Rooming-in Vs. Nursery Care

Specialties Ob/Gyn

Published

Rooming-in. This is the option we encourage most mothers and babies to enjoy. Full rooming-in allows you to exercise your mothering instincts when the hormones in your body are programmed for it. In our experience, and that of others who study newborns, mothers and babies who fully room-in enjoy the following benefits:

Rooming-in babies seem more content because they interact with only one caregiver--mother.

Full rooming-in changes the caregiving mindset of the attending personnel. They focus their attention and care on the mother, who is then more comfortable and able to focus on her baby.

Rooming-in newborns cry less and more readily organize their sleep-wake cycles. Babies in a large nursery are sometimes soothed by tape recordings of a human heartbeat or music. Rather than being soothed electronically, the baby who is rooming-in with mother is soothed by real and familiar sounds.

Mother has fewer breastfeeding problems. Her milk appears sooner, and baby seems more satisfied.

Rooming-in babies get less jaundiced, probably because they get more milk.

A rooming-in mother usually gets more rest. She experiences less separation anxiety, not wasting energy worrying about her newborn in the nursery, and in the first few days newborns sleep most of the time anyway. It's a myth that mothers of nursery-reared babies get more rest.

Rooming-in mothers, in our experience, have a lower incidence of postpartum depression.

Rooming-in is especially helpful for women who have difficulty jumping right into mothering. One day while making rounds I visited Jan, a new mother, only to find her sad. "What's wrong?" I inquired. She confided, "All those gushy feelings I'm supposed to have about my baby--well, I don't? I'm nervous, tense, and don't know what to do." I encouraged Jan, "Love at first sight doesn't happen to every couple, in courting or in parenting. For some mother-infant pairs it is a slow and gradual process. Don't worry your baby will help you, but you have to set the conditions that allow the mother-infant care system to click in." I went on to explain what these conditions were.

All babies are born with a group of special qualities called attachment- promoting behaviors-- features and behaviors designed to alert the caregiver to the baby's presence and draw the caregiver, magnet like, toward the baby. These features are the roundness of baby's eyes, cheeks, and body; the softness of the skin; the relative bigness of baby's eyes; the penetrating gaze; the incredible newborn scent; and, perhaps, most important of all, baby's early language--the cries and precrying noises.

Here's how the early mother-infant communication system works. The opening sounds of the baby's cry activate a mother's emotions. This is physical as well as psychological. Upon hearing her baby cry, a mother experiences an increased blood flow to her breasts, accompanied by the biological urge to pick up and nurse her baby. This is one of the strongest examples of how the biological signals of the baby trigger a biological response in the mother. There is no other signal in the world that sets off such intense responses in a mother as her baby's cry. At no other time in the child's life will language so forcefully stimulate the mother to act.

Picture what happens when babies and mothers room-in together. Baby begins to cry. Mother, because she is there and physically attuned to baby, immediately picks up and feeds her infant. Baby stops crying. When baby again awakens, squirms, grimaces, and then cries, mother responds in the same manner. The next time mother notices her baby's precrying cues. When baby awakens, squirms, and grimaces, mother picks up and feeds baby before he has to cry. She has learned to read her baby's signals and to respond appropriately. After rehearsing this dialogue many times during the hospital stay, mother and baby are working as a team. Baby learns to cue better; mother learns to respond better. As the attachment-promoting cries elicit a hormonal response in the mother, her milk- ejection reflex functions smoothly, and mother and infant are in biological harmony.

The baby-in-plastic-box scene. Now contrast this rooming-in scene with that of an infant cared for in the hospital nursery. Picture this newborn infant lying in a plastic box. He awakens, hungry, and cries along with twenty other hungry babies in plastic boxes who have by now all managed to awaken one another. A kind and caring nurse hears the cries and responds as soon as time permits, but she has no biological attachment to this baby, no inner programming tuned to that particular newborn, nor do her hormones change when the baby cries. The crying, hungry baby is taken to her mother in due time. The problem is that the baby's cry has two phases: The early sounds of the cry have an attachment-promoting quality, whereas the later sounds of the unattended cry are more disturbing to listen to and may actually promote avoidance .

The mother who has missed the opening scene in this biological drama because she was not present when her baby started to cry is nonetheless expected to give a nurturing response to her baby some minutes later. By the time the nursery- reared baby is presented to the mother, the infant has either given up crying and gone back to sleep (withdrawal from pain) or greets the mother with even more intense and upsetting wails. The mother, who possesses a biological attachment to the baby, nevertheless hears only the cries that are more likely to elicit agitated concern rather than tenderness. Even though she has a comforting breast to offer the baby, she may be so tied up in knots that her milk won't eject, and the baby cries even harder.

As she grows to doubt her ability to comfort her baby, the infant may wind up spending more time in the nursery, where, she feels, the "experts" can better care for him. This separation leads to more missed cues and breaks in the attachment between mother and baby, and they go home from the hospital without knowing each other.

Not so with the rooming-in baby. He awakens in his mother's room, his pre-cry signals are promptly attended to, and he is put to the breast either before he needs to cry or at least before the initial attachment-promoting cry develops into a disturbing cry. Thus, both mother and baby profit from rooming-in. Infants cry less, mothers exhibit more mature coping skills toward their baby's crying, and the infant-distress syndrome (fussiness, colic, incessant crying) is less common than with nursery-reared babies. We had a saying in the newborn unit: "Nursery-reared babies cry harder; rooming-in babies cry better."A better term for "rooming-in" may be "fitting in." By spending time together and rehearsing the cue-response dialogue, baby and mother learn to fit together well--and bring out the best in each other. :balloons:

Your baby was on an O2 monitor in your room??! :uhoh21: Not cool.

Why, we do that on occasion. If you have very involved parents, and a baby that is not critical, it's fine for the parents to watch, as long as the nurses are around if need be. In my opinion, the parents are far more likely to really watch (sometimes too closely) the numbers on the Sat monitor than nurses are.

Sometimes, nurses tend to try and rxclude parents from the baby's care. Sometimes, we have to step back and rememebr that the baby belongs to the parents: not to us and they certainly have a right to be involved in the baby's care.

My situation was a bit different than most. I live away from most of my family (across the country) and my husband had to stay with our other child. My mother-in-law couldn't come and stay. I was completely alone with the exception of occasional visits for those days. I also have an autoimmune disorder that, as most do, rears its ugly head with stress.

Don't automatically assume they returned the baby for feeding. I was supplementing. She was a great latch and would feed well from me, but we had other GI issues with her so we were doing both. The nurses knew they could have given her something. I know all about bonding and breastfeeding and all the rest. This was my third child and I had already had years of experience in L&D. No one needed to teach me or my underlying maternal self to bond. The baby and I had already shown we were fine in that area.

I simply needed one night of sleep to recoup from the problems I had at delivery and the exhaustion from the heavier than normal bleeding...methergine was given twice....my counts weren't quite low enough to warrant a transfusion. Nevermind the stress from worrying about the baby.

All of this is simply one example of why strict rooming in may not be best in EVERY case. I wasn't saying rooming in is bad. Heck, I wanted her there, but I simply wanted a short reprieve. One night wouldn't have killed the baby...or the nurses. The best part of the whole story is one year later, I was finishing my BSN and did my preceptorship on that very same unit. I was told by a group of nurses chatting: " Lots of moms ask for us to take the baby but they just need to learn to deal. We're not going to be there when they go home." Very similar to a previous post. This is cold. I work in a CVICU now and imagine if I had one of my open-heart patients laying in tears, throwing up from exhaustion, bleeding more than expected, outright asking for help after FOUR days and nights and I told them they just had to stick it out on their own...I won't be there when you go home! This is the recovery period, I came to the hospital in case I needed help. I could have homebirthed, but didn't (thank goodness). How about instead of just lumping every patient into one way of treatment, we ASSESS the patient and treat them like they had individual needs.

There is a huge differnce between a cardiac patient and a new nursing mother. Let's compare apples with apples. Encouraging a breastfeeding mother to sleep through and have the baby fed in the nursery is undermining that mother/baby couplet. As a nurse (but here as a lactation consultant) I have to say that you, as that L&D or PP nurse will not be the one trying to undo what has been done in the hospital when the mom is having difficulties that may never have needed to happen.

It's important to assess each situation carefully. Is the mom asking for a temporary reprieve so she can catch her breath and care for her child better? Or is she asking for babysitting service so she can yak on the phone and show off the new doll clothes to visitors?

I really think moms need to be given a lot more information on breastfeeding, rooming-in, the couplet rhythms that are meant to develop naturally, etc. LONG before delivery. They need time to be exposed to these ideas and absorb them when they're not under duress. Maybe lactation counselors should see them in their fifth or sixth month. I know, I know, insurance companies would have a cow (pardon the pun), but if more moms had the vision of how things are supposed to be, maybe it wouldn't be such scary and loaded topic.

Women who have never seen successful breastfeeding and who don't have staunch advocates and examples are often just lost, no matter how highly motivated they are. Natural mothering becomes a litmus test for personal worth instead of a blessing. You can endure a lot to achieve a goal if you can picture the rewards awaiting you and if you have some confidence in your ability to get there. Without those things, doubt and discouragement take on greater power. Some moms quit just to get out of the minefield.

I think LCs get a bad rap as high-pressure guilt-mongers because they have to compress a job that could well fill several months with education and inspiration into a few short minutes spent with a mom who is, by nature of the referral, already having problems.

Here's an idealistic wish. Wouldn't it be wonderful if there were natural parenting classes the same way there are natural childbirth classes? After all, L&D is over in a flash compared to the rest of the baby's life.

Honestly, by the time we get them in PP, it's almost too late.

Miranda

Specializes in CV Surgery Step-down.

1st child - breastfed, roomed in. Didn't dare ask a nurse to take the baby to the nursery for fear I'd be labeled a "bad mother".

2nd child - 23 mos. later, same hospital - breast fed, roomed in on first night (born at 2100). Second night - nurse checks in 2300 after feeding and asks if I want to send the baby to the nursery until his next feeding. I'm now in love with this woman!!! Yes, yes, yes! I knew that this would be my last few hours of un-interrupted sleep before heading home the next day to a two-year-old and a newborn. Baby returned 3 hours later for a feed, and stayed with me until I was DC'd the next day.

Rooming-in is for HEALTHY couplets only.

If a mom or baby is compromised, staffing must provide for special care for the patient w/those needs.

Babies on monitors do NOT belong in room w/mom. If a baby is that compromised that he/she is on a monitor, then that is a "special care" case, requiring close watch by nursery personnel.

Conversely, if a mom is sick (Magnesium therapy comes to mind, among other things) then she needs special care too----she may not be capable of caring for her baby for a number of reasons. If this is the case, then again, staffing needs to allow for special care of that mom, e.g. someone to watch over the infant's needs/care while mom is sick.

Rooming-in really IS the way to go, for all the advantages listed. But like I said, it is NOT for a compromised couplet. I would not want to work in a place where medical needs of a patient are not considered in the rooming-in process.

Also of note: my sympathties for moms does NOT extend to the case of a breastfeeding mom who wants to "sleep all night and have her infant in the nursery" but DO NOT DARE FEED HIM ANYTHING. I have seen this more times than I care to mention. And I will tell them, if you are breastfeeding, baby will come back for eating, period. This is how it will be at home, so you need to be accustomed to this pattern. You will lose a lot of sleep. That is how it is, when you have a newborn. If you are dead-set on a "full night's rest" in the hospital I will do what I can to give you your sleep, but the baby WILL Be eating in your absence, which may compromise your breastfeeding relationship at a critical time, when you need to be learning each other's cues in the earliest days.

Most get it, others are still clueless and I wonder what their lives will be like when they go home and there is no nurse to "deal" for them. :coollook:

Excellent post, Deb!

This is one reason why I encourage limiting visitors during the day so mom can rest. Most hospitals I worked at in Canada did not have well baby nurseries at all. I'll let that sink in for a moment.... NO WELL BABY NURSERIES.... It's a foreign concept to many nurses;). Healthy moms and babes stayed together the vast majority of the time. Moms were encouraged to limit entertaining visitors during the day so that they could sleep when the baby slept. Babies sleep about 70% of the time so that makes for a lot of opportunities for moms to rest if they aren't being disturbed every 20 minutes by visitors/staff. They had private rooms so a significant other could stay with them and help. Occasionally a mom would need the baby to be out so she could have a shower or go for a smoke and no SO in the room. That wasn't a problem in general and I can only remember one woman complaining that we wouldn't take the infant out to a nursery for the night. The vast majority of women want their babies with them in the room.

I previously worked at a hospital that was just at the start of the "Baby Friendly Initiative", and the whole concept with me and the other RN's went over like a lead balloon. I ended up quitting before they formally started. I am currently working at a hospital that is very diligently working towards Baby Friendly status, and I must say, as an RN, it is no where near as bad as I thought it would be.

Now, as the bad mother who bottle fed her babies, I sent all of mine into the nursery at night. Would I do it again now? I don't know. I found when I did try to keep them with me, and I did try, I wasn't able to sleep well. It didn't help that when I delivered my 3rd, there was a woman arrested at a local hospital for impersonating a healthcare worker with the intentions of abducting a baby.

I love Miranda's idea about the natural parenting classes. I have often thought a realistic postpartum class should be part of the Childbirth Education classes.

Bottle feeding does not make a bad mother.

Bottle feeding does not make a bad mother.

Oh, I know! It was always a joke with me and my RN coworkers. It's funny though, my eight year old son recently asked me if I breastfed him and when I told him no, his response was, "Thank God, that's gross!" :)

Oh, I know! It was always a joke with me and my RN coworkers. It's funny though, my eight year old son recently asked me if I breastfed him and when I told him no, his response was, "Thank God, that's gross!" :)

I wasn't breastfed either and I turned out just fine. I know rooming in probably started as a way to encourage breastfeeding, but our bottle feeders did it too.

Why, we do that on occasion. If you have very involved parents, and a baby that is not critical, it's fine for the parents to watch, as long as the nurses are around if need be. In my opinion, the parents are far more likely to really watch (sometimes too closely) the numbers on the Sat monitor than nurses are.

Sometimes, nurses tend to try and rxclude parents from the baby's care. Sometimes, we have to step back and rememebr that the baby belongs to the parents: not to us and they certainly have a right to be involved in the baby's care.

If a baby is sick enough continuous oxygen saturation monitoring is warrented, it is not a parents job to "watch the numbers".They are not trained to do so.

It is not part of being involved the baby's care as say diaper changing and bathing would.

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