Article révisé par les pairs
Résumé : Objective The immediate postpartum period is critical for women and newborns’ health. The COVID-19 pandemic disrupted healthcare to women and newborns. This study assesses change in postpartum length-of-stay during COVID-19 compared to secular trends before the pandemic in 33 countries, and provides a contextual understanding of adaptations made to maternal postpartum length-of-stay during COVID-19 in six comparative country cases. Methods We used an explanatory sequential mixed-methods design: 1) secondary analysis of quantitative longitudinal data from 33 countries, comparing percentage annual change in maternal postpartum length-of-stay before (2010–2019) to percentage change during COVID-19; 2) qualitative consultations with experts from six countries (Belgium, Costa Rica, Malawi, the Netherlands, Nigeria, and Slovakia) providing contextual insights. Results In 27/33 countries, the time women spent in healthcare facilities declined during COVID-19, ranging from −1.7% (-3 hours) in Finland to −17% (-15 hours) in India. In Canada and South Korea, length-of-stay was unchanged, whereas it increased in Nigeria, Mauritania and the Netherlands. These changes resulted from: 1) decisions enabling earlier discharge made by health authorities, healthcare facility managers or healthcare providers, and 2) increase in complexity of case-mix in healthcare facilities, including due to COVID-19 infection among pregnant/postpartum women. Shorter stays were compensated by intensifying pre-discharge education, task-shifting postnatal care to community health-workers, and upscaling midwifery home-visits and telemedicine. Conclusions With or without the pandemic, an overall historical trend of decreasing postpartum length-of-stay exists. In the context of a pandemic, this could have potential implications on quality of care, particularly considering the lack of context-specific evidence informing adaptations.

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