Randomized Trial of Postpartum Care After Hospital Discharge

Abstract

Objective. Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants. These may be prevented by adequate breastfeeding frequency; however, rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent. This study addressed the question, “Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours’ postpartum who received either community nurse (home visit) or hospital nurse (clinic) follow-up?” Methods. A randomized, controlled trial was conducted at a university teaching hospital (3700 births/y) and affiliated community health centers. A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge; 513 (87.5%) contributed data on 1 or more outcomes. Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home (experimental) or at the hospital (control) were provided. The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks’ postpartum by maternal diary and weight at home by research assistants, masked to group allocation. Results. No clinically important or statistically significant group differences were found in daily breastfeeding frequency (mean difference experimental minus control = 0.1 feeds [95% confidence interval: −0.1–0.3]) or daily rate of infant weight gain (−1.1 g [−2.5–0.3]) based on intention-to-treat analyses. Conclusions. Follow-up by nurses after short postpartum hospital stays, in either the home or a hospital-based clinic, of healthy infants discharged at <36 hours seems associated with satisfactory infant breastfeeding outcomes.