Booby Traps Series: “Breasts don’t stretch down hallways and under doors.” Why do so few hospitals make rooming-in the standard?

This post is the 18th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

A few years ago a mothers’ group in my area sponsored a talk by Dr. Bobbie Phillip, pediatrician and medical director of The Birth Place at Boston Medical Center (BMC), a large, urban hospital delivering 2,400 babies each year.  Until very recently, BMC was the only Baby Friendly Hospital in my state of Massachusetts.

Bobbie talked about the story of how her hospital became Baby Friendly – a process involving lots of naivete, chutzpah, luck, knock-down fights, ribbon cuttings, and numerous Costco sheet cakes to celebrate small victories.  She’s a wonderful speaker and advocate, and if you’d like to learn more about this story, here’s a video of her giving this funny and inspiring talk.

One of the lines I remember vividly from her talk was related to the practice of rooming in.  Now, to be come Baby Friendly hospitals have to comply with the 10 Steps to Successful Breastfeeding.  Rooming-in, which means having babies stay in rooms with their mothers, unless separation is medically necessary, is one of those steps.

Bobbie showed one picture which was hard to forget.  But first, recall that BMC is a large, urban hospital with about 2,400 births a year.  The picture was of the nursery nurse, who usually brings a book to read because her nursery is so often empty.  Why? “Because the babies are well, and they’re with the mothers.”  I also remember her saying, “breasts don’t stretch down hallways and under doors.”

What’s the evidence showing that rooming-in is associated with better breastfeeding outcomes?  Studies dating as far back as the 1950′s have shown that mothers breastfeed longer and more exclusively if babies room-in with their mothers.  Studies have also found that when babies and mothers were kept together, mothers’ mature milk came in earlier, babies gained weight more quickly, and were at lowered risk of jaundice.

So if rooming-in is so important to breastfeeding, all hospitals encourage it, right?  Like Bobbie Phillip’s hospital, nurseries in all hospitals should either be dark or contain a bored-looking nurse, right?

Not so, says recent CDC data.  For 2009, only 33% of U.S. hospitals reported to the CDC that “≥90% of healthy full-term infants, regardless of feeding method, remain with their mother for at least 23 hours per day during the hospital stay.”

33%.

Now you may be wondering how much of that poor showing is a result of maternal request – in other words, moms asking that their babies be taken to the nursery so they can rest.  And it’s certainly true that many moms do request this. (Note to readers:  If you did, that does not make you a bad mom.  It makes you a tired mom.)  But, as Jennifer Block articulated so well in a guest post for this blog on early elective birth:  “It is physicians’ and midwives’ responsibility to practice good, evidence-based medicine and to educate their patients.”  There is nothing stopping a nurse, physician, or midwife from explaining that both mother and baby will be better off in the long run if the baby remains in the same room.  In light of the significant amount of evidence confirming this, don’t they have an ethical responsibility to do so?

If Bobbie Phillip’s nursery can be empty, why can’t your hospital’s be, too?

Did you room in with your baby?  Did your hospital support it?  Did nurses suggest that your baby be taken to the nursery “so you can rest?”



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14 Responses to Booby Traps Series: “Breasts don’t stretch down hallways and under doors.” Why do so few hospitals make rooming-in the standard?

  1. Amy says:

    My hospital does not give you a choice, if your baby is healthy baby stays with mom other wise the baby is in the nicu. There is no nursery. It was awesome!

  2. Rebecca says:

    I gave birth at home, so my son stayed with me from the moment he was born and was NEVER taken away from me by anyone except for my husband. It was bliss! he’s turning 1 year old at the end of the month and we still have a strong Breastfeeding relationship and cosleep. If I were to ever have my baby in the hospital, I would never let him/her leave my sight. But if I have anything to do with it, I will make sure to stay low risk and have my babies at home!

  3. Julia says:

    I’ve had three babies and during my hospital stays, I probably had them with me about 23 hours a day. I always called the nurses to take them to the nursery long enough for me to shower. :) This was at 3 different hospitals with different levels of breastfeeding-friendliness and thus different amounts of “suggestion” from people that I could use a break. The worst offender was an (older, not-my-regular) pediatrician who tried to convince me that my milk would come in faster if I sent my baby to the nursery to get some sleep. Ummmm, no?

  4. Lorraine says:

    @Amy I’ve never heard of a hospital without a nursery, that’s sweet. I roomed in with my baby and the hospital supported it. But, they offered to keep my baby in the nursery.

  5. Hannah says:

    The hospital I gave birth in was working towards Baby Friendly I think?
    Anyway, rooming in was the norm. If they had space in the nursery and your nurse wasn’t busy, they could take your baby for a bit. At one point the nurse offered to take him for a bit, he went to the nursery for ~3 hours during the middle of the night (he slept the whole time, so did I…like a rock, I was exhausted), then I buzzed the buzzer and she was there with him in about 30 seconds. The nursery was just a few doors down the hall. I think it helped me relax and sleep deeply, but it for sure wasn’t necessary. Planning a home birth this time around, so, no nursery!

  6. Kristine says:

    At my hospital it was totally up to the mom. There was a nursery, but it was close by. I had three c-sections and if I asked them to keep the baby for a few hours they would always bring baby to me when he or she was hungry. They definitely didn’t push breastfeeding one way or another, but they did have the option of rooming in and never supplemented any of my babies if they were in the nursery.

  7. Deborah says:

    The hospital my 1st baby was born in had a nursery, and I was encouraged to use it to “get some rest” – I slept so well, and most of the nurses brought the baby back to me at the earliest signs of hunger. One nurse, however, gave her a bottle of formula without my knowledge or consent (even though my baby’s bassinet was clearly marked with the hospital’s official card stating “breast-feeding – do not give bottles or pacifiers”)… argh! So, while I appreciated the nursery, I can see why it can be a problem.

    My second child was born at a hospital similar to Amy’s: no nursery, all babies room-in unless they are in the nicu. Unfortunately, the hospital doesn’t explain to mothers or fathers why this is the case. My husband asked about sending the baby to the nursery and all we got was a fairly snotty “you made her, you take care of her.” So, we were left with the impression the lack of a nursery was a matter of the nurses’ and hospital’s convenience. I would have been more understanding if I knew then what I know now about rooming-in. As usual, education is the key.

  8. I am in Canada and my hospital, Royal Columbian, closed its nursery a number of years back. It only has a special care nursery now. As it should be. :-)

  9. Bente says:

    I am in Denmark, and we have had rooming-in and bedsharing since 92!! I still remember the discussions about this. The mothers loved it, but the nightnurses were terrified; babies behind closed doors?, how could they observe the babies sufficiently? who had the responsability, if a baby had apnoe or … or …..or…
    Now we can look back at nearly 20 years of rooming in an its amazing! Thats how it should be!

  10. j says:

    I have worked in nurseries at a hospital and even though they say they will bring them back at the first sign of hunger…. lots of the nurses don’t know what that means for a breast-fed baby. They will try to hold them off for as long as possible. They do it to “give the mom a break.” However, this still is NOT in the breastfeeding dyad’s best interests. Rooming-in is really the only option to really be aware of your baby’s cues!

  11. I delivered at Adventist in Portland and kept my son with me the whole time. They had a nursery – We saw it when we accompanied Baby to get his first tests & shots. There were two babies there when we visited, both under jaundice lights. Our room was clearly designed for rooming in and I am glad that I kept my son with me every moment. My husband did suggest that the nurses take him at one point when we were both very, very tired, but I refused. (For what it’s worth, my son is a year old now and still sleeping within arm’s reach of me.)

  12. gillian says:

    My daughter was premature and sent to NICU. On her third day, I was told she was stable, and I just needed to establish breastfeeding. I hoped she would be able to come to the ward, but no. Then at 7 days I was chucked out of hospital, and had to leave her behind. My husband would not have suported me if I wanted to take our baby home, believing THEY know best.
    I am proud to say,I succeded INSPITE of the hospital. If I had a 2nd child, and the same circumstances, I would have done it differently. If I was lucky, I might have been allowed to stay in hospital 3 days. Then when they say ‘all you have to do is establish breastfeeding’ [although we would be separated] I would ask if baby could leave hospital if bottle-fed. If they said yes, I’D SAY OK. Then when I got home I would breastfeed, but have a few bottles for show when the midwife came, in case they tried to remove the baby.

  13. Denise says:

    I had my first in 2003 and the hospital was a “rooming in” hospital. They only took him when he was circumcised. Everything else was done in the room. With my second, I did ask them to take the him in the middle of the night for a few hours for me to get rest, since my husband went home to take care of the first. They did not supplement him or give him a pacifier and brought him back as soon as I requested. With my third, the nurses suggested that with a c-section (emergency) that the baby go to the nursery the first night. I’m so glad they did. Again, I was alone and wasn’t able to move at all. The things on the legs to keep from clotting and the pain. Wow. I was so not prepared for that. They did not supplement him and he slept the whole 6 hours (which is the last time he’s slept that long in a row and he’s 6 months. Ha!). I breastfed all three. The first for 5 months then I returned to work. I had such a wonderful lactation consultant that was on speed dial. She helped me through difficult latch, thrush, forceful letdown, over production of milk and mastitis. The second I breastfed for 8 months, pumped after returning to work for 3 months. This time around I’m hoping to get to at least 1 year. We will see. But I could not have done it without the lactation support. And she was in the room with my first the very first day. Made a huge difference. Plus I am stubborn. I was determined to do it and there was no telling me otherwise. And I did not know anyone who breastfed when I was growing up. I had 1 friend out of 4 with babies that breastfed. All the others bottle fed.

  14. Desiree T says:

    My hospital did not and will not allow my babies to room with me. I have had a son and daughter by C-section, and will give birth next week. Their reason, the hydrocodone I was on for pain. First of all, it makes no sense what so ever to me. That is their policy and I have no choice to follow it no matter how many times I asked.
    With my first C-Section, I was on Morphine, and also had a very traumatic birth. Breastfeeding was Horrible and difficult. They just did not understand the proper techniques to show me. Luckily the lactation Nurse came to my rescue.

    With my second child my recovery was amazing. I breastfed within an hour, and it went perfectly. No complications, pain was managed well on my part. I asked if he could spend the night, the 2 nights I stayed. They would not allow it. The hospital does encourage rooming in, but not in the case of a C-section birth. If they do their jobs right, what is the problem? They dont stay in while I nurse, so it made no sense to me. They would wait 3-4 hours before bringing my son to me at night!! I was awake an hour before he got the room because my breasts would become sore! It made me very sad for my baby. He came in sucking at his hands with force. Even with my first child they did this and she would scream so they told me to use formula because I was not doing it right.
    On the third day I told my doctor I needed to go home, I was up and walking and I just felt I could handle it. She let me go that afternoon. THANKFULLY. My son ate A LOT, and my milk was in before discharge. At home he fed about every 2 hours at night and 1-2 during the day. He got chunky fast, but that was what he wanted and he was a happy baby. My poor baby was practically starved by those nurses! Mommy knows best.

    Im due for my 3rd C-section Sept 10. I am worried what course this will take. My hospital is in Rhode Island, they encourage breastfeeding more now. Most of the nurses are the same. I am glad the Lactation Nurse is still there! I will call her to complain about them this time. I am not afraid to speak up. I know a lot better now. I am bringing a sign for my babies crib to let them know newborns breastfeed more often and usually constant while awake. As well as no pacifiers and such. If I cannot get my baby in room, I will make sure they understand I am not playing games. My Dr tried telling me I would be there 5 days this time, I said NO. 3 days the most. He agreed that was perfectly fine just most people don’t ask. If they want me to go crazy, by all means.

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