Family-Centered Maternity Care and Rooming-In

A thread in the Ob/Gyn nursing forum got me thinking about this. Family-centered maternity care (FCMC) is a buzzword that's no doubt quite familiar to many in maternal/child nursing circles. In my almost-eight years as a nurse - not long in comparison to many of my colleagues - I have seen several hospitals in my area make the switch from all separate units to some form of FCMC and rooming-in.

Family-Centered Maternity Care and Rooming-In

There are, according to Dr. Celeste Phillips, 10 principles upon which FCMC is based:

  1. Pregnancy and childbirth as normal and healthy processes
  2. Personalized prenatal care
  3. Comprehensive perinatal education, with active input from the family
  4. Healthcare professionals assist the family in making decisions important to their care
  5. Mom's support system is actively involved in prenatal care, labor, birth, and infant care
  6. Support people present at Mom's discretion
  7. Labor and postpartum care provided in as much of the same space and by as many of the same people as possible
  8. Moms are encouraged to keep their babies in the room with them at all times if possible.
  9. The same nurse cares for Mom and baby as a couplet
  10. Parents included in as much of the sick newborn's care as possible.

Obviously, this is going to look different at every hospital, but for the most part, I have seen it work at mine. Our unit is not set up to have LDRP rooms; women give birth in Labor & Delivery, then are transferred to Mother/baby for the rest of their stay. As it is currently, a baby is brought to the nursery about an hour after birth (unless unstable, then brought sooner) for bath and assessment, then is back out to mom as soon as possible. If Mom requests, we can do the bath and assessment in the delivery or postpartum room; unfortunately, we are not currently staffed to do this for everyone, which I do not like.

In the mother/baby unit, we try to promote mother-baby togetherness pretty much from the start. As soon as we admit the mother, we let her know that we do encourage her to keep the baby with her as much as possible, and we encourage a support person to stay with her and help her. And of course, we nurses are there to help her with her baby as well.

Of course, there are times when Mom is physically unable to care for the baby - she is hemorrhaging, is just plain tired after laboring and then a c/s, is vomiting up her toenails (so to speak) or for infection control purposes - and we are able to work around that. We can bring a baby out to her for feeds, or we can feed the baby in the nursery with a cup or a bottle (Mom's choice) until she is feeling better. We also have occasions where a baby is up for adoption, or resulted as a product of the mother being raped - we go on a case-by-case basis. Some mothers want their babies with them, others do not. We certainly do not force anything on anyone. These situations are fortunately the exception rather than the rule.

It never ceases to amaze me how often rooming-in works, though. I have seen it work with moms of babies up for adoption, prisoners, single moms, married moms, moms of all nationalities, ages, socioeconomic strata, and personality. It never ceases to amaze me how often moms want to keep their babies with them; maybe it shouldn't, but it does. Even fresh c-section moms!

There are some things I do to help them out. If I'm in the room, I change diapers so Mom can pee or do whatever she has to do to take care of herself. I help settle fussy babies, so Mom can rest her eyes and arm, and often they are both sound asleep by the time I walk out of the room and they stay that way for a while. I show new parents how to swaddle and settle so that they don't lose their sanity with a screaming baby all night. I try to help Mom make sure she's got a good latch (if she's breastfeeding) and baby's getting enough to eat so he'll sleep between feeds. I try to cluster my care so that I don't have to wake the family up multiple times - sometimes if they're all sleeping when I walk in, I just leave a note on a paper towel in the baby's crib for Mom to call me when they all wake up so I can assess/medicate/whatever else. In the middle of the night, I don't knock before I open the door - again, wanting to preserve sleep! I tell Mom this when I start my shift at 7 pm and give her a chance to object, but most don't. Most thank me for not knocking every time I need to lay eyes on them. (That said, I would never ever take a baby out of the room without letting Mom or Dad know where and why.)

If Mom is at her breaking point and just needs a break from the baby - which many moms do at some point, whether in the hospital or at home - I let them know the nursery is there. I just tell them I need to know what to do about feedings: bring the baby back to feed, feed a bottle in the nursery, or cup feed in the nursery. All most moms ask is just for a few hours to take the proverbial edge off. Our hospital is fortunate to have a nursery staffed with two RNs so that this is an option. More often than not, though, with a little help, my moms keep their babies. I'm not a 'You-MUST-keep-your-baby' taskmaster, but sometimes all it takes is an extra pair of hands or a listening ear. Many a mom has spilled her guts about fears or frustrations or just the awesomeness of childbirth when I pull up a chair in her room at 2 am.

I really try to do my best to individualize my care. Some moms want me to leave them alone and let them do their thing. As long as she and baby are safe, fed, and ok, I'm fine with that. Others want more hands-on care. I'm fine with that too. Often first-time moms need so much cheerleading because we (I'm including myself in that category) are SO unsure about our abilities to parent. We are certain that we'll never figure out what's wrong with the baby when he cries, or that we'll never learn what sounds we can sleep through. I try to be that nurse that reminds them that for millennia, moms and dads have learned what their babies need, and so will this one that's in front of me. It's so easy as a nurse that swaddles a baby a hundred times a night to lose patience, and remember that this new daddy has never done it before and is afraid his baby will break if he wraps her too tight. But remember we must.

There are so many other issues that tie into FCMC - feeding baby, visiting hours, co-sleeping, psychosocial issues, infection control, and many others - that there's no way I can possibly do them justice in these few paragraphs. But I am interested in how your hospital handles FCMC, or what challenges you have had in your transition to FCMC, or anything else related to the topic.

Great FCMC resource:

http://www.pandf.com/index.html

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Elvish

About Elvish, BSN, DNP, RN, NP

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Specializes in Trauma.

Elvish, you are helping me so much becoming acquainted with becoming a new mom. It's a scary thought to me and I go in and out of these fear moments. I just don't even know how to imagine it, b/c I hear so many different POV. I love the idea of FCMC, it makes the best sense to me!!

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Specializes in Community, OB, Nursery.

Awww, thank you, CityKat. It's funny - I remember when I brought my son home, and everybody had left, and it was just us two. I had RN behind my name and baby experience...and was scared to death because I had NO CLUE what to do with him. Don't let anybody pull that "You're a nurse" bit.

You will, however, do fine.

For millenia, moms and dads have learned what their babies need

:icon_hug:

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This is great! I love your viewpoint on this and wish my nurses were like this. I never wanted my babies to leave my side yet was scared to death the first time of this tiny little screaming baby. If I had a nurse like you, I probably wouldn't have gotten so stressed out. Individual attention from your nurse can mean the world to a new mom. I hope, if I end up a nurse in L&D or PP, I will be like you. :)

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Hello,

As LDRP nurse, one thing that I have noticed with the advent of "Family Centered OB Care" is that sometimes the laboring patient or new mom has visitors in the room that she doesn't want there, but is not able to tell them. As the nurse in this environment, sometimes I need to be the patient's advocate (be the bad guy) and kick them out. When a mom is in labor, especially, I've found that many of the visitors seem to have an "it's all about me" attitude. The patient is lying on her side, facing away from the visitors, to stop fetal heart rate decelerations; while the visitors sit and have a party. What are your thoughts about this?

KMRN2001

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Specializes in Trauma.

Geesh, I have actually been thinking about that lately. I only want a few people there. It seems difficult to concentrate on breathing and relaxing with all these people in the room. I've been trying to figure out who I want in the room with me in November!!

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Specializes in Community, OB, Nursery.
Hello,

As LDRP nurse, one thing that I have noticed with the advent of "Family Centered OB Care" is that sometimes the laboring patient or new mom has visitors in the room that she doesn't want there, but is not able to tell them. As the nurse in this environment, sometimes I need to be the patient's advocate (be the bad guy) and kick them out. When a mom is in labor, especially, I've found that many of the visitors seem to have an "it's all about me" attitude. The patient is lying on her side, facing away from the visitors, to stop fetal heart rate decelerations; while the visitors sit and have a party. What are your thoughts about this?

This is definitely a problem, agreed. Laboring/postpartum moms don't need to feel like they're 'entertaining' guests, and I do see the 'me' attitude in visitors as well.

I don't have a problem being the bad guy and kicking people out either. If she wants them there, that's cool, but if she doesn't, they're gone. It's my belief that the baby and mom (and dad, if he's in the picture) are the most important players in the game, so to speak. Everybody else can take a number and get in line. On the postpartum end, I tell the patient flat-out that if she wants people to leave, we can have a code word/phrase/signal, or whatever works for her that indicates to me she wants me to kick them out.

Good point!!!

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Specializes in Psych, Med/Surg, LTC.

I am not a labor/delivery nurse, but I delivered in a hospital where rooming in was required... IT was fabulous. I loved it. By baby never left my side. I didn't have to worry that anything was being done against my wishes. My dh was encouraged to stay with me, too. It was great.

The second place I stayed was not baby friendly. I cried so much when my baby was taken from me, my dh was discouraged from staying (they tried talking him out of it by saying there were no beds, he said that is fine, I can sleep sitting up in a regular chair, you aren't getting rid of me. Then they suddenly found a cot. :yeah:) I won't deliver there again. I want my baby with me for everything. My dh can care for them if I am too tired.

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Specializes in Community, OB, Nursery.

Gooey, the second hospital you describe sounds like the place where I had my son. They would not allow him in my postpartum room until after his bath, because he was considered 'biohazard.' (And exactly what is all this stuff coming out of my nether regions??) I am seriously considering delivering elsewhere OR raising a lot of Cain about that among other things. It bothers me that so many hospitals treat the baby like he's theirs, and not his parents'.

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I am not a nurse (yet), but I have delivered a baby in a family friendly hospital and loved the experience. Considering I was there for 4 full days for the experience (c-section) I really appreciated the opportunity to have my first born son with me when I wanted him there, but equally appreciated that I could ask the nurse to take him to the nursery when I wasn't up to "full alert" mode (you all know how first time moms are alerted to EVERY SINGLE THING that goes on with a new born?!?!)

The post concerning family in the room was actually pretty funny to me. I did not want my mother in the room with me and she was insisting that she be there. My nurse and I came up with the "one extra person in the room rule", meaning that my husband could stay but everyone else was out. Ultimately it didn't matter since I had to be sent down the hall to the ER for a baby that was too big c-section, but I was happy for her to be the bad guy. Thank you Barbara J, you were a great L&D nurse.

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Specializes in LDRP.

Most of my 17 years as a RN has been spent in a LDRP unit at two different hospitals. At the first hospital we had rooming in, allowed support person to stay, and we had visting hours for everyone else!

The hospital I work in now allows rooming in, does not have any specific visting hours, allows as many people in the delivery as the patient wants ( if feasable). I am a huge supporter of family centered care. But by that I mean the family unit. Mom, support PERSON, and baby. It seems these days the birthing process is more a circus than an intimate family event. I long for the days of visiting hours. We have so much to do and teach the family unit in 2 days, its hard to fit it all in.

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FCMC is great when mom is physically able to car for baby. One of my daughters delivered (c/s)-and was told that there was no nursery. In this case, "family centered" meant that you better hope and pray that you had someone with you to care for you and baby...scary part this was only 2yrs ago...

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