Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Criteria for Discharge Less than 48 hours after birth
Maternal Newborn
PURPOSE: To ensure postpartum mothers are safely discharged following the birth of their baby, they should meet basic criteria and have appropriate arrangements for ongoing care. Prior to discharge, the following criteria should be met: PURPOSE: To ensure newborn infants are safely discharged, they should meet basic criteria and have appropriate arrangements for ongoing care. The baby should be healthy in the clinical judgment of the physician, and the mother should have demonstrated a reasonable ability to care for the child.
  • Vaginal delivery
  • Care for the perineum will be ensured
  • No intrapartum or postpartum complications that require ongoing medical treatment or observation*
  • Mother is mobile with adequate pain control
  • Bladder and bowel functions are adequate
  • Receipt of Rh immune globulin and/or rubella vaccine, if eligible
  • Demonstrated ability to feed the baby properly; if breastfeeding, the baby has achieved adequate “latch”
  • Advice regarding contraception is provided
  • Physician who will provide ongoing care is identified and, where necessary, notified
  • Family is accessible for follow up and the mother understands necessity for, and is aware of the timing for, any health checks for baby or herself
  • If home environment (safety, shelter, support, communication) is not adequate, measures have been taken to provide help (e.g., homemaking help, social services)
  • Mother is aware of, understands, and will be able to access community and hospital support resources

* Mothers should NOT be discharged until stable,
if they have had:

  • significant postpartum hemorrhage or ongoing bleeding greater than normal;
  • temperature of 38°C (taken on two occasions at least 1 hour apart) at any time during labour and after birth;
  • other complications requiring ongoing care.
  • Full-term infant (37-42 weeks) with size appropriate for gestational age
  • Normal cardiorespiratory adaptation to extrauterine life†
  • No evidence of sepsis†
  • Temperature stable in cot (axillary temperature of 36.1°C to 37°C)
  • No apparent feeding problems (at least two successful feedings documented)
  • Physical examination of the baby by physician or other qualified health professional within 12 hours prior to discharge indicates no need for additional observation and/or therapy in hospital
  • Baby has urinated
  • No bleeding at least 2 hours after the circumcision, if this procedure has been performed
  • Receipt of necessary medications and immunization (e.g., hepatitis B)
  • Metabolic screen completed (at >24 hours of age) or satisfactory arrangements made
  • Mother is able to provide routine infant care (e.g., of the cord) and recognizes signs of illness and other infant problems
  • Arrangements are made for the mother and baby to be evaluated within 48 hours of discharge
  • Physician responsible for continuing care is identified with arrangements made for follow-up within 1 week of discharge

†Infants requiring intubation or assisted ventilation, or infants at increased risk for sepsis should be observed in hospital for at least 24 hours.

 

Canadian Paediatric Society (1996). Facilitating discharge home following a normal term birth. [Online].
Available:
http://www.cps.ca/english/statements/FN/fn96-02.htm