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.”


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 Comments | Last revised on 09/07/2011

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