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. Published in Obstetrics & Gynecology, online
Source: Chicago Tribune
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