Document Type : Original Article

Authors

1 Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh (UT), India

2 Department of Community Medicine, Mahatma Gandhi Medical College and hospital, Jaipur, Rajasthan, India

Abstract

INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours
post‑delivery. Hence, this time period is very crucial for the survival of newborns and mothers both.
As per maternal and child health program guidelines in India, it is clearly mentioned that all the
government health facilities should discharge the mother and baby only after 48 hours of delivery in
case of normal delivery and after 7 days in case of delivery conducted by cesarean sections.
AIM: The aim of the study was to find the various factors responsible for early maternity discharge
(<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities.
MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from
May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study
were included after taking proper informed consent. A questionnaire was developed by the investigators
to interview the women. The questionnaire consists of 26 items which included the socio‑demographic
details and questions on various factors affecting postnatal stay at the health facility.
RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean
age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them,
12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the
district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines.
It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries
were significantly associated with early discharge. Among those who had NVD and stayed beyond
48 h, most of them mentioned that the round‑the‑clock availability of doctors/nurses was the main
reason for their staying at the health facility.
CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There
is a need for essential counseling to be imparted to the mothers by doctors/nurses at all the health
facilities for staying till 48 hours and by health workers during the antenatal period of the importance
of the stay at the facility post delivery .

Keywords

  1. WHO Technical Consultation on Postpartum Care WHO
    Technical Consultation on Postpartum and Postnatal Care NCBI
    Bookshelf. Available from: https://www.ncbi.nlm.nih.gov/
    books/NBK310595/. [Last accessed on 2020 Jan 13].
    2. Li XF1, Fortney JA, Kotelchuck M, Glover LH. The postpartum
    period: The key to maternal mortality. Int J Gynaecol Obstet 1996;
    54:1‑10.
    3. The Lancet Every Newborn Series – Healthy Newborn Network.
    Available from: https://www.healthynewbornnetwork.org/
    resource/the‑lancet‑every‑newborn‑series/. [Last accessed on
    2020 Jan 13].
    4. Sustainable Development Goals: Sustainable Development
    Knowledge Platform. Available from: https://
    sustainabledevelopment.un.org/?menu=1300. [Last accessed
    on 2020 Jan 13].
    5. Is Quality of Care During Childbirth Consistent from Admission
    to Discharge? A Qualitative Study of Delivery Care in
    Uttar Pradesh, India. Available from: https://journals.plos.org/
    plosone/article?id=10.1371/journal.pone. 0204607.[Last accessed
    on 2020 Jan 13].
    6. National Family Health Survey. Available from: http://rchiips.
    org/nfhs/haryana.shtml. [Last accessed on 2020 Jan 13].
  2. 7. Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R,
    Tunçalp O, et al. Measuring maternal health: Focus on maternal
    morbidity. Bull World Health Organ 2013; 91:794‑6.
    8. Maternal Mortality: Who, when, where, and Why – Science
    Direct. Available from: https://www.sciencedirect.com/science/
    article/pii/S014067360669380X. [Last accessed on 2020 Jan 13].
    9. Determinants of Early Discharge of Mothers from Hospitals
    after Delivery in Beed Block of Beed District, Maharashtra, India
    2014 Clinical Epidemiology and Global Health. Available from:
    https://cegh.net/article/S2213‑3984(15)00088‑3/fulltext. [Last
    accessed on 2020 Jan 13].
    10. Merenstein & Gardner’s Handbook of Neonatal Intensive
    Care E‑Book - Sandra Lee Gardner, Brian S. Carter, Mary I
    Enzman‑Hines, Jacinto A. Hernandez - Google Books. Available
    from: https://books.google.co.in/books?id=idpiCAAAQBAJ&p
    g=PA462&lpg=PA462&dq=United+States+reported+that+mothe
    rs+aged+older+than+35+years+were+likely+to+be+discharged+
    early&source=bl&ots=zKWG1nNSCj&sig=ACfU3U1LSr0DtQovx
    ky0J2rmPEChuoMMpQ&hl=en&sa=X&ved=2ahUKEwimkZS744
    DnAhXmwzgGHc7pBO0Q6AEwDHoECAoQAQ#v=onepage&q
    =United%20States%20reported%20that%20mothers%20aged%20
    older%20than%2035%20 years%20were%20likely%20to%20be%20
    discharged%20early&f=false. [Last accessed on 2020 Jan 13].
    11. Vaginal Delivery: How does Early Hospital Discharge Affect
    Mother and Child Outcomes? A Systematic Literature Review.
    Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/
    PMC5588709/. [Last accessed on 2020 Jan 13].
    12. Neiger R. Long‑term effects of pregnancy complications on
    maternal health: A Review. J Clin Med 2017;6. pii: E76.
    13. Janani Suraksha Yojana (JSY) National Health Portal of
    India. Available from: https://www.nhp.gov.in/jananisuraksha‑yojana‑jsy‑_pg. [Last accessed on 2020 Jan 13].
    14. Janani Shishu Suraksha Karyakaram (JSSK) National Health
    Portal of India. Available from: https://www.nhp.gov.in/
    janani‑shishu‑suraksha‑karyakaram‑jssk_pg [Last accessed on
    2020 Jan 13].
    15. Salve HR, Charlette L, Kankaria A, Rai SK, Krishnan A, Kant S.
    Improving access to institutional delivery through Janani Shishu
    Suraksha Karyakram: Evidence from rural Haryana, North India.
    Indian J Community Med. 2017;42:73‑76.
    16. Gupta SK, Pal DK, Tiwari R, Garg R, Shrivastava AK, Sarawagi R,
    et al. Impact of Janani Suraksha Yojana on institutional delivery
    rate and maternal morbidity and mortality: An observational
    study in India. J Health Popul Nutr 2012; 30:464‑71.