title: [Maternal discharge: conditions and organization for mothers and newborns returning home. The French National Authority for Health recommendations update].
abstract: In light of changes in both medical practices and the organization of medical care, the French National Authority for Health (Haute Autorité de santé, HAS) proposed new recommendations on the discharge of mothers and newborns, updating its 2004 recommendations on early discharge of mothers and newborns. This decision in turn made it necessary to define optimal discharge conditions and accompanying measures for mothers and infants returning home. The problem was approached by adopting the usual HAS methodology for drafting good practice recommendations. This involved establishing a working group bringing together representatives of all medical and care fields related to perinatology as well as patient representatives. This working group submitted draft recommendations, based on updated published references, to a committee. The committee then proposed amendments to the recommendations, which the working group was free to accept or reject. The updated recommendations that emerged from this process apply four essential principles : first, preparing for discharge as early as the prenatal period, ideally during the third trimester of pregnancy, in particular by providing expectant mothers with information on how the discharge will be organized and anticipating problems that might arise; second, ensuring care continuity between hospitalization, discharge to home, and follow-up; third, ensuring optimal conditions for discharge after a maternity stay of 72-96 h for normal delivery or 96-120 h in case of caesarean section (this hospital stay duration allows for neonatal screening); and fourth, defining how mothers and children are to be accompanied during the first postnatal month. In conclusion, these recommendations resulted in an increase in the duration of as well as an improvement in routine newborn surveillance, whether in hospital or after discharge, in what is a critical phase of infant development. They encourage ambulatory postnatal monitoring. The new recommendations ensure continuity of care while taking into account mothers' and couples' wish to take responsibility for organizing their own healthcare.
authors.affiliation: EA3450-DevAH, néonatologie,université de Lorraine, maternité régionale universitaire, CHRU de Nancy, 54035 Nancy, France. Electronic address: jm.hascoet@maternite.chu-nancy.fr.
authors.forename: J-M
authors.initials: JM
authors.lastname: Hascoët
authors.affiliation: Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis-La-Plaine, France.
authors.forename: K
authors.initials: K
authors.lastname: Petitprez
mesh_terms: D005260:Female; D005602:France; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D010351:Patient Discharge / Q000592:standards*; D011181:Postnatal Care; D011247:Pregnancy