What SHOULD Happen With Rooming-In
Step 7 of the Ten Steps to Successful Breastfeeding calls for facilities to “enable mothers and their infants to remain together and to practice rooming-in 24 hours a day.” Regardless of whether a mother is breastfeeding or formula feeding, they should room-in with their newborn. This helps mothers and babies get to know each other and prepares them to go home. While rooming-in is the standard of practice for Baby-Friendly hospitals, it’s important to also note that Baby-Friendly requirements for rooming-in include an exception for any medical/safety issues or parental request.
These policies are often misunderstood. BFUSA would like to set the record straight.
We spoke with Lori Feldman-Winter, MD, MPH, about this issue. Dr. Feldman-Winter is Professor of Pediatrics at Cooper Medical School of Rowan University and member of the Division of Adolescent Medicine, Department of Pediatrics, at The Children’s Regional Hospital at Cooper in in Camden, New Jersey. She is widely recognized for her work related to breastfeeding education programs and nutrition policy and is a veteran breastfeeding practitioner with extensive experience implementing Baby-Friendly.
Feldman-Winter reminds us that rooming-in is not a new idea. Until the middle of the 20th century, breastfeeding was the norm and it was standard practice for mothers and babies to share a room. But then in the 1950s and 1960s, as the influence of the commercial milk formula industry began to take hold, the culture shifted away from breastfeeding to formula feeding and to housing babies in nurseries.
Now, thanks in large part to the Baby-Friendly Hospital Initiative, the tide has shifted back to keeping babies and moms together as the best way to build their bond and support breastfeeding. Still, some misperceptions persist.
“A common belief about rooming-in is that it’s just a way to shift the burden of responsibility from the hospital’s nursing staff and other professional staff to the mother,” says Feldman-Winter. “Some moms believe that, since their baby is in the same room with them, they won’t get as much help from the hospital staff.”
Nothing could be further from the truth.
So, what SHOULD happen with rooming-in?
“I like to think of rooming-in as the mom and baby sharing a semi-private room,” says Feldman-Winter. “Many patients in a hospital share a semi-private room with a stranger. With rooming-in, the mom and baby are both patients being cared for by staff in the same room. The only difference is that they’re not strangers. They’re doing the important work of getting to know each other and learning each other’s cues – and that can’t happen if they’re separated.”
Feldman-Winter understands how new mothers might have misunderstandings about rooming-in at first. She says some mothers have a “misperception of aloneness,” believing incorrectly that they’ll need to fend for themselves and figure it all out on their own without support.
The reality is that the hospital staff is there to help the mom care for the baby in the room as much as needed. And if the mom is not able to care for the baby, including feeding, then a nurse can provide this care without separation.
“Staff should conduct regular rounding in the early days after delivery to provide the care needed for the baby and the mother, who are both still recovering from delivery and may have differing levels of disability,” she says. “There should also be mechanisms to alert staff so they can provide immediate assistance if additional care is needed or requested. Moms often don’t realize they can ask staff to help care for their baby if the baby is in their room.”
Benefits of rooming-in
Rooming-in has many benefits for both mother and baby. The most obvious is that it helps establish breastfeeding.
“We recommend feeding 9-10 times in a 24-hour period,” says Feldman-Winter. “It’s very difficult to get the baby to the mom that many times if a baby is being housed in a separate room. So, you’re going to miss feedings, and if you miss feedings, you’re going to interfere with the establishment of breastfeeding.”
“It’s not about volume or nutrition at this age,” she says. “It’s about babies and mothers practicing and learning how to work together in this very complicated dance of breastfeeding.”
Staying in the same room also eliminates the natural level of stress and concern many mothers feel when separated from their infant.
“Moms are not supposed to be separated from their babies. It’s unnatural for mammals,” says Feldman-Winter. “When you remove a baby whale from its mother, for example, the mother whale emits a horrible guttural sound as though she’s dying. Keeping mothers and babies together, regardless of feeding method, supports the normal wellness of both the mother and the baby.”
What should happen when a mother insists on separation for a period of time?
“If an appropriately counseled mother still requests the baby be taken out of the room, then the staff should absolutely support that mother, acknowledge her wishes, and care for that baby in a separate space,” says Feldman-Winter.
“But before doing that, the mom should be reassured by the nursing staff that she can get some rest and not have to worry about the baby,” she says. “If the baby cries, a nurse will be right there to settle the baby down. Often the staff can settle the baby without a feed and wait for the mom to wake.”
It’s also important that the hospital maintain a space that is safe where babies can be taken and cared for when separation is appropriate.
“I’ve seen facilities park babies in the hallway at the nursing station,” says Feldman-Winter. “That is what shouldn’t happen.”
Does Baby-Friendly force hospitals to close their nursery?
“That’s not in the Baby-Friendly guidelines,” says Eileen FitzPatrick, BFUSA’s Chief Executive Officer. “BFUSA’s Guidelines and Evaluation Criteria require only that rooming-in be the standard of practice, consistent with Step 7 of the Ten Steps to Successful Breastfeeding, while of course providing an alternative safe caregiving space to use if birthing parents so choose.”
For her part, Feldman-Winter would like to eradicate the term “nursery.”
“This idea of an idealized place where babies are separated from their moms as the norm in our culture is actually unsafe,” she says. “I would like to see the whole concept replaced with a new paradigm.”
