[Physician Comment] Next-day discharge after planned Cesarean delivery results in equivalent patient satisfaction, no increase in complications

Image: CC/Salim Fadhley

Study author Prof. Dr. Tan Peng Chiong, talks to 2 Minute Medicine Professor in Obstetrics and Gynecology at the University of Malaya in Malaysia:

“Many women prefer an early hospital discharge after childbirth, even after a Cesarean delivery. Our study shows that next day discharge following a planned Cesarean delivery is feasible for a large majority, acceptable and safe. Although additional domiciliary care is not required, home support and adequate analgesia are important.”

Key study points:

 1. Next-day (post-Cesarean day 1) discharge resulted in similar rates of patient satisfaction, exclusive breastfeeding and no increase in complications as compared to women discharged on post-Cesarean day 2.

2. Next-day discharge is feasible for most women undergoing planned Cesarean section.

Primer: Cesarean section is the delivery of a baby through incisions in the mother’s abdomen and uterus. There are a number of situations in which planned Cesarean delivery may be preferred to trial of labor, including multiple gestations, breech presentation, cephalopelvic disproportion, maternal infections such as HIV, placenta previa, among others. Cesarean delivery may occur in a number of other settings, including Cesarean delivery after failure to progress or failure to descend or emergent Cesarean delivery after signs of fetal distress (e.g. sustained late decelerations on fetal heart monitoring) (1).

Compared to more urgent Cesarean deliveries, outcomes after planned Cesarean deliveries are better, owing at least in part to a healthier maternal population. However, an inpatient hospitalization is still required to monitor for signs of bleeding or infection, await return of bowel and bladder function and manage pain control (2). The average length of stay after Cesarean section in the United States is between 2 and 4 days, but the ideal length of stay in this low-risk group of women after planned Cesarean delivery is not known. Longer inpatient hospitalization comes with a number of cons, such as higher cost and risk of nocosomial infections but also comes with certain benefits such as higher rates of early breastfeeding (4).

The present work evaluated rates of patient satisfaction and early initiation of breastfeeding in women with next-day discharge (post-operative day 1) as compared to women with day 2 discharge after planned Cesarean delivery.

Background reading:

1. ACOG FAQ’s: Cesarean birth

2. Up-to-date: “Post-operative issues after Cesarean delivery”

3. ACOG Task Force Report: Cesarean delivery

4. Pre-labor Cesarean delivery associated with decreased likelihood of early breastfeeding

This [randomized controlled] trial  compared rates of patient satisfaction and exclusive breastfeeding in women randomized to discharge after post-Cesarean day 1 (next-day discharge) to those in women randomized to discharge after post-Cesarean day 2. Healthy women with full-term (37 or greater completed weeks of gestation) singleton pregnancies were enrolled; women with placental anomalies and greater than two previous Cesarean deliveries were excluded. Patient satisfaction with timing of discharge was assessed at the time of 2-week post-operative appointment and exclusive breastfeeding was reported at 6 weeks after discharge.

Patient satisfaction with timing of discharge was similar (day 1 discharge= 87%, day 2=85.5%; p=0.75), as was exclusive breastfeeding (day 1=45%, day 2=45%; p=0.99). Both intention-to-treat and per-protocol analyses showed no differences in a variety of secondary outcomes, including rehospitalizations, unscheduled outpatient consultations and maternal anxiety and depression.

In sum: Next-day (post-Cesarean day 1) discharge resulted in similar rates of patient satisfaction, exclusive breastfeeding and a range of complications when compared to post-Cesarean day 2 discharge.

Click to read this article in Obstetrics & Gynecology

By [LH]

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