Rooming-in: Keeping newborns and mothers together
Most hospitals no longer have nurseries for well babies
It's a familiar sight in American movies and TV shows: rows of newborn babies lined up in cots behind a viewing window. But it's not something you will see in countries like Australia and it hasn't been for decades!
Photo of the Admitting Nursery at a Houston-area hospital with listed times for baby showings in approximately 1960. John P. McGovern Historical Collections and Research Center, Houston Academy of Medicine – Texas Medical Center Library; Houston, Texas
As early as the 1980s, hospitals moved away from routinely separating mothers from their babies. The method of keeping babies in nurseries under the care of nurses was shown to decrease breastfeeding rates and increase the use of infant formula. Indeed, the concept was introduced in many parts of the world under the sponsorship of formula brands. Reasons it was popular included passers-by enjoyed looking at the babies but it also allowed visiting fathers to view their babies: the only option until mother and baby were discharged up to two weeks after delivery.
Newborn babies at the nursery of Kandang Kerbau Hospital, Singapore 1986
When babies were routinely fed according to strict schedules, it was convenient for nursing staff to keep all babies on the same routine and wheel them out to their waiting mothers at the same time. In some instances, babies were even transported together by trolley and off-loaded bed-by-bed in passing.
Rolling out the babies for feeding time - double stacked! 1950s Australia
Mothers who were attempting to breastfeed were given strict times to do so, no more than ten minutes each breast before babies were scooped up by nurses for the return journey. These babies were then routinely “topped-up” with formula by nurses who enjoyed feeding the babies by bottle. Meanwhile their mothers either fretted about not making enough milk or experienced painful engorgement from not being permitted to feed their child long enough.
By the time I had my first child in early 1984, Australian hospitals were encouraging mothers to care for their babies in portable cots wheeled to their bedside at dawn and wheeled back to the nursery at night to be cared for by nurses who would wake mothers to come breastfeed.
Just three years later, my second baby was rooming-in 24 hours a day and by the time their brother arrived in 1991, it was standard practice and nurseries were gradually converted for other use. Special Care Nurseries (SCU) were used for sick or premature babies who needed observation by medical staff but not the level of care offered in Neonatal Intensive Care Units (NICU).
It is interesting that the US has been so slow to make the change compared to Australia, the United Kingdom and other countries. It was only when US hospitals began the Baby-Friendly Hospital Initiative accreditation process that more facilities began the transition, as a core criteria is keeping mothers and babies together through rooming-in.
There has been resistance by American parents though, who feel caring for their newborn will decrease opportunities to rest and recover. Given 1 in 4 new mothers return to the paid workforce within the first month, it is understandable that mothers feel this way. However, the majority of maternity facilities now practice rooming-in routinely - coming into line with the rest of the Western world.
In many countries, mothers and babies have always shared a bed in a communal ward for women who have recently birthed. The inclusion of rooming-in in the BFHI accreditation is as much about encouraging these facilities not to move to nurseries in an attempt to modernise. Once again we are reminded that humans have been having babies for millennia and the practices of a few decades in time have been experimental and not always with desired outcomes.
Even closer
While some countries are still catching up with rooming-in, others have moved forward to keeping mothers and babies physically close, using side-car cots attached to the mother’s bed in place of bassinets on wheels.
In New Zealand and Australia, the Pepi-pod program has been successfully rolled out not only in the homes of families who traditionally bed-share with their babies but also in hospitals including the Royal Womens Hospital in Melbourne.
In Europe, infant beds which attach to the adult hospital bed have been developed. Innovative design allows for the infant to sleep close to their mother on a separate sleep surface.
Jessa Hospital, The Netherlands
The Gelderse Vallei hospital in the Netherlands
Ardz Hospital, The Netherlands
With greater recognition of the importance of keeping mothers and babies close in the postnatal period, it is hoped such practices are rolled out to all hospitals.
