Rooming-in: An Essential Evolution in American Maternity Care

Posted April 28, 2016 by Jennifer Ustianov, MS, BSN, RN, IBCLC

Jennifer Ustianov
Jennifer Ustianov, MS, BSN, RN, IBCLC
Over the past few years, many U.S. hospitals have moved away from the traditional use of nurseries for healthy newborn infants, choosing to move toward rooming-in and couplet care. Rooming-in is an evidence-based practice that promotes keeping healthy newborn babies and their mothers together in post-labor recovery rooms. This recent change in practice and policy for many hospitals is partially based on recommendations in the World Health Organization’s (WHO) Ten Steps to Successful BreastfeedingExternal Link and the increased movement toward earning Baby-Friendly designation in the U.S.

The transition from the automatic use of the nursery to rooming-in has raised some concerns among parentsExternal Link. Over the past few generations, it has become standard for new mothers, during their hospital stay, to have their infants cared for by nursing staff in the nursery. This included the expectation that their baby might stay in the nursery for long periods of time beginning after birth, especially at night.

Now with mounting evidence and changing practices, many families worry that having babies in mothers’ rooms will only compound the anticipated exhaustion most new mothers and parents experience. The systematic use of nurseries remains an expectation for many families, and now the move to rooming-in is challenging for the hospital staff and parents because many families do not understand the value of rooming-in. 

However, rooming-in is about improving the health of both moms and their babies. Evidence showsExternal Link that mothers and newborns benefit from staying together, and understanding this would ease some of the concerns around rooming-in.

One of the rationales for rooming-in procedures is to promote breastfeeding and ultimately increase exclusive breastfeeding. The American Academy of Pediatrics recommends 6 months of exclusive breastfeedingExternal Link, but the national average was only 18.8 percent as of 2014External Link. When combined with other postpartum practices, rooming-in is considered one of the most effective methods for increasing the duration of breastfeedingExternal Link. By having their babies in the same room, moms can learn feeding cues and establish feeding patterns before they’re discharged. The hope is that breastfeeding will become routine during the hospital stay so that mothers won’t start using formula supplementation during their children’s first 6 months.

But the benefits of rooming-in go beyond breastfeeding. For example, sharing a room leads to better sleep for moms and newbornsExternal Link. Instead of learning about their newborns’ unique behaviors at home, new mothers who are not separated from their infants have an opportunity to ask providers about normal behavior and proper care techniques. Having concerns alleviated during their hospital stay can help ease the transition at home.

Although research is mounting in favor of rooming-in, it has not become the expected practice for the majority of families, nor is it a consistent practice in U.S. hospitals. It is becoming more widely accepted, but there needs to be an ongoing conversation about rooming-in for it to become a standard part of the birthing experience. This conversation should take place during prenatal appointments, as mothers enter care in our birthing centers and within our communities. Discussions about changes in maternity practices help promote understanding between medical professionals and the communities they serve. This discussion should also include options for cases when rooming-in is not the best option for the mother and/or her baby. Nurses and providers should be aware of the criteria for separation and feel confident that they are maintaining safe and equitable rooming-in practices. Individualized care options should be provided, whenever possible, with high quality, evidence-based care and patient safety as balanced priorities.

Healthcare professionals should be provided the evidence, support and tools needed to implement and sustain changes in practice. These in turn will enable health professionals to provide parents information about rooming-in, its benefits and the circumstances when nursery care will be provided. Most moms and babies can benefit from spending their hospital stays together, and simple explanations of the evidence will help patients understand that.

Addressing concerns and questions is a large part of making rooming-in the norm, and with safety in mind we can gradually move away from the nursery-first system.


Jennifer Ustianov, MS, BSN, RN, IBCLC, is a senior director and the Perinatal Lead at NICHQ.

Share:

Add your comment

 
 

 

Archive

Tagcloud

breastfeeding new york state hospitals mom mother partners quality improvement epilepsy QI data AAP early childhood eccs coiin pdsas wic texas community support learning session IM CoIIN infant mortality children's health new technology engineering transgender collaboration collaborative learning engagement planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke nichq toolkit e-module infant health dental care oral health underserved populations health inequity public health Maternal and Child Health Journal tips leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization safe sleep sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support family engagement families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting preterm birth prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing NASHP issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series health equity health disparities access New York BQIH exclusive breastfeeding LARC long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in Baby-Friendly parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching PDSA Cycle leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Best Fed Beginnings Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening ASTHO reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis Huffington Post fundraising campaign first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Measurement Cross-Sector Collaboration Knowledge Sharing Child Health Systems Design systems change