Next-day discharge after C-section may be OK
Some women who deliver by cesarean section may be able to check out of the hospital the next day without raising their risk of problems, a small new study suggests.
The findings come from a clinical trial in Malaysia, where 360 women were randomly assigned to go home either one or two days after having a C-section. Both groups were equally satisfied with their care, and the women who were discharged sooner seemed to have no more problems with breastfeeding or mental well-being.
Those results, reported in the journal Obstetrics & Gynecology, don’t mean that hospitals should start kicking women out the day after a C-section, researchers say.
But they do suggest that a next-day discharge is something women can talk about with their doctors, according to the study’s lead author Dr. Peng Chiong Tan, of the University of Malaya in Kuala Lumpur.
In the U.S., where C-sections are done in about one-third of births, women typically stay in the hospital for three to four days after the procedure. That compares with about two days for women who deliver vaginally.
Historically, there have been concerns about insurers pushing new moms to leave the hospital before they’re ready. That led to a 1996 law, known as the Newborns’ and Mothers’ Health Protection Act, requiring insurers to pay for a 48-hour hospital stay after a vaginal delivery and a 96-hour stay after a C-section.
Still, the American College of Obstetricians and Gynecologists (ACOG) says a shorter stay after a C-section is an option if the baby is ready to go home - though the mother should meet certain requirements first.
They include normal blood pressure, no signs of infection at the C-section site and adequate pain control, among other things.
At Tan’s hospital in Malaysia, women who have a C-section are routinely told to expect just a two-day stay. And some providers there have discharged new mothers the day after their cesarean.
To test whether next-day discharge is any worse for mothers or babies, Tan’s team randomly assigned 360 women having a planned C-section to go home either one or two days after delivering. (Doctors could, however, keep a woman longer if it seemed necessary.)
In the end, 16 percent of the women in the day-after group were not discharged that early - because either they or their babies were having problems.
But when new mothers and babies did go home the day after, there seemed to be no greater risk of difficulties. When the women were interviewed two weeks after giving birth, 87 percent of the next-day group said they were happy with their discharge timing.
The same was true for almost 86 percent of women who went home two days after their C-section.
When it came to breastfeeding, the same proportion of each group - 45 percent - said they were exclusively breastfeeding six weeks after giving birth. (There have been concerns that early discharge could interfere with new mothers’ ability to take up breastfeeding.)
Tan’s team also found no difference between the groups in mothers’ anxiety levels and depression symptoms, or in their risk of problems with the C-section wound. Only one woman in each group needed to be rehospitalized.
According to Tan, the findings on women’s physical recovery would likely extend to other countries, too.
The caveat, though, is that these Malaysian women typically went home to a lot of support - often, an “extended family network,” Tan said in an email.
“Where this support is not available,” Tan said, “next-day hospital discharge may not be associated with the same degree of satisfaction, acceptability and good outcome as we have found.”
ACOG says that women who want an earlier-than-average discharge after a C-section can discuss it with their doctor. But if they do go home early, the group advises having a home visit or at least phone call with a health provider - such as a lactation consultant - within two days.
Tan said their advice to women who want an early discharge is to talk with their own doctor. If they do go home soon after a C-section, Tan added, they should be sure they have enough support at home, as well as adequate pain relief.
In the U.S., the cost of a hospital stay after a C-section averages $5,300, according to the Agency for Healthcare Research and Quality. That compares with $2,600 to $3,200 after a vaginal delivery, depending on whether there are complications.
SOURCE: Obstetrics & Gynecology, online October 25, 2012.
Hospital Discharge on the First Compared With the Second Day After a Planned Cesarean Delivery: A Randomized Controlled Trial
RESULTS: Of the 360 women randomized, results of 170 compared with 172 and 142 compared with 148 (day 1 compared with day 2) were available for intention-to-treat and per-protocol analyses, respectively. Nine women fulfilled discharge criteria but declined day 1 discharge, and 12 women allocated to day 2 discharge took their own discharge on day 1. Intention-to-treat analysis showed that satisfaction with discharge protocol was expressed by 148 of 170 (87.1%) compared with 147 of 172 (85.5%) (relative risk 1.1, 95% confidence interval [CI] 0.6-2.1, P=.75) and exclusive breastfeeding (at 6 weeks) was reported by 76 of 170 (44.7%) compared with 77 of 172 (44.9%) (relative risk 1.0 95% CI 0.7-1.5 P=.99 for day 1 compared with day 2 discharges, respectively). All secondary outcomes assessed at up to 6 weeks after discharge including unscheduled maternal or infant medical consultations, rehospitalizations, maternal antibiotic use, and maternal well-being, anxiety, and depression status, were similar. Results on per-protocol analysis were also similar.
CONCLUSION: Day 1 discharge compared with day 2 discharge after a planned cesarean delivery resulted in equivalent outcomes.
CLINICAL TRIAL REGISTRATION: ISRCTN Register, ISRCTN.org, ISRCTN27523895.
Chiong Tan, Peng FRCOG; Jin Norazilah, Mat MD (UKM); Zawiah Omar, Siti MOG