Next-day discharge after C-section may be okay: study

Some women who deliver their babies by cesarean section may be able to check out of the hospital the next day without raising their risk of problems, according to a Malaysian study.

The study, which appeared in the journal Obstetrics & Gynecology, looked at 360 women in Malaysia, who 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.

“Day 1 discharge compared with day 2 discharge after a planned cesarean delivery resulted in equivalent outcomes,” wrote lead author Peng Chiong Tan, at the University of Malaya in Kuala Lumpur.

Those results don’t mean that hospitals should start discharging women the day after a C-section, but they do suggest that a next-day discharge is something women can talk about with their doctors, researchers said.

In the United States, 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.

In the past, there were concerns about insurers pushing mothers to leave the hospital before they’re ready. That led to a 1996 law 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 such as normal blood pressure, no signs of infection and adequate pain control.

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.

Tan’s team randomly assigned the 360 women having a planned C-section to go home either one or two days after delivering. 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 they did go home the day after, there didn’t seem to be a greater risk of difficulties. When the women were interviewed two weeks later, 87 percent 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.

While the findings would likely extend to women in other countries too, these Malaysian women typically went home to a lot of support - often, an extended family network, Tan said.

“Where this support is not available, next-day hospital discharge may not be associated with the same degree of satisfaction, acceptability and good outcome as we have found,” she added.



Hospital Discharge on the First Compared With the Second Day After a Planned Cesarean Delivery: A Randomized Controlled Trial

: 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.
Chiong Tan, Peng FRCOG; Jin Norazilah, Mat MD (UKM); Zawiah Omar, Siti MOG

Provided by ArmMed Media