Rooming-in can be beneficial for both mother and baby after birth, but it's also taking the choice away from parents who need it.

By Risa Kerslake
Updated December 17, 2019
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Illustration by Emma Darvick

While Melanie Forstall knew she would be giving birth in a hospital without a nursery, she was in no way prepared for what that would mean.

Her Baton Rouge-based hospital practiced rooming-in, where mother and baby would remain together the whole stay. It was better for the bonding experience, she was told.

But after 48 hours with a nursing baby and no sleep, she begged her nurse for help and got a break for 30 minutes while the baby was taken for a checkup. Her husband held the baby another three hours during the night so she could sleep. "I finally felt human again," recalls Forstall.

Where Did All the Nurseries Go?

Experiences like Forstall's aren't unusual. Rooming-in is part of the Baby-Friendly Hospital Initiative (BFHI) launched by the World Health Organization and UNICEF in 1991 in an effort to raise breastfeeding rates around the world. The first opened in the U.S. in 1996 and since then 25 percent of babies are born every year in a Baby-Friendly-certified hospital. (The Baby-Friendly USA site includes a place to search for specific hospitals.)

In order to become certified, hospitals must adopt 10 steps that include telling moms about the benefits and management of breastfeeding, helping them start breastfeeding within the hour after birth, and allowing infants to remain with moms for 24 hours. The latter is a point that has received backlash from parents and experts alike.

This spreads the belief that mothers should be caring for their babies full time, with support only when they need it or ask for it, says Harvey Karp, M.D. "That's completely abnormal," adds the author of Happiest Baby on the Block and inventor of the SNOO, Smart Sleeper.

While Baby-Friendly USA explains it doesn’t force mothers to care for their babies “every minute of their stay” or require newborn nurseries to close, these are trends that have been taking place across the country. Emory University Hospital Midtown in Atlanta and Dartmouth-Hitchcock in New Hampshire are just some examples of hospitals that no longer use nurseries, according to the Boston Globe. In other hospitals, labor and delivery nurses have reported their unit’s nursery lying vacant, used for storage, or a place to perform a quick newborn procedure. The consequence becomes new mothers shouldering the responsibility of their babies 24 hours a day even when they aren't able to.

Rebecca Weinberg, Psy.D., a psychologist for West Penn Hospital Women's Behavioral Health department says she hasn't personally seen evidence that rooming-in has a negative effect on mothers postpartum, but she does acknowledge the lack of control a mother can have if she doesn't receive support she needs. That alone can play a role in developing postpartum mood disorders.

It can also lead to increased stress on the parent and danger to the baby as moms are more likely to fall asleep in bed with them, risking injury due to falls and in some cases, infant death. Reports found underreporting of “cases of infant deaths and near deaths while bed sharing” within 24 hours after giving birth in maternity wards.

How to Better Support New Moms

It's clear new parents need more aid. Asking staff for help taking the baby is certainly something mothers can do, but as both Dr. Karp and Dr. Weinberg acknowledge it's not always a feasible solution.

What could be useful, suggests Dr. Weinberg, is doing research ahead of time by touring the hospital and making sure there's a nursery if that's a high priority for parents.

She regularly coaches her patients on having flexible expectations, but this is especially important if parents have to deliver at a hospital without a nursery. "You don't know how your delivery is going to go and what help you're going to need," warns Dr. Weinberg. "If you have a lot of social supports, you may be fine. But if you don't, it could be difficult."

Therefore, Dr. Weinberg says hospital should carry the responsibility and do better. "They should be able to offer some flexible options if they don't have a nursery for parents who need more support," suggests Dr. Weinberg. Nurses can also check in more frequently on moms, especially those with limited support systems. 

Other options that some units are implementing are quiet times with lights dimmed and procedures and assessments are kept to a minimum so moms can get some rest.

Dr. Karp has been working with hospitals on another solution with his SNOO bassinet, which soothes a baby by being swaddled and secured, giving them the sensation of still being in the womb. It's been trialed in 25 hospitals and expected to be in more postpartum rooms around the country. It's a win-win: mother can have support and hospitals can reduce liability at a cost cheaper than added staff, according to Dr. Karp. "It's like having an assistant nurse in the room with the mother," he adds.

For Forstall, whose child is now 11, better assistance would ultimately have made all the difference during her delivery.

"We don't appreciate what women go through in childbirth," she says. “It would have been really nice to be able to say, ‘I've had 12 hours with this baby and now she's going to the nursery to give me two hours to shower.’ I don't think there's anything wrong with that."

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