In Defense of Rooming-In

Rooming-in is the maternity model of care which allows for mothers and infants to stay together and minimizes unnecessary separation.  It is also one of the Ten-Steps to Successful Breastfeeding which are the backbone of the Baby-Friendly Hospital Initiative.  So why does rooming-in seem to be getting such a bad rap these days?  Some social media posts suggest that rooming-in is a hardship for mothers, and that women are being “forced,” to keep their babies with them 24/7.   But rooming-in was never meant to be a negative model of care for families.  In fact, it was mothers themselves who protested the nursery model of care which separated them from their infants.

 A brief bit of history:

• Before the 1900s: Women gave birth at home - everybody was “rooming-in.” 
• 1920s: Women began to move to the hospital to give birth for the promise of safety and pain control.
• In the hospital, physicians were in control of the birth and recovery process, and new mothers were required to adhere to strict bed rest for 10-14 days.
• It was not possible for mothers to care for newborns while on strict bedrest; nursing staff had to care for the babies.
• It was more convenient for staff to care for all babies in one place and so the “nursery” was born.
• Nurses came to be considered more competent to care for babies than mothers.
• Infant formula marketing influenced parents and providers with promises of artificial feeding superiority, and mothers were discouraged from breastfeeding. Many mothers were given medication to “dry up” milk.
• The majority of babies were formula fed in nurseries, and breastfeeding rates plummeted well into the 1960s and 1970s

 Bottom line?  Babies were removed from mothers for the convenience of the staff, and mothers were not allowed to keep babies with them, even if they wanted to.  It was nearly impossible for mothers to breastfeed successfully under those conditions.  The rooming-in model of care aimed to remedy that. 

 Research tells us that there are plenty of good reasons to support mothers and babies staying together:

 Mothers who have baby with them in the room:

• Learn more about baby’s normal responses and sleep-wake cycle
• Demonstrate more attachment behaviors & report more confidence
• Produce more milk sooner
• Breastfeed longer 
• Have similar rates of sleep as compared to non-rooming-in mothers

 Babies who stay with mothers in the room:

• Have fewer crying episodes
• Maintain more stable body temperature
• Breastfeed more frequently
• Have lower cortisol levels

 Nurses play a key role

A 2017 study (Theo & Drake) exploring rooming-in found that 96% of mothers reported “the nurses had a positive influence on their rooming-in experience.”   Not surprisingly, nurses who were identified as “professional, kind, respectful, understanding, attentive, supportive, considerate, timely, thoughtful, empathetic, encouraging, and very informative,” contributed to the positive rooming-in experience.

 Providing care for baby in mom’s room allows for nurses to educate and support the transition to motherhood. Think about all the ways in which nurses role model behaviors when they care for babies in mom’s room:

• How to care for baby -
  • Changing diapers, swaddling, bathing, holding, positioning, latching
• How to relate to baby-
  • How to soothe, what to do when baby cries, making eye contact, talking to baby
• Understanding infant behaviors-
  • What to do when baby sneezes, hiccups, or spits up, what are normal reflexes and what is normal newborn behavior

 “But new parents need some rest,” you might say.  No argument there.  New parents are tired for sure, but taking the babies in and out of the room, back and forth to the nursery for routine exams, lab work, baths, hearing screens, vital signs, and admissions does not decrease parental fatigue.  Those are unnecessary interruptions.  On the other hand, when separation is necessary for the safety and/or well-being of the mother or at mother’s request, interruption of rooming-in is still an option.

 It's hard to imagine a time when mothers would not be “allowed,” to keep their babies with them, but it wasn’t that long ago.   Babies were only brought to mothers on a strict schedule, every infant procedure was done apart from the mother, and breastfeeding-if it happened at all-was restricted and timed.   The instructions in the photo above (circa 1968) are evidence of why rooming-in was a much needed change in maternity care.   So in the spirit of recognizing that mothers and babies do better when they are together, let’s support rooming-in as the superior model of care that it is. 

Mary Foley RN BSN IBCLC

Crenshaw, J., 2007. Care practice# 6: No separation of mother and baby, with unlimited opportunities for breastfeeding. The Journal of perinatal education, 16(3), pp.39-43.

De Bernardo G, Riccitelli M, Giordano M, Proietti F, et al. Rooming-in reduces salivary cortisol level of newborn. Mediators Inflamm.2018   Article ID 2845352.

Keefe, M.R., The impact of infant rooming‐in on maternal sleep at night. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 1988;17(2), pp.122-126.

Kim ES, Park YS. The effect of rooming-in on maternal attitude and self confidence for infant care among primiparas. Korean J Women Health Nurs. 2001; 7(3): 256-270.

Meek JY, Noble L, Section on  Breastfeeding; Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057988. 

So YA, Sun YK, Kyung AK et al. The effect of rooming-in care on the emotional stability of newborn infants. Korean J Pediatr.2008;51(12):1315-1319

Theo LO, Drake E. Rooming-In: creating a better experience. J Perinat Educ 2017;26(2):79-84

Waldenström U, Swenson A. Rooming-in at night in the postpartum ward. Midwifery. 1991 Jun;7(2):82-9.