Home-based versus hospital-based postnatal care: a randomised trial


Dr M. Boulvain, Department of Obstetrics and Gynaecology, Maternité-HUG, CH-1211 Geneva 14, Switzerland.


Objective  To compare a shortened hospital stay with midwife visits at home to usual hospital care after delivery.

Design  Randomised controlled trial.

Setting  Maternity unit of a Swiss teaching hospital.

Population  Four hundred and fifty-nine women with a single uncomplicated pregnancy at low risk of caesarean section.

Methods  Women were randomised to either home-based (n= 228) or hospital-based postnatal care (n= 231). Home-based postnatal care consisted of early discharge from hospital (24 to 48 hours after delivery) and home visits by a midwife; women in the hospital-based care group were hospitalised for four to five days.

Main outcome measures  Breastfeeding 28 days postpartum, women's views of their care and readmission to hospital.

Results  Women in the home-based care group had shorter hospital stays (65 vs 106 hours, P < 0.001) and more midwife visits (4.8 vs 1.7, P < 0.001) than women in the hospital-based care group. Prevalence of breastfeeding at 28 days was similar between the groups (90%vs 87%, P= 0.30), but women in the home-based care group reported fewer problems with breastfeeding and greater satisfaction with the help received. There were no differences in satisfaction with care, women's hospital readmissions, postnatal depression scores and health status scores. A higher percentage of neonates in the home-based care group were readmitted to hospital during the first six months (12%vs 4.8%, P= 0.004).

Conclusions  In low risk pregnancies, early discharge from hospital and midwife visits at home after delivery is an acceptable alternative to a longer duration of care in hospital. Mothers' preferences and economic considerations should be taken into account when choosing a policy of postnatal care.