Rooming-in Vs. Nursery Care

[isemalo]

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:

[babynursewannab]

hmmm.... While I am all for the theoretical aspects of rooming in, I know from experience it is not always the best choice. In fact, in my case, rooming in was a significant factor in excessive fatigue and postpartum depression. Granted this was because we were there for 5 days. However, the "rooming in" mindset of the facility prevented me from getting more than 2.5 hours of sleep each 24 hour period. While in my room, my daughter was on billi lights and antibiotics and an O2 monitor so monitor alarms, pump alarms and bright lights were constantly on or sounding.

On night four, I was throwing up from lack of sleep (the unfortunate way my body handles that situation), I started bleeding excessively and I was barely able to keep any conversation going with my husband...just couldn't think straight. I BEGGED for the baby to go to the nursery at 4am. I got a look of total shock from the nurse and an "oooooooooKaaaaayyyyy" as she slowly rolled the bassinet out of my room. I am not kidding here when I tell you they returned the baby to me 2, TWO hours later!!!!! WTF???? I became so angry and resentful at that point towards the staff, my husband, my mother-in-law, my other daughter and also the baby. I was sent home 5 hours later to the usual new-parent, breast-feeding, other-children-at-home fatique without any rest whatsoever after delivery. That anger ended up being the major manifestation of my pp depression. I didn't even recognize myself. It took a while to resolve, but it did. All I had needed was sleep after delivery to cope better. I'm not saying I wouldn't have experienced some degree of ppd, but my anger and resentment always trailed back to the hospital whenever I thought a lot about it.

So, while in most cases....and I do believe in most...rooming in is probably the best option, it certainly is not ALWAYS best. I think facilities and nursing staff need to pay really close attention to the mothers' behavior patterns and not just vital signs (as I have seen in most cases -- yes I have worked L&D). Many are tired or don't want to be pests so don't really say what they need.

This wasn't a flame on the OP, I just wanted to give another viewpoint to the story.

-Alyssa

[BETSRN]

hmmm.... While I am all for the theoretical aspects of rooming in, I know from experience it is not always the best choice. In fact, in my case, rooming in was a significant factor in excessive fatigue and postpartum depression. Granted this was because we were there for 5 days. However, the "rooming in" mindset of the facility prevented me from getting more than 2.5 hours of sleep each 24 hour period. While in my room, my daughter was on billi lights and antibiotics and an O2 monitor so monitor alarms, pump alarms and bright lights were constantly on or sounding.

On night four, I was throwing up from lack of sleep (the unfortunate way my body handles that situation), I started bleeding excessively and I was barely able to keep any conversation going with my husband...just couldn't think straight. I BEGGED for the baby to go to the nursery at 4am. I got a look of total shock from the nurse and an "oooooooooKaaaaayyyyy" as she slowly rolled the bassinet out of my room. I am not kidding here when I tell you they returned the baby to me 2, TWO hours later!!!!! WTF???? I became so angry and resentful at that point towards the staff, my husband, my mother-in-law, my other daughter and also the baby. I was sent home 5 hours later to the usual new-parent, breast-feeding, other-children-at-home fatique without any rest whatsoever after delivery. That anger ended up being the major manifestation of my pp depression. I didn't even recognize myself. It took a while to resolve, but it did. All I had needed was sleep after delivery to cope better. I'm not saying I wouldn't have experienced some degree of ppd, but my anger and resentment always trailed back to the hospital whenever I thought a lot about it.

So, while in most cases....and I do believe in most...rooming in is probably the best option, it certainly is not ALWAYS best. I think facilities and nursing staff need to pay really close attention to the mothers' behavior patterns and not just vital signs (as I have seen in most cases -- yes I have worked L&D). Many are tired or don't want to be pests so don't really say what they need.

This wasn't a flame on the OP, I just wanted to give another viewpoint to the story.

-Alyssa

>

I notice that you mention that your baby was returned to you two hours later (as above here). You also mention breastfeeding. I assume you were nursing and if that is the case it is perfectly natural for the baby to want to eat every two hours. Obviously, the baby wouod have come back out to you in a couple of hours.

Would you not maybe get only 2 1/2 hours of sleep at home with your new infant?

While I am all for new mothers getting rest, the hospital stay is also so that Mom learns to care for her new infant and respond to the baby's cues. That cannot happen if the baby is sitting in a nursery.

We always respect a mother's wishes and help out as much as possible. We usually take babies under phototherapy to the nursery at night so that Mom can sleep and not have the bili lights bother her (not to mention we have to know that the baby's eye shield is on corectly). but during the waking hours, the baby stays with Mom as much as possible. We show her how to take baby in and out,etc., and are always available to help with questions or problems.

However, when nurses take babies to nurseries under the guise of letting Mom rest, we are doing her no favors, whatsoever. When Mom goes home, the nurses are not going with her and the reality is that she will indeed, be on duty 24/7. The more familiar she is with her infant, the better.

If she is breastfeeding, she will be feeding that baby every 1-3 hours anyway. The more that baby is withher in the hospital, the easier her adjustment will be at home.

It sounds like your baby had a lot going on. I was mostly speaking for the feeding issue.

[rn/writer, RN]

Rooming-in does promote attachment. But so does a mom who isn't physically maxed out.

I've seen moms who were so drained that they felt absolutely overwhelmed and defeated. Most of them are very aware of the rooming-in advantages. All they want is an uninterrupted chunk of sleep to regroup and then they'll gladly jump in with both feet.

Last week, I had a lovely mom with her seventh child. She was nursing frequently but had a migraine headache and could only take tylenol d/t allergies. She was exhausted and faced discharge the next day. We took the baby into the nursery, supplemented her one time (yes, I know, another no-no), and handed her back to mom five hours later. Mom was a new woman. She eagerly took back her newborn and felt like she could go home in much better shape.

Undoubtedly, she was a good risk because she was a very experienced mom. But even new moms sometimes feel like they just need to get ahead of the game.

I do try to facilitate awareness of feeding cues by bringing the babies into the room before they start crying. I tell the moms I will be doing this and they usually stir but don't fully awaken when the babies come in. This allows them to experience the pre-crying sounds and mentally start waking themselves up. Once the moms get some real rest, nearly all of them plunge in with enthusiasm and enjoyment.

I HAVE noticed a difference in the rooming-in habits of moms who have a significant other staying with them. Dads who get up and hand the baby to mom and change the little one afterward seem to foster a sense of security and rest in their women. The moms who stay alone have a harder time and not just for the obvious reasons. I think it has to do with feeling like SHE matters along with the baby.

I try diligently to promote breastfeeding and rooming-in, but I will be fully supportive of the mom whatever choices she makes. That is, supportive of her as a person, although I may wish she had chosen differently. If taking baby into the nursery for four hours will allow a mom to "get a handle" on her fatigue, I will gladly mother the mother so she can mother her child.

I should add that I work noc shift. The moms have the babies with them all day.

Miranda

[dawngloves, BSN, RN]

While in my room, my daughter was on billi lights and antibiotics and an O2 monitor so monitor alarms, pump alarms and bright lights were constantly on or sounding.

-Alyssa

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

[SmilingBluEyes]

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.

[babynursewannab]

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.

[SmilingBluEyes]

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.

I live a couple thousands of miles from my family, too---being military. Had one child at home (7 years old)---who my dh had to see to....I had a csection w/my dd. After the 1st operative day, I determined I would have to get out of bed and care for my baby myself. I did that, despite a lot of pain and the like. Post-op pain is tough to get around those first few days out of bed.....I know that much.

If my daughter needed feeding, I was right there; she roomed in w/me. If she needed diaper changes, etc, it was up to me. The nursing staff offered to take her one night. I let them....... I heard her crying out there, and had to get out of bed and get her. Seemed she could only be consoled by me.

I did supplement her w/cups of formula til my milk came in on day 3. Reason, she was 9 lb (at 38 weeks) and always hungry. MY breasts were beyond sore after nursing for hours at a time in one shot....she cluster-fed like a champ.

I did all that myself, however. I did not ask nursing staff to do these things just because I knew they had other couplets and also because I knew they did not go home w/me once I was discharged.

After having had a baby in a NICU/SCN (my first son) I was NOT amenable to letting my daughter spend time in the nursery at all. I felt, being healthy, we belonged together. It was only natural to me.

I, too, had no one in family nearby when she was born. NO grammas or aunties to come help me out, even after I got home til the 3rd day when Scott's gramma came to help care for my son. (thank goodness for her).

In the hospital and at home, I had to see to her care myself. I think doing so, got me out of bed, sooner and on a faster course of recovery from my csection. I was walking 1-2 miles a day one week after surgery.

I think the sooner we resume the moms to the healthy status as MOTHERS, the better for them and their babies. In a normal birth, neither is sick, and we dont' need to treat them as such. Moms are not helpless, and we need to teach them that from hour one after birth. They cannot learn their infants' cues for feeding, changing and attention if they spend their time in a nursery, even at night. Even if it's not the first baby, each newborn has unique behaviors and cues that moms and dads need to learn, early on.

That is why I am not for well-baby nursery care, at all. If a mom is sick, or just freshly post-op, I see the need. Otherwise, I truly believe in a healthy situation, the baby belongs in room w/mom and s.o. 24/7 so they can learn how to care for them in the short time they are with us.

JMO as always.... :)

[babynurselsa, RN]

I think what we need to realize that there can be a happy medium here. Yes rooming in is the best for mom and baby. Yes there are circumstances that baby can go to the nursery for a while and let mom get a nap and the entire bonding process will not be put into jeopardy.

There is a difference between the mom who parks her kiddo on the nursery so she can go smoke(18 or 19 times a shift), or sends her baby to the nursery because he smells suspiciously, or they just don't want to mess with the baby. I have seen my share of moms that send the baby to the nursery at 9pm and don't want to be disturbed for the rest of the night and demand no supplemental feedings or pacifiers. Our policy was breast babies to mom q2-4 hours period we were not supplement unless mom insisted.

We also need to be flexible in allowing a baby to come into the nursery if mom is exhausted, sick or hurting. Even if the baby goes back out for feedings and allow mom to get 2-3 hours of sleep. Some experienced moms with other children at home may request a feeding supplemented to let her get a stretch of sleep before she gets home and is on 24/7. There is nothing wrong with this.

This is why we need to assess each situation on a case by case basis and see what the needs of this pair are and act accordingly.

[SmilingBluEyes]

I think what we need to realize that there can be a happy medium here. Yes rooming in is the best for mom and baby. Yes there are circumstances that baby can go to the nursery for a while and let mom get a nap and the entire bonding process will not be put into jeopardy.

There is a difference between the mom who parks her kiddo on the nursery so she can go smoke(18 or 19 times a shift), or sends her baby to the nursery because he smells suspiciously, or they just don't want to mess with the baby. I have seen my share of moms that send the baby to the nursery at 9pm and don't want to be disturbed for the rest of the night and demand no supplemental feedings or pacifiers. Our policy was breast babies to mom q2-4 hours period we were not supplement unless mom insisted.

We also need to be flexible in allowing a baby to come into the nursery if mom is exhausted, sick or hurting. Even if the baby goes back out for feedings and allow mom to get 2-3 hours of sleep. Some experienced moms with other children at home may request a feeding supplemented to let her get a stretch of sleep before she gets home and is on 24/7. There is nothing wrong with this.

This is why we need to assess each situation on a case by case basis and see what the needs of this pair are and act accordingly.

I agree. I do give "breaks" to exhausted moms or those in severe pain.

But I get annoyed when they ignore our advice to rest up during the day, entertaining a cast of 100 visitors and like you said, going down to smoke time after time again. We only have so much time and so much of our selves to spread around at work. The ones in pain and/or exhausted get my priority, as do those who are truly sick.

[babynurselsa, RN]

I agree 100% Deb.

That is just what I was talking about.

I do find I have little patience for the mom by her 15/16 smoke break halfway through the shift. But, I do have pity on the mom who was a 3 day induction actively laboring for 18 hours and pushed for 2. I think she is alloted a little rest before resuming mommy duty.

See the difference? :)

[gr8rnpjt, RN]

Wow!! all that in 2 days or less!

Just kidding, that was very well written and thought provoking. You should print it up and hand it out in the delivery room