Ambulatory deliveries: the trend that is here to stay

A little over a month ago, Sofía Garcés, a Chilean who has been living in the United States for a few years, had her second daughter in New York. Exactly 24 hours after giving birth, she was released to go home. Stories like hers are repeating themselves more and more and are part of an increasingly common phenomenon: these are called ambulatory deliveries.

In 2018, the image of Kate Middleton with Prince William of England presenting her third child and being discharged seven hours after giving birth was widely commented on. With her second daughter, she had returned home after only nine hours.

The UK is perhaps the country best known for what is known as outpatient births or out of hospital births and average postpartum stays range from 6 to 24 hours. But there are also other countries like Sweden, Germany, Austria, Netherlands, Iceland, Canada, Ireland and Mexico where this trend has established itself with average times between 24 and 48 hours. Some time ago, this phenomenon also reached Chile, where, for example, the German clinic in Santiago began to implement it in 2019. This phenomenon will probably only increase in the coming years.

Sofia’s experience, he says, has been good. “I was mentally ready to go home,” she says. Two years earlier, in 2021, she had her first daughter in New York, but that time it was a caesarean section and also, since it was a pandemic, she had been hospitalized for three nights. At that time, and as a result of Covid, the atmosphere in the hospital was tense, with patients and few visitors subject to many restrictions. “As a new mum, I was dreading coming home in case something was wrong, but I remember the relief I felt at arriving somewhere safe and relaxed, where we weren’t “We weren’t constantly interrogated and restrained. For the first time, I felt I could rest,” he says. She adds that, for this reason, during this second birth, she wanted to leave the hospital as soon as possible. soon as possible, and although they offered her to stay longer, she chose not to. “I trusted my medical team and felt ready to go home,” she says.

The German clinic is one of the hospital centers in Chile that has been implementing this trend since 2019, in a progressive and continuous way. According to Dr. Francisca Bocaz, gynecologist at the gynecological-obstetrical emergencies of the clinic, today the average stay after childbirth is 2.5 days and in caesarean section 3.3 days. “We started with stays of 3 and 4 days, respectively,” he explains. The above, at first glance, may not seem like a lot, but the reality is that it represents a decrease of approximately 12 hours of hospitalization, which is high.

The specialist comments that the traditional times of postpartum stay are those dictated by the lex arts of obstetrical practice: 48 hours in the event of a normal delivery and 72 hours in the event of a caesarean section. These deadlines are also those established by the general technical standard for comprehensive care of the puerperium, of the Ministry of Health. “In the private world and in the clinic, however, due to atavistic culture or customs – both of the medical team and of our patients – postpartum dwell times tended to be noticeably longer. As we mentioned before, the patients stayed in the hospital on average 1 day longer,” he points out. And he adds that the new mode of attention seeks to advance towards the objectives of 48 and 72 hours by rationally using resources, while maintains as its central goal to be excellent and innovative maternity and to provide a safe and satisfying experience for parents and their newborns.

The model is known in the German clinic as “Safe Discharge”, and it is applied to mothers and newborns who meet certain criteria to be discharged. Similarly, it extends clinical care to the postnatal period through telematic management of breastfeeding and early neonatological control. Dr. Bocaz comments that, within the framework of the surveillance of the Alta Segura, “We use indicators of safety and quality of care as a percentage of rehospitalization of newborns before 10 days of life, within 40 days postpartum and emergency consultations before 10 days of life . In each of them, we have always remained below international standards”.

This modality where women pass the shortest possible duration of hospitalization in the postpartum period has been given globally mainly due to the pressure that exists in the healthcare world regarding cost containment that have increased over the past few decades, according to Dr. Bocaz.

However, these early discharge models only work when combined with a strong home care system run by nurses or midwives. “In our case, we tend to strike a balance between efficiency in the use of resources and the experience and quality of care our patients receive,” he says.

Overall, the benefits of outpatient birth are numerous. First, it allows the family to meet earlier, which also promotes bonding, the couple’s involvement in the care of the newborn, and also reduces sibling rivalry. Also, it improves rest and sleep for the mother, as she is not exposed to hospital care routines.

But not only. Shorter hospital discharge also influences less exposure of mother and newborn to intra-hospital infections and increases mother’s self-confidence in caring for the baby. It also promotes breastfeeding on demand.

Sofía Garcés points out that this type of measure seems effective when a delivery occurs without major complications, and allows costs to be reduced both for the patient and from a structural point of view, since the beds are freed up earlier, there are less staff used, among other things. .

However, she believes that one of the drawbacks of this model is that a shorter recovery time can generate apprehensions among mothers – especially new ones or those who do not have enough support at home -, who do not feel unprepared to face motherhood alone. .themselves or who fear potential complications for themselves or the newborn. “More time and help from medical teams can definitely help build confidence and prepare to go home,” he says.

Sofia believes that this new modality is a step in the right direction towards a more efficient system in the case of uncomplicated deliveries. “Now, this requires a significant cultural shift because in Chile, postpartum recovery is expected to be longer. I think the big question here is how to move towards more outpatient births and, at the same time, provide preparation and support tools for an earlier return home,” she comments.

From Clínica Alemana they consider that the interest in joining this trend will increase. This, explains Dr. Bocaz, because there is a large group of patients who seek care that respects the natural or physiological processes of childbirth and the postpartum period. “This group is growing by the day and is one of those that strongly embraces the concept of shorter postpartum stays,” he says. He also says that there is a group of foreign patients who are already culturally accustomed to these practices. “We can see how this cultural change is happening in multiple ways, from the institution and its collaborators, but also from the users themselves who are driving the progress,” he says.