There is a growing trend across the country, including Massachusetts hospitals, toward 24-hour-a-day rooming-in for moms and babies versus the use of well-baby nurseries. In many of these hospitals, well-baby nurseries are reserved for a small handful of babies who can’t stay with their mothers for a variety of reasons and some have been renamed “Neonatal Observation Units.”
Many moms are not aware of this trend and may be surprised to learn that the nursery isn’t as readily available to them as it once was. This is due to the World Health Organization’s (WHO) Baby-Friendly Hospital Initiative (BFHI) whose guidelines can directly impact your birth and postpartum experience. The WHO defines the BFHI as “a global effort to implement practices that protect, promote and support breastfeeding.”
According to the BFHI website, “Baby-Friendly hospitals and birthing facilities must adhere to the following Ten Steps to Successful Breastfeeding to receive, and retain, a Baby-Friendly designation:”
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in the skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give infants no food or drink other than breast-milk unless medically indicated.
7. Practice rooming-in; allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
The following Massachusetts hospitals and birthing centers have been granted the official Baby-Friendly designation: Massachusetts General Hospital, Boston; Boston Medical Center, Boston; Cambridge Birth Center, Cambridge; Good Samaritan Medical Center, Brockton; Melrose-Wakefield Hospital, Melrose; Fairview Hospital, Great Barrington; Holyoke Medical Center, Holyoke; and Tobey Hospital-Southcoast Hospital Group, Wareham.
Massachusetts General Hospital (MGH) holds the official Baby-Friendly designation, so what can moms expect if they deliver there? Amelia Henning has been a certified nurse-midwife at the hospital’s OB/GYN Midwifery Service for the past 11 years. She’s also a certified lactation specialist and a member of the Baby-Friendly Committee at the hospital. She sees and cares for women throughout their pregnancies, birth and postpartum and explains some of the designation benefits: “It has been well-demonstrated when hospitals follow the WHO’s ‘Ten Steps,’ rates of breastfeeding initiation and duration increase substantially. We know how important this is to the health of babies: fewer respiratory and ear infections and hospitalizations for diarrhea.” Henning goes on to say that breastfeeding reduces obesity and allergies in childhood and moms have fewer reproductive cancers and lower cardiovascular disease risk.
One of the “Ten Steps” involves rooming-in, a practice MGH has had for years because they’ve seen its success. Henning says that when babies sleep in the same room as their mothers they tend to cry less, feed better (whether by breast or formula), and appear to get to know their parents better. She says, “A common concern among mothers is they won’t get the rest they need if baby is staying in the same room. Interestingly, studies show mothers actually get the same amount of sleep – or more sleep – with rooming-in.”
If a mom insists on having her baby go to the nursery, Henning explains, “Moms who are not physically or emotionally capable of caring for their infants in their room will receive additional support. We have staffing available to provide the extra support many families need. Additionally, there are times when transferring the baby to the nursery is the best care for mom and baby. In the event that mom and baby are stable, but mom feels she wants her baby transferred to the nursery, that choice is discussed, and ultimately, what the woman chooses for her and her baby is honored.”
As per the BFHI guidelines, “When a mother requests that her baby be cared for in the nursery, the health care staff should explore the reasons for the request and should encourage and educate the mother about the advantages of having her infant stay with her in the same room 24 hours a day. If the mother still requests that the baby be cared for in the nursery, the process and informed decision should be documented.”
Not all hospitals are rushing for Baby-Friendly designation, choosing instead to embrace some of the BFHI tenets but not others. For example, Beth Israel Deaconess Medical Center (BIDMC) has not yet officially gone with the initiative but agrees that breastfeeding is very beneficial. “We are committed to completing the steps of the process that have been demonstrated to help with breastfeeding success. We hold strongly to the idea that patients are the only people who can make the right choice for themselves and their babies. We are not here to dictate or prescribe a course of action. Our role is to educate ourselves and our patients and families about the benefits of breastfeeding and make it easier to achieve breastfeeding success for those patients who choose to breastfeed,” says Toni Golen, M.D., vice chair of Quality and Safety for the OB/GYN department and the medical director of Labor, Delivery and Postpartum. Golen has been on staff at BIDMC for the last 21 years and interacts daily with moms and families delivering babies and caring for them postpartum.
Some moms who have delivered in Baby-Friendly hospitals or birth centers express dismay that the well-baby nursery was not as available to them as it was for previous births. Golen says if a mom asks for her baby to go to the BIDMC nursery they comply without hesitation: “The time to encourage rooming-in is not when the patient is completely exhausted or after a long and difficult labor. This education begins many months before and affords the patient and family with the proper tools and information to make the right decision themselves. The patient decides.”
Most patients request that the baby be in the nursery for at least a brief period of time at BIDMC. Golen says, “It might occur if they want to take a shower and are nervous about not being able to quickly respond to the baby’s needs or at a time when a patient has been awake for 72 hours, had a long labor and pushed for four hours, and she simply needs to sleep for her own health and well-being. The patient knows her body best. She is best positioned to make the right decision for herself and her baby.” If a mom decides to breastfeed, Golen recommends rooming-in as much as possible but is very clear, “Restricting access to the nursery may be part of achieving the Baby-Friendly Designation, but it does not necessarily have to be a part of a successful breastfeeding program.”
Michelle Guerra, 41, of West Roxbury, who delivered her third child by C-section at South Shore Hospital in Weymouth, the same hospital where she had her two older children, was surprised to learn of the new room-in policies.
Guerra shares, “I requested the nurse take my daughter to the nursery for a period of time so I could get some rest as I was not feeling well and my husband had gone home. I was told at that point that they had done away with the well-baby nursery, but if I needed a break they would take my daughter to the nurses’ station and they would keep her with them for a period of time.” Guerra did send her daughter to the nurses’ station for a bit so she could recover from her surgery.
Increased time with babies is a positive, Guerra said, but she feels that making the nursery less available (or in some cases completely unavailable) to moms is not the answer.
Diane Catricala, 35, of Stoneham, is a mother of four expecting her fifth baby this spring. All of her births were at Brigham and Women’s Hospital in Boston and each time she used the well-baby nursery. She shares, “I breastfed each of my children. I would nurse, change, burp, swaddle and put them to sleep. At that point, I would ask the nurse to bring them to the nursery so I could sleep peacefully until the next feeding. This meant that I took care of my baby [while awake] and someone else kept an eye on them while they slept.” Catricala feels strongly that it should be a mother’s choice to use the nursery and it was only because of the nursery that she could get some much needed, uninterrupted rest.
Moms who don’t mind rooming-in may find it a challenge even for a second birth. Stephanie Harrington, 29, of Hudson, gave birth to her two sons at Emerson Hospital’s Birthing Center in Concord and found rooming-in more difficult than she anticipated. “My husband went home at night to watch our oldest and so I felt quite alone. The nurses gave me space, almost to a fault, and I felt a bit overwhelmed at times. Breastfeeding wasn’t coming as easy to me this time,” she says. However, there was an upside, she shares, “I was able to figure out a rhythm on my own with my son, and figure out his personality a bit. I think this made the transition home easier.” But Harrington does note that it should be a mother’s choice, not a policy.
Kimberly Solo is a licensed social worker in private practice in Westwood and not affiliated with any hospitals. She treats women who are struggling during the pregnancy and postpartum period specializing in perinatal complications as well as trauma. She says, “I really feel strongly that the push toward limiting nursery access does not have a woman’s best interest in mind. The moment a woman becomes pregnant, there is an abundance of focus on the baby’s health and well-being and simultaneously a neglect of the mother’s emotional well-being.” Solo goes on to say that there is typically no screening during pregnancy in order to assess a mother’s mental health yet there is a high correlation between mental health disorders during and subsequent to pregnancy. “Limiting access to well-baby nurseries perpetuates this message that the baby’s needs are paramount to the mother’s,” she explains.
All moms should do their research, ask questions, visit the maternity floor and choose to deliver in a place that fits their needs for birth and postpartum care. Being an informed and educated patient leads to better and happier outcomes for both mom and baby.
To learn more about the Baby-Friendly Hospital Initiative and rooming-in, visit babyfriendlyusa.org.