Review question
For women who give birth in health facilities in resource-limited settings and their
newborns (P), does discharge from hospital within 24 or 48 hours of birth (I) compared
to discharge at a later time (C), increase the risk of maternal or neonatal readmissions for
morbidity and stopping breastfeeding at six weeks or six months after birth (O)?
Summary of evidence
In total, 924 studies with the potential to be included were reviewed. Studies that had a
robust design (RCTs, but also quasi-randomized and cohort studies) and included healthy
women who had uncomplicated vaginal deliveries in health facilities and gave birth to
healthy neonates who were not of very low birth weight were eligible if they compared
outcomes by time of mothers’ discharge from health facilities (within 24 or 48 hours of
birth versus later). Thirteen studies – seven RCTs (1–7), three prospective cohort (8–10)
and three historical cohort studies (11–13) – met these criteria and were included in the
final analysis. These studies were all conducted in developed country settings except for
one study from Mexico.
For all but one of the seven RCTs, early discharge was accompanied by follow-up contacts
through home visits by nurses or midwives, alone or in combination with phone contacts.
These contacts were made within the first two weeks after birth for providing domiciliary
midwifery care. In the cohort studies, the timing of discharge after birth was determined
by third parties external to the health facility, such as the mother’s insurance package.