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While antepartum prophylaxis of Rh immunization is much more costly and the postpartum program is much more cost-effective, the question is whether the antepartum program is sufficiently cost-effective to warrant its use. How, in any given region, should the issue be tackled? This article addresses that question.
Of 1647 women in confinement (mean age 26years) and 185 students nurses (mean age 18 years), the majority wanted two children. 8% of the women in confinement and 2% of the student nurses had received no previous family planning information, whereas 38% of the women in confinement and 81% of the student nurses had practiced contraceptive methods with a Pearl-index of 3 or less (oral contraceptives, basal-temperature-method). 31% of the women in confinement had already had unplanned pregnancies (mean: 1.4 pregnancy per woman). The last pregnancy was not planned in 27% and in these 4 out of 5 pregnancies were caused by incorrect application of the contraceptive method. Faulty practices and unsatisfactory results, in spite of the availability of secure contraceptive methods, emphasize the necessity of intensifying family planning. Because programmes including personal counsel have yielded better results, these should be favoured and include a clinical post partum programme. The latter was considered necessary by 95% of the women attending such a programme in our hospital.
OBJECTIVES: This study assessed the effect of the national Healthy Start Program on its clients. METHODS: We used a cross-sectional survey of a sample from Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) rosters of women less than 6 months postpartum who were residents of Healthy Start Program areas. RESULTS: Healthy Start clients revealed higher sociodemographic risk, but not behavioral risk, for adverse pregnancy outcome than other area residents. They did not differ from other residents in receipt of services except for a greater likelihood of receiving case management, using birth control at the time of the interview, and rating their prenatal care more highly. CONCLUSIONS: The Healthy Start Program succeeded in enrolling women at high risk. It had little effect on the immediately concluded pregnancy, but it might influence future outcomes.
PROBLEM BEING ADDRESSED: Rapid postpartum discharge has reduced opportunities to detect early newborn or parenting problems and to teach neonatal assessment and maternal postpartum care to medical trainees. OBJECTIVE OF PROGRAM: Development of a program to not only ensure adequate care of mothers and newborns after early hospital discharge, but also to teach outpatient assessment skills to family medicine residents. MAIN COMPONENTS OF PROGRAM: In an urban, secondary care, university-affiliated teaching hospital predominantly training family medicine residents, an interdisciplinary committee created and supervised a neonatal and maternal postpartum assessment program. Newborn infants and their mothers are seen by a family physician, a family medicine resident, and a nurse within 48 hours of discharge, after which care is assumed in the community by the child's primary care physician. An assessment protocol developed by the interdisciplinary group promotes standardized mother and child care and a structured learning experience for trainees. CONCLUSION: Rapid follow up of early discharged infants and their mothers can be facilitated by a program of standardized assessment by a roster of pooled, interacting family physicians and nurses. When this assessment occurs in a teaching milieu, a comprehensive learning experience can be combined with defined objectives that emphasize and encourage newborn and maternal assessment for ambulatory patients.
The Postpartum Care Center, an outpatient, in-hospital follow-up clinic began in 1991 in response to shortening maternity stays and the resulting need to provide follow-up care to mothers, infants, and families. This innovative model of postpartum follow-up care is cost effective and allows one nurse to see two to three times as many families in a clinic day as could be seen at home. Support services including the laboratory, pharmacy, social service, and anesthesia service are in close proximity to the clinic.
Throughout the world, early postpartum discharge programs are emerging as one strategy for reducing health care costs and, in some areas, relieving the shortage of hospital beds. This article summarizes the research findings to date regarding programs of early postpartum discharge. Additionally, findings from recently completed work on a program of early discharge for high-risk childbearing families is discussed.
The effects of pre- and/or postnatal infant car safety education were examined. Educational approaches included demonstrations and talks on automobile crash statistics in the prenatal course; and a car safety film on the hospital television, a pamphlet given to each mother, and instructions to nurses to encourage parents' purchase and use of car restraints in the postpartum period. Although differences were not statistically significant, the reported and actual use of infant restraints on the trip home was highest in the pre- plus postnatal education group. Counseling in any period was associated with higher restraint use than on counseling. The pediatrician's role in effecting positive behavioral changes in this and other areas is emphasized.
Because of ever-decreasing lengths of maternity stays and the emphasis on reducing health-care costs, there is a need for innovative, low-cost postpartum follow-up programs. The Postpartum Care Center, begun in 1991, is a model program that provides early postpartum assessment and support to mothers, infants, and their families for one third the cost of a home visit. This article reviews program development, description of services, and program outcomes.
The philosophy of the FBC strengthens the concept of childbirth as a normal physiologic process. Couples are guaranteed a high level of quality nursing and medical care. Simultaneously, provisions are made to enhance the family's assertiveness in obtaining a satisfying experience in the hospital that extends to the home environment. With careful planning and decision making throughout the pregnancy, early discharge becomes a satisfying and safe alternative for families and provides a means to decrease the ever rising cost of health care.
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OBJECTIVE: To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. METHODS. DESIGN: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends. SETTING: A managed care plan. INTERVENTION: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services. PARTICIPANTS: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect. INDEPENDENT MEASURES: Pre-ROLOS or the post-ROLOS year. OUTCOME MEASURES: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. RESULTS: Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per day; after, there were 4.60. Well-child visits increased slightly to.98 visits per dyad, but urgent visits did not. CONCLUSION: This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.
For many women living in developing areas, childbirth is the only time when they receive medical care in a clinical setting. These women may not return until they are ready to deliver their next baby. Without access to family planning counseling and effective contraceptive methods, they are likely to become pregnant again within a year or two. Where contraceptive information and services are available to women receiving maternity care, many choose to begin using contraception in the postpartum period. Some elect to have an IUD inserted immediately after delivery or to undergo sterilization while still in the hospital. Under a postpartum contraceptive program administered by the IMSS in one hospital and the same program established in another hospital of the SSA, more than half of postpartum and postabortion women began using contraception or underwent sterilization before they left the hospital. In contrast, the other hospitals under the analysis showed a wide range of contraception coverage from 7 to 55 percent. A formal postpartum contraception program is necessary to establish in all the hospitals in order to improve coverage. Counseling is an important component for all women who must have adequate information before they choose a contraceptive method.
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