With four million births a year, the delivery of a child is the single most common reason for hospitalization in the U.S., yet the amount of time new mothers and their infants spend in the hospital after birth has declined continuously. Since mothers and infants may be discharged from the hospital before necessary services have been provided and before an adequate plan for follow-up care has been developed, short hospital stays have raised concerns about the adequacy of postpartum and post-birth care. In contrast to the extensive scientific and public debate about ideal length of stay, not much attention has been given to follow-up services after new mothers and babies leave the hospital. At this point, little is known about the types of post discharge services offered, to whom they are offered, who actually uses them, and what their impact is in alleviating potentially adverse effects of short hospital stays. Without understanding the utilization and impact of post discharge services, it is not possible to assess their value in compensating for short hospital stays. The two primary goals of the proposed study are to address these gaps in our current knowledge by (1) investigating new mothers utilization of post discharge services, including factors influencing their decisions about use, and (2) determining the impact of specific post discharge services on medical care utilization patterns, health status and breast-feeding. To achieve these objectives we will collect longitudinal data from a representative sample of first-time mothers in the Seattle Metropolitan area immediately following delivery, and two weeks post-delivery through in-person and telephone interviews. The interview data will be supplemented with information obtained from daily checklists the mothers will be asked to keep for the first two weeks post birth, and with data obtained from hospitals and public health departments. The analyses are guided by the Health Belief Model. The results from the proposed research will make a significant contribution to the ongoing debate about short hospital stays associated with the birth of a child. The results will be critical to health care providers and policy makers in their efforts to improve new mothers' access to post discharge services and in designing appropriate services that efficiently use available health care resources.
