Maternity: early exit, a follow-up map
In some maternity hospitals, if all goes well, you can go home earlier than planned, and then be followed at home by a midwife. Illustration at Tours Hospital.
Childbirth: the quick return home: what is it?
At the maternity hospital of Tours, mothers can return home only 48 hours after delivery. For 5 to 8 days, midwives travel at home. The goal? A tailor-made accompaniment for the mother and her newborn.
In her pink romper, Eglantine looks a little crumpled. It must be said that she has only two days. Chantal, her mother finishes the toilet of her baby under the watchful eye of Diane, a young midwife. "To clean the eyes, use a compress each time soaked in saline. And above all, do not forget to pass it from the inner corner of the eye to the outside ... "Eglantine lets herself be done. As for Chantal, she really manages like a chef. "I have a 5-year-old girl, so all these things are a bit like cycling: it's coming back quickly! She laughs. After an hour together, the verdict falls: no problem. Confident and autonomous, this mother has passed handily "the test" bath and toilet. But to get their "certificate of exit", Chantal and Eglantine are not finished yet.This young mother is a candidate for a quick return home: only 48 hours after giving birth - against 5 days on average in France.
Quick home return after childbirth: demanding families
Families are more and more demanding, and it must also be said, budget constraints and lack of space are also for something. With nearly 4,000 births, the activity of the maternity hospital Olympe Gouges has increased by more than 20% compared to 2004. This trend to bring out moms earlier wins the whole territory: in 2002, the outings 15% of deliveries in Ile-de-France and 7% in the provinces.
Delivery: a return home under conditions
Since then, the phenomenon has continued to grow. "We first want to respond to the demand of future parents," says Dr. Jerome Potin, obstetrician gynecologist, in charge of this project. Chantal confirms: her delivery under epidural went well "barely two hours", and the little Eglantine showed at birth a very good score: 3,660 kg. "How good are we staying here longer? And then, I really want to find as quickly as possible Judith, my big daughter, and also my husband, "she slips.
In Tours, this early departure from maternity is therefore freely chosen by the mothers, but to be beneficial, it must be carefully prepared and supervised. This solution is usually evoked with the expectant mother during her pregnancy, to give her time to think about it. "But in the end, not everyone will benefit. We have very strict selection criteria, "warns Dr. Potin: reside less than 20 km from the hospital, have a fixed home with the phone, enjoy family support or friendly home ...
Then, medically, we must be able to attest to pregnancy and childbirth without worry. This does not prevent a mother caesarized, if everything went well, to go out too early, that is to say, three or four days after birth, against a good week in general. As for the newborn - the twins being excluded - he must also be in good shape and not have lost more than 7% of his birth weight when leaving the maternity ward. Finally, the nature of the mother-child bond, the mother's psychological profile and her autonomy to provide care for her newborn are taken into account.
The pediatrician has already passed Eglantine with a magnifying glass. No problem. His vital functions, his genitalia, his tone, everything is perfect. Ophthalmologic examination and screening for deafness were performed. It has of course been weighed and measured, and its growth seems already well under way. But to get the best of all, Eglantine has to pass a specific test: a test of bilirubin to detect a possible risk of severe jaundice. But everything is fine. Before leaving, the doctor gives Chantal a prescription that contains vitamin D, which is necessary for the healthy development of the child, and vitamin K, because this mother intends to breastfeed her baby. Before leaving the room, the pediatrician still gives some safety tips, such as putting his child on his back, or not smoking in his presence ... Eglantine will then be reviewed on his 8th day by a pediatrician in town.
Early discharge from motherhood: the mother's examination
It's now the mom's turn to be screened. The midwife will examine her to make sure she can return home in the best conditions. Here she controls tension, pulse, temperature, before carefully watching her legs ... In addition to the haemorrhagic danger, the main risks of the diaper are indeed infection and phlebitis.
She will also check the good healing of the episiotomy, do a uterine palpation, then monitor the setting to check the effectiveness of the sucking ... A real check-up, and the opportunity also for the mother to evoke all the questions that bother her. And why not, if she still feels tired, say it. You can totally change your mind at the last moment and decide to stay one or two more days at the maternity ward. This is not the case of Chantal who greets with a broad smile Yannick, her husband, come to recover them. He took a paternity leave and promises to help at home, to go shopping, to take care of the children ... For this dad, as for Judith the big sister of 5, this early exit, it is the opportunity to discover the baby faster and settle gently in this new life to four.
Early discharge after childbirth: a very personalized follow-up
Since the introduction of this new service at Tours University Hospital, more than 140 mothers have already benefited from it. In the long term, it is planned to welcome around 60 mothers every month. At Rochecorbon, near Tours, Nathalie is one of the lucky women elected. Installed comfortably in her sofa, she waits for the visit of Françoise. This midwife of the hospital has been made available to a private structure, ARAIR (AIde Regional Association for the care and return of patients at home), and ensures a perfect continuity in the care .
In the living room, Eva, barely a week, sleeps quietly in her baby carriage. "In the maternity ward, we have to adapt to the rhythm of the staff. We are often disturbed. At home, it's easier. We adapt to the rhythm of the baby, "rejoices Nathalie, the mother. The midwife who has just arrived asks for news of the family. "It's true, we share a form of intimacy. We know the house, which allows us to find tailor-made solutions, "explains Françoise. A few days ago, Nathalie found Eva's hands a little cold. It's easy to go to the baby's room to check the temperature. There are also cats, Filou and Cahuette. "They are not dangerous, but they are curious, so better not to leave the baby alone with them," advises the midwife. To simply avoid nestling in the basket when he is not there, Françoise advises to put aluminum paper because they hate it.
After doing the medical assessment of the mother, Eva wakes up. She too will be entitled to a detailed examination, but for now, she seems rather hungry. Again, Françoise reassures the mother: "She has fun with the tip of the breast as with a Chuppa Chups, but she drinks very well! The proof, she takes 60 g on average per day. But Nathalie grimaces: "I have microcrevasses. It's a little tight. Françoise explains to her that the last drop of milk should be spread on her nipple or apply breast milk compresses: "It helps to heal better. Nathalie is a rather serene mother, but "thanks to this very personalized follow-up, we feel cocooned". A bespoke care that would have more beneficial effects on the breastfeeding rate of mothers.
Early maternity leave: 24-hour support
Beyond the regular visits of the midwife for 5 to 8 days, or even 12 days if necessary, a 24 hour hotline has been set up. This hotline, provided by a midwife, advises mothers at any time, or even if more serious problem to move to their home or to refer them to the hospital.
"But to date, we have had no rehospitalization, either on the side of babies or moms," says Dr. Potin. "And the calls are rather rare and mainly concern the crying of the baby and the anxiety of the evening," explains Françoise. Here again, it is usually enough to reassure the mother: "The first days at home, the newborn must get used to his new world, noise, odors, brightness ... It's normal that he is crying. To soothe him, we can cuddle him, give him his finger to suck, but we can also bathe him, gently massage his belly ... ", details the midwife. Nestled on her mom's chest, Eva did not wait to fall asleep. Satiated.
