Early Postnatal Discharge in a French Perinatal Network
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.
Inclusion Criteria:

 "1" low risk mothers ith uncomplicated pregnancy and birth defined as

 -  lack of mental disability

 -  lack of referred problems about mother to infant bonding

 -  lack of precarious state

 -  vaginal delivery without bleeding more than 500cc

 -  lack of postpartum complications during hospitalization

 "2" low risk baby defined as

 -  singleton

 -  gestational age >= 38 weeks

 -  apgar score > 7 at 5 minutes life

 -  normal weight expected for gestational age

 -  lack of infection, or jaundice

 Exclusion Criteria:

 -  person deprived of liberty

 -  person who does not speak French

 -  person not covered by health insurance