Table 1 Characteristics of included studies

Carty 1990 [29], Canada

RCT

Vaginal birth, prenatal classes attendance, stable relationship with partners

Group 1: discharge from 12 h to 24 h + nurse home visit on days 1, 2, 3, 5 and 10 (44)

Group 2: discharge from 25 h to 48 h + nurse home visit on days 3, 5 and 10 (49)

Group 3: discharge at 4 days + nurse home visit on 10 (38)

Mean (SD)

30.24 (3.80)

Maternal outcomes

▪ Morbidity

Problems requiring physician referral in the first 10 days postpartum

Intervention: 5/93 (urinary tract infection, episiotomy infection, mastitis, subinvolution)

Control: 3/38 (endometritis, episiotomy, subinvolution)

▪ Hospitalization within the first 1 month

Intervention: 1/93 (urinary tract infection)

Control: 1/38 (endometritis)

▪ Psychological functioning

Depressive affect at 1 month (Beck Depression Index)

Significant difference between group 2 and group 3 in favour of group 2 (p < 0.05)

Confidence (subscale of a questionnaire for women during their childbearing years)

At 1 week: score in favour of group 1 in comparison with group 3 (p < 0.03), no significant difference between group 1 and 2

At 1 month: no difference between groups

Neonatal outcomes

▪ Morbidity

Problems requiring physician referral in the first 10 days postpartum

Intervention: 4.3% (hyperbilirubinemia and cord infection,)

Control: 2.6% (ABO incompatibility and diaper rash)

Breastfeeding duration

Intervention: 87%

Control: 79%

Length of stay: mean in days (SD)

Group 1: 1.12 (0.40)

Group 2: 2.06 (0.56)

Group 3: 4.03 (0.69)

Gagnon 1997 [36], Canada

RCT

Parity 0 to 4, normal pregnancy, ability to speak English, French or Spanish, telephone availability, residence within 30 min of hospital

Discharge between 6 to 36 h, nursing care by telephone within 48 h and at 10 days, home visit at days 3 and 5 postpartum. Prenatal preparation: home visit at 34 and 38 weeks’ gestation (80)

Discharge between 48 to 72 h, and follow-up as determined by woman’s and infant’s physicians (100)

Mean (SD)

29.6 (4.7) vs 29.1 (5.3)

Respectively int. and control

Maternal outcomes

▪ Competence in mothering

Perceived Maternal Task Performance Scale

Mean difference (95% CI) at 1 month: 4.3 (−7.7–16.3)

Neonatal outcomes

▪ Infant health contacts

For feeding, crying, sleeping or care of the umbilical cord

RR (95% CI): 0.88 (0.45–1.73)

▪ Infant weight gain

Mean difference (95% CI) during the follow-up period

1.2 (−2.8–5.2)

▪ Neonatal hyperbilirubinemia

RR (95% CI) 0,50 (0.10–2.50)

Breastfeeding

(predominantly at 1 month)

Intervention: 55.1%

Control: 39.2%

RR (95% CI): 1.41 (1.02–1.94), ns when adjustment in those to breast-feed at baseline

Length of stay: mean in hours (SD)

Intervention: 37.5 (19.7)

Control: 54.3 (18.0)

Hellman 1962 [30], USA

RCT

NR

Discharge within 48 h or between 49 and 72 h + midwife home visits within 48 h of discharge, within first week and sometime at 3 weeks

(1941)

Discharge after 5 days + midwife home visits within first week and sometime at 3 weeks (316)

Mean

23.6 vs 23.8

Respectively int. and control

Maternal outcomes

▪ Re-admission at 3 weeks

Intervention 1.8% Control 0.6%, ns

▪ Complication rate

Significant difference in febrility, lochia, involution of the uterus and breast engorgement in favour of control group

▪ Need for advice rate

Significant difference between groups

For mother

Intervention 72.6% vs control 63.0%

For newborn

Intervention 72.5% vs control 62.8%

Neonatal outcomes

▪ Re-admission rate at 3 weeks

Intervention 1.1% vs control 0.6%, ns

▪ Mortality

Intervention 0.46% (aspiration of milk, massive bronchopneumonia, unknown reason) vs control 0.24% (heart-disease), ns

▪ Weight gain

Results reported in graph (no significant difference)

▪ Complication rate (Morbidity)

Intervention 35.1% Control 32.1%, ns

Breastfeeding

▪ Rate at 3 weeks

Intervention 15% control 6%

▪ Breast engorgement

Results reported in graph

Sainz-Bueno 2005 [31], Spain

RCT

Healthy term neonates (34/42 weeks), weigh >2500 g, vaginal delivery with normal evolution

Discharge in the first 24 h with qualified nurse visits over the next 24 to 48 h, monitored at 7 to 10 days in practice, telephone consultation at 1, 3 and 6 months.No prenatal preparation

(213)

Discharge after minimum 48 h, monitored at 7 to 10 days in practice, telephone consultation at 1, 3 and 6 months

(217)

≤ 30 y. 53.9%

Maternal outcomes

▪ Readmission within 6 weeks

RR (95% CI) = 0.81 (0.21–3.03)

▪ Maternal consultation

RR (95% CI) = 0.78 (0.30–2.10)

▪ Morbidity

RR (95% CI) = 0.73 (0.30–2.20)

▪ Depression

At 1 week

RR (95% CI) = 0.64 (0.25–1.63)

At 1 month

RR (95% CI) = 0.30 (0.33–3.20)

▪ Fatigue

At 1 week

RR (95% CI) = 0.85 (0.43–1.64)

At 1 month

RR (95% CI) = 0.50 (0.04–5.54)

Neonatal outcomes

readmission within 28 days

RR (95% CI) = 0.61 (0.15–2.56)

Breastfeeding

At 1 week

RR (95% CI) = 0.48 (0.14–1.65)

At 1 month

RR (95% CI) = 0.58 (0.25–1.36)

At 3 months

RR (95% CI) = 0.62 (0.42–0.91), p = 0.16

At 6 months

RR (95% CI) = 0.68 (0.46–1.0006)

At > 9 months

RR (95% CI) = 0.81 (0.49–1.32)

Evaluation of costs

Saving of 18.1% by an early discharge program with 1 home visit and telephone follow-up

Smith-Hanrahan 1995 [34], Canada

RCT

English or French speaking, social support at least 12 h/days during 2 frist days, no major obstetrical complications, no prolonged mother-infant separation in hospital, healthy newborn infant with a wiegth between 2500 and 4500 g. feeding established.

Length of stay <60 h, nursing follow-up by phone call starting within 24 h after discharge with home visit in case of need, phone number available 24 h/24 and 7d/7, paediatric and obtretric office visits (35)

Length of stay ≥60 h, paediatric and obtretric office visits (46)

Mean (SD)

29.5 (4.5) vs 29.3 (4.6)

Respectively int. and control

Maternal outcomes

▪ Re-admission at 6 weeks

Intervention 0/35 Control 0/46, ns

Neonatal outcomes

▪ Re-admission at 6 weeks

Intervention 0/35 Control 0/46, ns

Breastfeeding

▪ Proportion of breastfed neonates at 6 weeks

Intervention 17/35 Control 29/46, ns

Waldenström 1987 [35], Sweden

RCT

No significant complication during pregnancy and birth, no significant morbidity in first 24 h for both mother and newborn, gestational age > 37 weeks, birthweight ≥3000 g, Apgar score at 5 min ≥ 7

Discharge between 24 and 48 h, prenatal nurse home visit 4 weeks before term, daily nurse home visit for 3 to 4 days post discharge, paediatric office visit on day 5

Discharge >48 h, standard hospital care without home visit after discharge

Early discharge 28 years vs late discharge 27 years

Maternal outcomes

▪ Re-admission at 6 weeks

Intervention 0/50 Control 1/54, ns

▪ Depressed mood in first 6 weeks

Intervention 3/50 Control 4/54, ns

Neonatal outcomes

▪ Re-admission at 8 weeks

Intervention 1/50 Control 0/54, ns

Breastfeeding

▪ Proportion of breastfed neonates at 2 months

Intervention 37/49 Control 45/52, ns

▪ Proportion of breastfed neonates at 6 months

Intervention 28/49 Control 20/52, ns

Yanover 1976 [32], USA

RCT

Parity 0 or 1, 19y < mother age < 35 y low medical risk, ≥ 12th-grade education, father’s attending prenatal preparation, communicate well in English, parents residing together within 32 km of hospital.

Antenatal preparation for child birth, early discharge, father participation. Infant in nursery for 6 h, Release from hospital as soon as the mother and infant (if fulfilled discharge criteria at 12 h). Daily home visits until day 4 postpartum (44)

Antenatal preparation for child birth. Infant in nursery for 24 h, discharge ≥48 h, paediatric visit at 2 weeks, obstetric visit at 6 weeks (44)

NR

Maternal outcomes

▪ Morbidity

No difference in frequency and types of morbidity within the first 6 weeks (obstetrical laceration, post-partum infection, postpartum haemorrhage)

▪ Re-admission at 6 weeks

Intervention 0% Control 0%, ns

Neonatal outcomes

▪ Morbidity

No difference in frequency and types of morbidity (need for hospital care: in each group 2 newborns for jaundice, 2 newborn in control group for pneumonia)

Evaluation of costs

Saving about 30% of daily costs for early discharge

Length of stay: median in hours (range)

Early discharge: 26 (12–86)

Conventional stay: 68 (31–167)