Remarks

• Despite insufficient evidence, the Guideline Development Group (GDG) acknowledged that it was important to establish a minimum time before discharge in light of the wide variation in length of stay after birth (11), including lengths of stay that were considered too short for the delivery of health facility interventions recommended in this guideline.
• The GDG acknowledged that timing of discharge from the health facility should be guided by the following.
• The time needed to complete the assessment of a comprehensive set of criteria to evaluate maternal and newborn well-being and needs, and the findings of these assessments, as per Recommendation 46 in this guideline.
• The health system’s capacity to organize postnatal care contacts after discharge through communitybased services (e.g. home visits) or in outpatient services (e.g. in the health facility or provider’s office). Most healthy women and newborns would be ready for discharge 24 hours after birth, provided functioning and accessible follow-up services are available.
• Unnecessarily prolonged stays in health facilities after birth should be avoided considering the increased risk of healthcare-associated infections, costs to the health system and to service users, and women’s and families’ preferences.
• Given the paucity of evidence, the GDG was not able to recommend a minimum time of care in the health facility after caesarean birth, but noted that discharge within 24 hours after caesarean birth increased the risk of adverse maternal and neonatal outcomes and reduced breastfeeding at six weeks. The content of postnatal discharge criteria and discharge preparation would also need to consider post-operative outcomes and the needs of women and newborns after a caesarean birth.
• As part of birth preparedness and complication readiness during pregnancy, women/parents/caregivers should be informed that stay in the heath facility after birth is recommended for a minimum of 24 hours. However, length of stay in the health facility will depend on individual health outcomes and needs, particularly after a caesarean birth, and the availability of postnatal care services for follow-up after discharge.