for HCPs due to lack of clinics dedicated to postnatal care, no scheduled appointment times for women, very limited guidance within the National Maternity Care guideline, and some HCPs (i.e., nurses) with no formal education on the components of postnatal care. These hinder the ability to provide information, education, support, and services to women.

Discharge readiness and its associated factors among first-time mothers undergoing cesarean section in China

BACKGROUND

Helping first-time mothers who have just undergone cesarean section and transitioning from hospital to home with their infant is a complex process. Therefore, understanding what contributes to discharge readiness is necessary.

OBJECTIVE

This study aimed to determine discharge readiness level and its associated factors among first-time mothers who have undergone cesarean section.

METHODS

A descriptive cross-sectional study was conducted among 233 first-time mothers who had undergone cesarean sections selected using quota sampling from the two largest referral centers in China. Data were collected from March to June 2021 using a demographic characteristics form, Readiness for Hospital Discharge Scale-New Mother Form (RHDS-NMF), and Quality Discharge Teaching Scale-New Mother Form (QDTS-NMF). Descriptive and inferential statistics were used for data analysis.

RESULTS

The discharge readiness of the respondents was at a moderate level. Age (r = -0.129, p = 0.049) and complications after cesarean section (r = -0.136, p = 0.038) had a negative correlation with discharge readiness. In contrast, the subscales of QDTS-NMF, particularly the content (r = 0.519, p = 0.000) and delivery (r = 0.643, p = 0.000), had a positive correlation with discharge readiness.

CONCLUSION

The findings enable nurses, midwives, and other healthcare professionals to understand discharge readiness and its related factors among first-time mothers undergoing cesarean section. It is also suggested that the quality of discharge teaching with a comprehensive assessment of first-time mothers preparing for discharge from the hospital and following the guideline to prevent post-cesarean section complications should be reinforced.