Rooming Out can be friendly, too

In 1991, UNICEF and the WHO conceived of the Baby-Friendly Hospital Initiative as a way to facilitate breastfeeding from the baby’s very first moments. Among the “Ten steps to successful breastfeeding” is a requirement for mothers to practice rooming-in, i.e, the baby should be by her mother’s side, in her room, day and night. While this may indeed be ‘baby-friendly’, in this country (which, to remind you, has breastfeeding initiation rates higher than the US), some women see this particular step as being decidedly mother-unfriendly…which is probably why there are no hospitals in this country without nurseries*. And yet, this is not necessarily an obstacle to successful initiation of breastfeeding.

The hospital where I gave birth to both my eldest and youngest (Hadassah Ein Kerem) is a large university-affiliated medical center and the largest hospital in Jerusalem; the medical school campus where I trained is connected to it. At the time I last gave birth (and according to what my patients tell me, this is still in effect), there were two or three “rooming in” rooms, each equipped for two patients and their babies and containing a bathroom and shower. Babies are examined at the mother’s bedside by the neonatolgist, and the nurses assist mothers with basic baby care such as bathing and nursing if she is inexperienced.

As my first birth ended in an emergency C-section, I was put in a room on the other side of the hallway and was not considered eligible for “rooming-in” – though in practice, as soon as I was able to get my son from the nursery, he was in my room pretty much all the time except for the neonatologists’ nursery rounds. But after my daughter was born and they wheeled me up from the L&D ward, I chirped enthusiastically to the staff on the maternity ward, “I want a rooming-in room, please!”. I couldn’t figure out why they were looking at me like I’d grown an extra head; one of the nurses asked, “Do you understand what rooming in is? You do realize your baby will be with you all the time, right?”. But in the end they gave me what I wanted: a “rooming-in” room in which, at that point, my baby daughter and I were the only occupants. Which suited us just fine.

Fast forward to 18 hours later: every pregnant woman in Jerusalem, it seemed, decided to give birth that weekend. The corridors (not to mention all the regular ward rooms) were lined with beds, all filled with women who’d given birth throughout the night and early morning. Yet my baby girl and I were still the only occupants of our room. When an ultra-Orthodox woman lying in the hallway got up and asked if she could use the bathroom adjoining my room, I asked her why she didn’t ask to move into my room – and got an odd look of distaste:”But that’s the rooming-in room!”.

She then explained that she’d just given birth to her 5th child, and having been up all night with the business of labor and delivery, she was quite happy to leave her baby to the tender loving care of the nursery staff, thankyouverymuch. Yes, she planned to breastfeed her baby, as she’d done with her previous 4 children. But other than when her presence was required, she was more than pleased that someone else was doing the bathing, diaper changing and monitoring of her baby while she got some much-needed sleep. There would be more than enough time for her and her baby to get acquainted once they got home.

I’ve discussed in passing the phenomenon of ultra-Orthodox women going to special convalescent homes for a few days after they give birth, beyond the regular 48-hour (for a vaginal birth) hospital stay, here. The practice is also partially subsidized by the insurance companies for these women following the birth of their 4th or subsequent child (supplementary insurance, not the basic package that comes with the socialized medicine territory). Such places, like the hospital, have nurseries where mothers can (and do) leave their babies at will. Imagine my surprise when I found that “my” hospital was now offering a similar service in their newly-built convalescent hotel (click on thumbnail below for full-size advertisement) – but to the public at large, and regardless of parity:

Notice that one of the attractions is the presence of a fully-staffed, 24/7…nursery. Lest you think this means the death knell of those breastfeeding dyads who managed to survive the baby-unfriendly maternity ward, their website (in Hebrew) also offers the services of on-site lactation consultants. While the baby-friendly hospital initiative has been shown to increase breastfeeding rates and, in some places, duration (most noticeably during the PROBIT trials in Belarus), it may be that some of those ‘ten steps’ may actually be counterproductive in some cases and/or in some cultures…or, at the very least, their contravention not as harmful as assumed by the WHO and UNICEF.

If faced with this decision again (unlikely but not impossible), I’d still choose rooming-in and elect to get back to my own comfy bed at home ASAP. But that mother-of-five I met in the hallway back then provided me with some valuable insight: it might not hurt, and perhaps even may help a budding breastfeeding relationship, to be a bit mother-friendly as well.

*to the best of my knowledge. Mothers can make the choice that I did with my eldest and keep their babies by their side, but nowhere are they required to.

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15 Responses

  1. With my oldest, he spent most of his time (during the night) in the nursery. Breastfeeding didn’t go so well with him, we ended up quitting at 5 months. My daughter roomed in with me, and breastfeeding is still going strong at 7 months. However, I don’t think the lack of rooming in is what messed things up with my son and I, as evidenced by the fact that we did well for a few months. 🙂

  2. Given that the normal hospital stay for NSVD is now barely 2 nights, I think it is essential for mothers to have the option to skip the 1 a.m. feeding –or any other feeding, if they’re not feeling up to it. During my years at Misgav Ladach, which DID have 24 hour rooming in, I saw far too many mothers almost fainting with exhaustion, not having had even two hours connected sleep after labors lasting a day or more. Exhaustion DOES affect milk supply, and I think this insistence on rooming in can be counterproductive.

  3. Antigonos – was rooming in compulsory at ML? I don’t remember – just that I and my roomie did, and that we had to ‘surrender’ our babies to the nursery in the mornings for neonatology rounds.

  4. (the relevant bit is the last section, though the rest is quite funny reading as well).

    I think this is a good example of a useful way of doing things becoming a rigid dogma. I do think that there were good reasons for moving away from a standard practice of keeping all babies in the nursery except when a nurse brought the baby to the mother for feeds – not because I believe that makes a blind bit of difference to bonding in the long term, but because it did make breastfeeding at least that bit more difficult. That doesn’t mean that every new mother should now feel obliged to have her baby with her 24/7 no matter what. I’d say the best compromise would be for rooming in to be the default, but for there to be someplace where mums could leave the babies with someone else whenever they needed to (whether that was for a night to get some sleep or for twenty minutes while they took a shower).

  5. A friend of mine and I were due on the same date and planned on using the same rooming in hospital. She gave birth two weeks earlier than me (and I was envious). She said one of the nice things was that the nurses took her baby for about five hours so she could sleep. During my stay, I kept waiting for this to happen, but it never did, much to my chagrin. I have to say that this expectation dashed was one of the biggest bummers of the hospital stay

    With regard to early initiation of breastfeeding, a friend is an L&D nurse in a community that is about 50% latino. Her experience is that latina mothers who allow a bit of formula to pass the baby’s lips in the hospital, instead of obsessing about early initiation, actually go on to breastfeed for a longer period of time. Wildly against the dogmatic thought, but true.

  6. From the Ironycentral link above:

    Am I the only one who is bothered by this state of affairs? They are saving money and trouble by offloading more work onto the parents, and we are supposed to be grateful for it? We’re supposed to go, “Oh, thank you for not caring for our newborn, so that I … I … zzzzzzz. (Sound of child striking floor after being dropped by unconscious parent.)”

    I’ve heard many a cynic claim the real reason many hospitals were quick to embrace baby-friendly status was because they saved mucho dinero by not having to maintain a nursery.

  7. Lisa – what was your son’s problem? I would suspect that if you lasted 5 months, any supposed benefits of rooming-in would be long past, mind.

    Willa – does your friend have an explanation for the phenomenon of the Latino moms? That’s really interesting.

    Mind you, one of the secretaries at my clinic just had her 4th child about 3 weeks ago. After each of her births, she’s needed to initially (first 6 weeks or so) supplement with formula. Though she tries to avoid doing so each time – because “everyone knows” this is bad, bad, BAD for the nursing relationship, her son (3rd child) ended up badly dehydrated in hospital at 10 days of age as a result, and her youngest nearly ended up the same way. It was absolutely amazing to see how an extra 4oz. of fomula after each feeding simply revived her. And most likely, like the other 3, she will ‘graduate’ to a full and exclusive BF relationship with Mom in a few weeks’ time. (No LC has been able to determine why this happens each time…it just does). Maybe I should ask her if she did it all wrong by not rooming in? 😉

  8. I think it was more my problem. I was trying to hard to make breastfeeding work (pumping to always have a store, etc.) that I think I stressed myself out and I quit producing.

    This time around, I’ve decided that I don’t care. If I need to leave my daughter with a sitter and there isn’t any milk in the freezer, I send along a can of formula. So far she’s had 10 or 11 bottles of formula (most of those were on one day that I was terribly ill to the point that I just couldn’t feed her so she stayed with my mom.) I think since I’m more relaxed about it, it’s had a very positive effect.

  9. I think my friend observes a similar attitude toward breastfeeding as you do in the ultra-Orthodox community, something like, ‘of course, I am going to do it, now let me get some sleep.’

  10. Esther, that may well be true–it’s certainly the reason NHS hospitals don’t have a well-baby nursery.

    my issues with the nursery are that they usually don’t have enough night nurses and they’re much more likely to just give formula than take the time to bring you the baby.

    I would be much more comfortable with having a well baby nursery if rooming in were equally available and supported–not just “if your roommate says it’s OK” or otherwise discouraged, which still happens a lot.

    Having given birth in an NHS hospital, i can say that rooming in isn’t so much the problem as a lack of basic help. (The day after my section I was pretty much expected to do everything myself–and that included getting to the NICU. Even having them find a wheelchair was a palaver.) Add in the fact that visiting hours for spouses are still restricted (I was exceptionally lucky in that I had 12 hours continuous visiting; many NHS hospitals are not that good) and a mother can wind up truly exhausted. That, and the rooming in coupled with 6 bed wards; very noisy!

  11. Alexis:”I would be much more comfortable with having a well baby nursery if rooming in were equally available and supported–not just “if your roommate says it’s OK” or otherwise discouraged, which still happens a lot.”

    I agree. My issue is forced rooming in, and/or pretending it’s a “make or break” part of a BF relationship.

  12. I think that rooming in after a c-section can be incredibly difficult, but no one mentioned this to me prior to my child’s birth. I went into it with the mindset that if I did NOT room in, I was sabotaging breastfeeding and attachment.

    Following 16 hours of labor and an emergency c-section, I went to sleep with my baby in my room. By 1:00 AM, I was weeping with pain and exhaustion, and my baby would. not. sleep. I finally agreed to send her to the nursery, but my husband went with her to hold her and make sure she wasn’t given the dreaded pacifier. We maintained this pattern for the next three nights of my hospitalization. Needless to say, both my husband and I were sleep-deprived zombies by the time we went home. It ended up being rather devastating, contributing both to ongoing problems with nursing, and postpartum depression.

    When I have a repeat c-section, I will send my baby to the nursery at night and while I nap, and just ask that the baby be brought in to nurse every few hours. I may even give give an okay to the pacifier! I want to get a better start at home, and a better start to my recovery from major surgery than I did last time.

  13. As a first time mom I heard again and again how important rooming in is for a BF relationship. In childbirth classes, on the web, in my pregnancy books. So of course I wanted to room in, not send my baby to the dreaded nursery where he may get a pacifier. It was presented as something that could “make or break” my BF success with my son (like you mention Esther).
    After getting little sleep Thursday night b/c of being in early labor, delivering at 10pm Friday night, not getting to my room until about 2am Saturday, nursing my son constantly Saturday night (he had an undiagnosed tongue tie which let him to not get any milk and basically starve the first several days of his life) and going home on Sunday at noon I was exhausted. I think that exhaustion, along with several other factors contributed to my ongoing problems with low milk supply. I also think if I had sent my son to the nursery on Saturday night maybe one of the nurses would have noticed something was up with him and he was having trouble nursing- as a first time mom who had heard over and over “new babies may nurse every hour” I didn’t realize anything was wrong.
    It was only after delivery that I learned several friends, including my SIL who successfully breastfed all of her children sent their babies to the nursery so they could get some sleep. In the future I will definitely take advantage of the newborn nursery after delivery so I can rest. I also have encouraged my friends who have recently delivered to do so as well. I truly think that, despite what you learn in the childbirth classes, there is very little in those first couple days that is “make or break” for a BF relationship (with the possible exception of a severe undiagnosed tongue tie, but that is another story).

  14. I don’t think rooming in the first night is all that safe. The baby is spitty the first night. Many a less than 24 hour baby would turn blue due to gagging in the nursery and we would suck them out and watch them closely. I just feel more comfortable with not rooming in the first night due to fluidy lungs.

  15. I’m so glad someone wrote this and is calling attention to this issue. I had a 20 hour labour followed by an emergency c-section in an NHS hospital. The hospital had a mandatory rooming-in policy, so after they let me sleep for a few hours, I was left on my own to look after baby for the next three days. I was very weak, still in a lot of pain and had a catheter in for awhile, making it impossible to walk around. My husband was only allowed to visit and help for four hours a day. I was completly on my own the rest of the time. It was a TERRIBLE experience and I will not have another baby until I can afford to go private.

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