Several early discharge programs with prenatal planning and postpartum followup have been successful for self-selected, primarily middle class patients. However, little is known about the impact of early discharge for low income mothers or for programs that are not voluntary or do not include followup services. Also, the impact of early discharge on the maternal-infant relationship has remained unexamined. A quasi-experimental design will be used to evaluate an existing unplanned early discharge situation for low income mothers and infants. To accommodate a growing high risk patient load, about 50 low risk mothers must be sent home 12-24 hours after delivery each month. Because no followup mechanisms exist and state law requires infant genetic testing no earlier than 48 hours after birth, infants must remain in the hospital an additional day. 100 low risk mothers will be randomly assigned to early discharge as the patient load requires. A control group of 100 mothers identified as low risk but not sent home early and the early discharge group will be matched for parity, racial-ethnic group and maternal age. The early discharge with infant separation group is expected to have more negative health outcomes at one week, including: higher incidence of maternal complications; higher incidence of infant complications, illnesses; more maternal self-reported worries and concerns; lower maternal behavior scores at an observed infant feeding; less maternal caretaking; and less favorable maternal assessment of her infant. Study results will guide development of a postpartum early discharge program specifically for low income mothers and infants. This program should provide better health services at a cost less than conventional discharge and no greater than existing early discharge for mothers plus nursery care for infant. Study outcomes will be relevant for hospitals and H.M.O.'s serving low income mothers and infant throughout the country that face growing high risk obstetric patient loads and/or cost containment pressures.
