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Postpartum Discharge: Do Varying Perceptions of Readiness Impact Health Outcomes?

  • Henry H. Bernstein
    Correspondence
    Address correspondence to Henry H. Bernstein, DO, Children's Hospital, PHA, Hunnewell Ground, 300 Longwood Ave, Boston, MA 02115
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  • Cathie Spino
    Affiliations
    From the Division of General Pediatrics, Children's Hospital, Boston, Mass (Dr Bernstein); Ann Arbor, Mich (Dr Spino); Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Ill (Ms Baker and Dr Slora); Bloomington, Ind (Dr Touloukian); and the Harvard School of Public Health, Boston, Mass (Dr McCormick)
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  • Alison Baker
    Affiliations
    From the Division of General Pediatrics, Children's Hospital, Boston, Mass (Dr Bernstein); Ann Arbor, Mich (Dr Spino); Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Ill (Ms Baker and Dr Slora); Bloomington, Ind (Dr Touloukian); and the Harvard School of Public Health, Boston, Mass (Dr McCormick)
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  • Eric J. Slora
    Affiliations
    From the Division of General Pediatrics, Children's Hospital, Boston, Mass (Dr Bernstein); Ann Arbor, Mich (Dr Spino); Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Ill (Ms Baker and Dr Slora); Bloomington, Ind (Dr Touloukian); and the Harvard School of Public Health, Boston, Mass (Dr McCormick)
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  • Carol Litten Touloukian
    Affiliations
    From the Division of General Pediatrics, Children's Hospital, Boston, Mass (Dr Bernstein); Ann Arbor, Mich (Dr Spino); Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Ill (Ms Baker and Dr Slora); Bloomington, Ind (Dr Touloukian); and the Harvard School of Public Health, Boston, Mass (Dr McCormick)
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  • Marie C. McCormick
    Affiliations
    From the Division of General Pediatrics, Children's Hospital, Boston, Mass (Dr Bernstein); Ann Arbor, Mich (Dr Spino); Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, Ill (Ms Baker and Dr Slora); Bloomington, Ind (Dr Touloukian); and the Harvard School of Public Health, Boston, Mass (Dr McCormick)
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      Objective.To assess maternal and pediatrician perceptions of mother-infant readiness for postpartum discharge and the impact of this decision making during the neonatal period.
      Methodology.We performed a prospective cohort study of mothers and healthy term infants during the first month of life. On nursery discharge and 1 month later, mothers and practitioners completed self-administered questionnaires assessing the discharge decision, maternal confidence in newborn care, and the adequacy of the length of obstetric care. We used Fisher exact tests, Wilcoxon tests, and exact logistic regression for analysis.
      Results.Twenty percent of 55 mother-infant pairs were classified as unready at postpartum discharge. Maternal education less than high school was a significant predictor for lack of readiness (P = .01). During the month after discharge, unready mothers identified themselves as being less happy, made twice as many phone calls on behalf of their infants, and more often placed their infants in the prone sleeping position (P < .01 for each) when compared with ready mothers. The latter 2 variables remained significant in multivariate analyses. The percent agreement between mothers and practitioners about readiness was 92% on discharge but 59% (κ = 0.09; P = .34) 1 month later.
      Conclusions.Maternal and pediatric perceptions of readiness for postpartum discharge of mothers and infants show substantial variation on the day of discharge and over time.

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