Hospital Toolkit

Promote Rooming-In


The American Academy of Pediatrics’ Sample Hospital Breastfeeding Policy for Newborns states, “The establishment of successful breastfeeding is facilitated by continuous rooming-in, both day and night. Therefore the newborn will remain with the mother throughout the postpartum period, except under unusual circumstances.”

 

Benefits of Rooming-in1-6

 

  • Improves breastfeeding outcomes
  • Facilitates on cue feeding
  • Higher weight gain in infant
  • Can help early breast milk production
  • Increased maternal attachment
  • Infants cry less and soothe more quickly
  • Infants less likely to develop jaundice
  • Lowers rates of child abuse, neglect and abandonment

 

Practice rooming- in, allowing mothers and infants to remain together 24 hours a day.

This is often easier said than done.  Rooming-in is a topic that seems to arouse strong feelings. Why?

 

Challenges

 

For Staff

 

  • Assumption that mother will get more rest if baby goes to nursery. 
  • Discomfort with the feeling that they are forcing mothers to room-in.  
  • Families’ recommendations to send the baby to the nursery.
  • Mixed messages from health care providers (e.g. some providers who say things such as, “There’s nothing wrong with having the baby in the nursery at night”).
  • Lack of policy or enforcement of policy regarding visitors.

 

When asked about rooming-in, nurses’ first response is often, “Yes, we do that.” But with a little probing, they often reveal that mothers ask to send the baby to the nursery so they can sleep. Lactation consultants often complain that nurses actively encourage mothers to do this, e.g. by saying “Don't you want me to take your baby to the nursery so you can get some rest?”

 

For Families

 

  • Lack of prenatal information on the importance of early contact to learn baby’s cues and how to respond.
  • Assumption that sleep quality is improved when mothers and babies are separated.
  • Assumption that routine separation is necessary for observation and medical procedures.

 

Strategies

 

Train staff about getting better results with couplet care. 

 

  • Emphasize and support the nurse’s role in facilitating the relationship between mother and newborn.
  • Emphasize that rooming-in is best practice for all mothers and newborns, regardless of type of feeding.
  • Help nurses understand the importance of early opportunities to learn baby’s cues, value of bonding and about the impact of early attachment.
  • Encourage nurses to model nurturing behavior as an example to mothers.
  • Procedures such as blood work, baths, etc., and examinations of the infant can be done in the mother’s room and can offer opportunities for teaching mothers and families.
  • Rooming-in can be a time-saver for staff.
  • Provide staff with key messages for mothers. (See Scripting for Staff Pg. ??)
  • Provide staff with opportunity to role-play responses to requests for babies to be taken to the nursery.

 

Inform staff about the impact of rooming in on mothers’ sleep.1,4

 

  • Review evidence regarding the impact of rooming-in on rest.
  • Share research that shows that mothers who room in do not sleep better or longer than those whose babies go to the nursery at night. For example:

A study from the journal, Clinical Lactation, “found that exclusively breastfeeding mothers not only slept significantly more hours during the night than other mothers but also reported significantly more energy during the day, a better mood, better overall health, and a greater sense of well-being.”

 

Promote a period of dedicated afternoon rest and a break from visitors. Develop a mother-baby unit policy requiring a rest period without visitors every afternoon.

 

There are several hospitals in Illinois that have adopted a special rest time in the afternoon. Lori Stevenson, director of the Maternal Child Center at St. Elizabeth’s Hospital in Belleville shares an example of this approach. “We have instituted “Lullaby Time” every afternoon from 2:30-4:30 to encourage limited visitors and parent/newborn bonding. We dim the lights on the unit and ask that just mom and dad remain in the room with the new baby. We limit staff interruptions and focus on allowing the new family to bond.”

 

  • Place posters in physicians’ offices, clinics, and hospitals’ waiting, examining, and patient care rooms. See fact sheet Practice Togetherness

Even if there is no formal rest period, nurses can informally encourage visitors to leave. At Pekin Hospital in Pekin, IL (a Baby-Friendly hospital), Beth Seidel explains, “We have recently started encouraging no more than one or two people in the room while mom is feeding and this is really helping us in our feeding education efforts, and in observing and assessing feedings. It also helps in decreasing distractions in the room, and competition for mom’s attention. Visitors are informed of this by the nurse while the mom is still in labor.”

 

Performance expectations:

 

  • Staff will promote rooming-in as the norm.
  • Staff will explore reasons for requests by mother for sending her baby to the nursery.
  • Staff will chart each time a newborn is separated from the mother, providing the reason. (Link to Tips from the Field – Beth Seidel, documentation at Pekin Hospital.)
  • Audit outcomes and share results. 

 



Rooming In Action Plan Template

(PDF/MS Word)

 

Resources and References




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