The Grapevine

Giving Birth Around The World: In Some Countries, Women Leave The Hospital In Half A Day

mother and child
A mother’s stay in a healthcare facility following childbirth varies considerably, with many women leaving too soon to receive sufficient postnatal care. Getty Images

In some areas of the world, a mother is up and out the hospital door just half a day after giving birth, calling into question the considerable effort world health officials have put into getting women to give birth inside health facilities rather than at home. Some countries, including Malawi and Hungary, have gone so far as to make home birth illegal. To understand whether these efforts impact practice, researchers from the London School of Hygiene & Tropical Medicine analyzed childbirth data from 92 countries. A mother’s stay in a healthcare facility following childbirth varies considerably between countries, they discovered, with a large proportion of women leaving too soon to receive sufficient postnatal care.

Their study found high income countries trending toward shorter hospital stays, though still within recommended health guidelines, while lower income countries showed substantial variation in average lengths from less than half a day to slightly less than a week.

In 2013, the World Health Organization reports 289,000 women died during and following pregnancy and childbirth, while 2.8 million newborns perished within 28 days of birth. The majority of these deaths occurred in low-resource settings. Most could have been prevented, WHO maintains, recommending all women stay in facilities at least 24 hours postpartum.

“Short lengths of stay can leave insufficient time to detect, diagnose, or treat complications,” wrote the authors of the current study led by Dr. Oona Campbell, a professor of epidemiology and reproductive health.

Too short a stay also proves inadequate when it comes to educating new mothers about caring for their newborns. A lack of support may result in low confidence or contribute to breastfeeding problems, depression, or dissatisfaction. Yet too long a stay has its own downsides. Lingering too long on the hospital bed increases the risk of some infections, the researchers note, and negatively impact sleep, family bonding, and sibling rivalry.

If erring in either direction is detrimental to the health of both mother and child, finding the happy medium is crucial and this process requires evidence. So the first step would be to identify current practices around the world; Campbell and her colleagues set to work.

Family Portraits

The team searched a variety of databases for childbirth specific data, including records created by the Organization for Economic Co-operation and Development and UNdata, which includes information compiled by WHO, the United Nations Children’s Fund, the United Nations Population Fund, and the World Bank. The researchers also examined national survey programs, such as Centers for Disease Control and Prevention Reproductive Health Survey and Pan Arab Project for Family Health.

After this exhaustive process of collecting data, they crunched the numbers, performed an extensive analysis, and ended with a precise, though incomplete view of childbirth around the world.

Ukraine and Egypt immediately stood out, positioned as they were at opposite ends of a continuum of experience. For instance, the average length of stay for a woman giving birth to a single child via vaginal delivery ranged from 0.5 days in Egypt to 6.2 days in Ukraine, the team estimated. For C-section deliveries, the average stay ranged from 2.5 days in Egypt to 9.3 days in Ukraine.

Meanwhile, in high-income countries, the team observed decreasing lengths of stay since the 1970s. On average, a woman in the United Kingdom “lays in” after a vaginal single birth for just one and a half days, the shortest period for all higher income countries. In the United States, the average length of stay is just two days.

Overall, in half the 30 low-and-middle-income countries with available data, more than 20 percent of women stayed for too short a period after giving birth.

“Ensuring that [postnatal] care is available, and that women and their newborns stay long enough to receive it, is essential,” concluded the authors. As a result of these new findings, they suggest countries formulate “coherent policy objectives” to clarify, among other details, length of stay following childbirth.

Source: Campbell OMR, Cegolon L, Macleod D, Benova L. Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys. PLOS One. 2016.

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