Trends in very early discharge from hospital for newborns under midwifery care in Ontario from 2003 to 2017: a retrospective cohort study

BACKGROUND

Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time.

METHODS

We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital.

RESULTS

The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% (n = 1479) to 83% (n = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort.

INTERPRETATION

Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.

Adolphe Pinard (1844-1934) of Paris and intrauterine paediatric care

Pinard was a pioneer of modern perinatal care. His provision of social care to deprived pregnant women progressed to a recognition of the value of medical care of mother and baby before as well as after birth. The creation of antenatal departments and wards in maternity hospitals followed. He also established abdominal obstetric palpation on sound principles.

From innovation to common practice: perinatal nursing pre-1970 to 2005

The history of perinatal nursing from before 1970 to the present is characterized by innovations that became common practice in later years. These innovations include fetal monitoring, mother/baby care, and early postpartum discharge. The driving forces behind changes in care within the social context of the times were scientific/medical developments and families' desires for the best possible childbearing experience. With innovations becoming commonplace, nursing practice became more complex. How nurses approach present-day challenges of increasing technology of birth, looming threats of litigation, and providing care under time and economic restraints is continuing to evolve.

Childbirth in ancient Egypt

Medicine in ancient Egypt was much more advanced than the rest of the Biblical world, especially in trauma surgery. Care at the time of childbirth was however virtually non-existent. There were no trained obstetricians or midwives but a galaxy of gods were at hand. This article traces what we can piece together about pregnancy of childbirth from the evidence we have in tombs and papyri of Egypt.

The history of Mother-Baby Units (MBUs) in France and Belgium and of the French version of the Marcé checklist

Until fairly recently, mentally ill mothers were separated from their new-borns because of the potential danger to the baby. Over the past 50 years, however, we have learned more about the perinatal period, with the development of child psychiatry and interest in maternal postpartum disorders. This knowledge has led psychiatric departments to develop new ways to provide care without separating mentally ill mothers from their babies. Joint full-time admissions began in Great Britain in 1948. The first Mother-Baby Unit (MBU) in France opened in 1979 and in Belgium in 1990. In 2003, there are 17 MBUs in France and 3 in Belgium. From 1995 to 1998, Odile Cazas and Nine Glangeaud, working with a group of child and adult psychiatrists and psychologists, adapted the English Marcé Checklist to the French and Belgian health and child protective systems and added items useful for research.

[Postnatal care in a cross-cultural and historical perspective]

BACKGROUND

In most societies, birth and the immediate postpartum period are considered a time of vulnerability for mother and child. Rituals for major changes in the life cycle are common in most societies. The aim of this study was to present some examples of postpartum customs in a cross-cultural and historical perspective. We also present research on associations between postnatal care and mental health.

MATERIAL AND METHODS

A systematic search was performed in Medline and the Science Citation Index Expanded (ISI) from 1966 until March 2003. Reference lists in books about pregnancy and birth from the library of the University of Oslo were used to get additional information.

RESULTS

The postnatal period is defined as approximately 40 days in most cultures; most societies have special postnatal customs that include special diet, isolation, rest and help in the household. The resemblance between different cultures is striking. Many postnatal customs from rural societies that were common before 1950 have disappeared. The focus on rest and help in the household for the mother after delivery has been reduced.

INTERPRETATION

We need more knowledge about the impact of different kinds of postnatal care on the mother's wellbeing.

The hospital and the postpartum experience: a historical analysis

In the United States, use of hospitals for childbearing started in the early 19th century for women who did not have suitable homes. Since then, the purpose and structure of hospital-based postpartum care changed several times. The trend toward shorter stays began almost 50 years ago. Although the economy was a driving force both now and 50 years ago, the purposes for changes were different. Knowing the history of postpartum care gives insight into the state of care at the turn of the millennium.

Soranus of Ephesus (circa AD 98-138) and perinatal care in Roman times

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