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Midwives, Physicians, and the Timing of Maternal Postpartum Discharge

Authors

  • Lewis H. Margolis MD, MPH,

    Corresponding author
      Address correspondence to Lewis H. Margolis, School of Public Health, University of North Carolina, Chapel Hill, NC 27599–7400.
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    • Lewis Margolis is an associate professor of maternal and child health in the School of Public Health of the University of North Carolina at Chapel Hill. He has worked with state health departments in the design and evaluation of perinatal programs.

  • Milton Kotelchuck PHD, MPH

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    • Milton Kotelchuck is a professor of maternal and child health in the School of Public Health of the University of North Carolina at Chapel Hill. He has directed several major evaluations of perinatal services including the recently concluded evaluation of the Healthy Futures/Healthy Generations initiative in 17 southern states.


Address correspondence to Lewis H. Margolis, School of Public Health, University of North Carolina, Chapel Hill, NC 27599–7400.

ABSTRACT

Hospitalization for childbirth has traditionally provided the opportunity to assure that infants and mothers have adjusted to the birth and that ongoing care has been arranged, but economic and social pressures have resulted in a dramatic decrease in the duration of hospitalization. Using a sample of mothers who delivered well infants from the 1988 nationally representative National Maternal and Infant Health Survey, this study examines how midwives and physicians used an extra day of hospitalization in response to demographic, economic, behavioral, health status, and health care risk factors. Although midwives were much more likely to discharge mothers early (OR = 2.29) there were marked differences between risk factors and discharge timing for midwives and physicians. For the patients of midwives, the only factor associated with early discharge timing was attendance at childbirth classes. For the patients of physicians, less than a high school education, inadequate prenatal care, receipt of Medicaid or lack of insurance, and no childbirth classes were associated with early discharge. In spite of the intense pressures to discharge patients early, midwives appear to have been more attentive to potential risk factors in making discharge decisions in 1988. Because brief hospitalization is now prevalent, attention to maternal and newborn adjustment after birth, as apparently practiced by midwives, is crucial.

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