“I am feeling slightly unprepared to go home today,” I expressed, requesting an extension of my postpartum stay at the hospital. My pregnancy journey has never gone smoothly, and this latest episode was no exception. Severe pelvic instability had confined me to my home for months. One day, as I attempted to balance my growing abdomen and a plate of food, I lost control and crashed the plate in the kitchen.
“We need to deliver this baby,” my doctor advised. The baby was healthy, but the aftermath of the birth was not. Simply holding my newborn made my walking unsteady, and I found myself needing to lean against walls, tables, or even the people I accidentally bumped into.
Initially, I laughed it off, ridiculing myself for not being able to hold my own baby. But as the problem persisted, my worries grew. If I lacked the basic ability to carry my newborn, how would I manage the stairs or care for my other children? What if I accidentally dropped the baby?
I explained my situation to the charge nurse, who informed me that she couldn’t grant an extension based on my doctor’s recommendation. It was disappointing to hear, but what stung more was the implication that I was trying to exploit the system. As a doctor myself, I had witnessed patients stretching their stays in various ways, from dropping subtle hints to making outright demands. Some even threatened legal action or appealed to their tax contributions. Relatives would promise daily to come and take someone home but never follow through, while others changed their minds at the last moment. Of course, there were cases of inappropriate and unsafe discharges, but every healthcare provider encountered patients with unrealistic expectations of the system.
Feeling too upset to argue, I went home. Thankfully, I had the support of my village — my parents driving and cooking, aunties rocking the baby, and friends pushing the stroller. It took weeks before I could walk properly again, and it was years later that I fully grasped the toll pregnancy had taken on my body. Looking back, a little understanding and professional advice would have made a world of difference.
When I read that nearly half of Australian women were being discharged from the hospital just six hours after giving birth, I couldn’t help but feel embarrassed. I had stayed for four whole days after a “normal” birth, which seemed like a luxury in today’s environment of limited resources.
However, I couldn’t help but wonder what it must feel like to be discharged after just six hours. Even for those eager to go home after a shower, what is a reasonable standard for everyone else?
In 1971, half of first-time mothers in Australia were under 24. Fast forward fifty years, and now half are 30 years old or older, with 17% being over 35. As life expectancy increases towards 90, these pregnant women in their 30s may be considered young, but they face a higher risk of pregnancy complications compared to those in their 20s. Pain, infection, and bleeding may not be immediately apparent.
So much has changed for modern women, yet the debate and guilt surrounding breastfeeding remains the same. The World Health Organization recommends exclusive breastfeeding for the first six months of a baby’s life, but less than 15% of Australian women meet this recommendation. Even migrant women, who come from cultures with strong breastfeeding traditions, struggle to reach this goal in a new country.
Negative experiences with breastfeeding within the first week after giving birth are associated with unmet breastfeeding goals. The most vulnerable groups are young women, first-time mothers, and those lacking social support. Early discharge leaves no time for counseling on breastfeeding or providing sound advice about alternatives. Without proper information, myths, misconceptions, and unnecessary stress thrive.
One valuable lesson a midwife taught me was how to swaddle a baby. It took practice and felt clumsy at first, but once mastered, it greatly improved my baby’s sleep and, consequently, mine.
Considering the rise in mental illness and the bidirectional link between sleep disturbance and mood disorders, new parents need evidence-based tips for managing sleep. Rushing to discharge precludes these valuable discussions and hopes for the best.
Experts warn that early cost-containment efforts in the healthcare system may lead to missed opportunities for education and support, which could eventually prove more costly for society. However, frontline workers argue that modern-day hospitals, run like businesses, have already lost their ability to provide the kind of personalized care these women deserve. So, it seems that sending them home, ideally to a peaceful and convenient environment, is the best option.
Therefore, the question remains: when is it too early to discharge a woman after giving birth? Unfortunately, things that may seem self-evident are not always clear-cut.
A 2021 Cochrane review of 17 trials involving over 9,000 women found that the evidence for or against early discharge is uncertain. While there may be a slightly higher risk of babies being readmitted to the hospital with early discharge, it does not correlate with increased mortality. Additionally, there is no clear difference in rates of maternal readmission, satisfaction, depression, breastfeeding, provider visits, or cost of care.
However, interpreting this data is challenging due to variations in the definition of early discharge, the level of antenatal preparation, access to nurse visits and primary care. The authors recommend the use of standardized approaches to assess outcomes.
Looking back, keeping me in the hospital for an additional day or two probably wouldn’t have changed much. However, it would have been beneficial to have my concerns heard, receive a review from a physiotherapist, and a referral to community resources before discharge. For another woman struggling with different issues, an extra day or two might just be a lifeline. This highlights the importance of addressing individual needs through staff who have the time to provide holistic care.
With 140 million births occurring worldwide each year, low-income countries experience about 40% of women facing postpartum complications, with pregnancy itself being a life-threatening condition for many. Australia, on the other hand, is one of the safest countries for the approximately 315,000 babies born each year and their mothers. As we develop standardized guidelines to improve postpartum care, it is essential to consider making them applicable to women beyond our borders.
Ranjana Srivastava is an Australian oncologist, award-winning author, and Fulbright scholar. Her latest book, titled “A Better Death,” discusses these challenging issues.
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