A Cochrane review included 10 studies with a total of 4 489 subjects. The studies compared early discharge from hospital of healthy mothers and term infants, of greater than or equal to 2500 grams, with standard care. The definition of early discharge differed across the studies; it was from 6 to 48 hours in 5 studies, less than 60 hours in 1 study, and from 12 to less than 72 hours in 4 studies. No statistically significant differences in infant (RR 1.29, 95% CI 0.60 to 2.79; 7 studies, n=3435) or maternal readmissions (RR 1.10, 95% CI 0.51 to 2.40; 8 studies, n=3509) were found. Five trials showed either no significant difference or results favouring early discharge for the outcome of maternal depression, although only 3 used a well-validated standardized instrument. Breastfeeding rates did not differ significantly between the early discharge group and the control group receiving standard care; proportion of women not breastfeeding in first eight weeks (RR 0.90, 95% CI 0.76 to 1.06; 8 studies, n=3845).
A systematic review including 5 RCTs (n=620), ten cohort studies (n=69 978), one case-control study (n=117) and 12 case series reports (n=11 298) was abstracted in DARE. There was moderate evidence of the safety of early (< 48h) discharge for a well-selected population of patients who receive adequate prenatal education and experience normal spontaneous vaginal delivery without complications.
A technology assessment report and a systematic review on early postpartum discharge were abstracted in the Health Technology Assessment Database. The authors could not find evidence on whether or not early discharge may pose a risk to maternal or neonatal health.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, high post randomization exclusions, and frequent non-compliance with allocated treatment) and by inconsistency (heterogeneity in interventions and outcomes).