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.