Maternity: early discharge, tailor-made follow-up

Childbirth: the rapid return home: what is it?

At the maternity ward of the Tours hospital, mothers can go home 48 hours after childbirth. For 5 to 8 days, midwives come to your home. The goal? Tailor-made support for the mother and her newborn.

In her pink romper, Eglantine still looks a little crumpled. It must be said that she is only two days old. Chantal, her mother finishes washing her baby under the watchful eye of Diane, a young midwife. ” To clean his eyes, each time use a compress soaked in physiological serum. And above all, do not forget to pass it from the inner corner of the eye to the outside … »Églantine lets it go. As for Chantal, she really does like a chef. ” I have a 5-year-old daughter, so all these gestures are a bit like cycling: it comes back quickly! She laughs. After an hour spent together, the verdict falls: no problem. Confident and autonomous, this mother has passed with flying colors “the ordeal”Of the bath and the toilet. But to get their “exit certificate”, Chantal and Églantine have not yet finished. This young mother is candidate for a rapid return home: only 48 hours after giving birth – against 5 days on average in France.

Rapid return home after childbirth: requesting families

Families are more and more demanding, and it must also be said that budget constraints and lack of space are also having something to do with it. With nearly 4 births, the activity of the Olympe de Gouges maternity unit has increased by more than 000% compared to 20. This tendency to get mothers out earlier is gaining ground all over the country: in 2004, outings precocious already concerned 2002% of childbirth in Ile-de-France and 15% in the provinces.

Childbirth: a return home under certain conditions

Since then, the phenomenon has continued to spread. ” We first want to respond to the demand of future parents », Specifies Dr Jérôme Potin, obstetrician gynecologist, in charge of this project. Chantal confirms: her delivery under an epidural went well “ barely two hours », And the little Églantine showed a very good score at birth: 3,660 kg. ” As everything is going well, why stay here any longer? And then, I really want to find Judith, my grown-up daughter, and also my husband as soon as possible. », She slips.

In Tours, this early discharge from maternity is therefore freely chosen by mothers, but to be beneficial, it must be carefully prepared and supervised. This solution is generally discussed with the expectant mother during her pregnancy, to give her time to think about it. ” But ultimately, not everyone will be able to benefit from it. We have very strict selection criteria », Warns Dr Potin: live less than 20 km from the hospital, have a fixed address with the telephone, benefit from family or friendly support at home …

Then, medically, you have to be able to attest to a worry-free pregnancy and childbirth. This does not prevent a Caesarized mother, if all went well, from also leaving early, that is to say three or four days after birth, against a good week in general. As for the newborn – twins being excluded – he must also be in good shape and not have lost more than 7% of their birth weight on leaving the maternity ward. Finally, the nature of the mother-child bond, the mother’s psychological profile and her autonomy to provide care for her newborn are taken into account.

The pediatrician has already scrutinized Eglantine. No problem. His vital functions, his genitalia, his tone, everything is perfect. An ophthalmologic examination and deafness screening were performed. It has of course been weighed and measured, and its growth already seems to be well under way. But to get your voucher before everyone else, Eglantine must still pass a specific test : a bilirubin assay to detect a possible risk of severe jaundice. But everything is fine. Before leaving, the doctor gives Chantal a prescription which contains vitamin D, necessary for the proper development of the child, and vitamin K, because this mother intends to breastfeed her baby. Before leaving the room, the pediatrician gives a few more safety tips, such as lying his child on his back, or not smoking in his presence… Eglantine will then be seen again on her 8th day by a pediatrician in town.

Early discharge from maternity: examination of the mother

Now it’s mom’s turn to be sifted through. The midwife will examine her to make sure that she can return home in the best conditions. Here she is check blood pressure, pulse, temperature, before carefully observing his legs … In addition to the hemorrhagic danger, the main risks of childbirth are indeed infection and phlebitis.

She will also check the proper healing of the episiotomy, do a uterine palpation, then monitor the latching to verify the effectiveness of the suction … A real check-up, and also the opportunity for the mother to raise all the questions that bother her. And why not, if she still feels tired, say so. You can completely change your mind at the last moment and decide to stay one or two more days in the maternity ward. This is not the case with Chantal who welcomes with a broad smile Yannick, her husband, who has come to collect them. He took a paternity leave and promises to help at home, to do the shopping, to take care of the children… For this dad, as for Judith the 5-year-old big sister, this early exit is the opportunity to discover the baby more quickly and to settle slowly in this new life together.

Early discharge after childbirth: a very personalized follow-up

Since the implementation of this new service at the CHRU de Tours, more than 140 mothers have already benefited from it. Ultimately, it is planned to welcome around sixty mothers each month. In Rochecorbon, near Tours, Nathalie is one of the lucky ones. Comfortably seated on her sofa, she awaits Françoise’s visit. This hospital midwife was made available to a private structure, the ARAIR (Regional Association of AIde for the maintenance and return of patients at home), and thus ensures perfect continuity in the care .

In the living room, Eva, barely a week, sleeps peacefully in her pram. “ In the maternity ward, we have to adapt to the rhythm of the staff. We are often disturbed. At home, it’s easier. We adapt to the baby’s rhythm », Rejoices Nathalie, the mother. The midwife who has just arrived asks for news of the small family. “ It’s true, we share a form of intimacy. We know the house, which allows us to find tailor-made solutions », Explains Françoise. A few days ago, Nathalie thought that Eva’s hands were a little cold. Nothing could be easier than going to the baby’s room to check the temperature. There are also the cats, Filou and Cahuette. ” They are not dangerous, but they are curious, so better not to leave the baby alone with them », Advises the midwife. To simply prevent them from nestling in the bassinet when it is not there, Françoise advises to put aluminum foil, because they hate it.

After having made the medical assessment of the mother, here is that Eva wakes up. She too will be entitled to a detailed examination, but for now, she seems rather hungry. Here again, Françoise reassures the mother: “ She plays with the nipple like a Chuppa Chups, but she drinks very well! The proof, she takes 60 g on average per day. “But Nathalie grimaces:” I have micro-crevices. It feels a bit tight. “Françoise explains to her that it is necessary to spread the last drop of milk on her nipple or to apply breast milk compresses:” It helps to heal better. »Nathalie is a rather serene mother, but «thanks to this very personalized follow-up, we feel cocooned ». A tailor-made care that would also have beneficial effects on the breastfeeding rate of mothers.

Early discharge from maternity: 24 hour support

In addition to regular visits by the midwife for 5 to 8 days, or even 12 days if necessary, a 24-hour hotline has been set up. This hotline, provided by a midwife, allows advise moms at any time, or even in the event of a more serious problem to come to their home or refer them to the hospital.

« But to date, we have not had any rehospitalization, either for babies or mothers. », Rejoices Dr Potin. “ Et calls are rather rare and mainly concern the crying of the baby and the anxiety of the evening », Explains Françoise. Here again, it is usually enough to reassure the mother: “ The first few days at home, the newborn must get used to his new world, to the noises, to the smells, to the light… It is normal for him to cry. To soothe him, we can cuddle him, give him his finger to suck, but we can also bathe him, gently massage his stomach … », Explains the midwife. Nestled on her mother’s chest, Eva did not wait to fall asleep. Sated.

Report produced in 2013.