Behind The Baby-Friendly Hospital Practice That Not All Moms Love

For years, newborn babies were whisked off to hospital nurseries soon after birth, and they remained for much of their stay. Nurses shuttled infants back and forth, taking them away from their mothers’ rooms to be weighed or evaluated while moms, the thinking went, rested. New mothers and babies spent much of their first few nights “together” largely, well, apart. 

But since the late 1990s, 24/7 nursery care has begun to fall out of favor in maternity wards across the United States, thanks in large part to the Baby-Friendly Hospital Initiative, a global collaboration between the World Health Organization and UNICEF. (In the U.S., it is run by Baby-Friendly USA, Inc.) The initiative aims to improve breastfeeding rates while encouraging mother-infant bonding. To earn the designation, hospitals and birth centers must subscribe to the practice of “rooming-in,” that is, keeping mothers and babies together around the clock. But while hospitals say the practice is beneficial, media coverage has been largely critical, warning that hospitals are robbing weary new mothers ― women who have just done the grueling work of birthing a human being ― of their only opportunity to get some rest. 

So who is rooming-in really good for?

Just over 350 hospitals and birthing centers across the United States have achieved the Baby-Friendly designation, though the number in states varies considerably. (California has roughly 80; whereas some states, like Arkansas, have one.) Facilities must follow 10 steps, like ensuring that mothers initiate breastfeeding within an hour of giving birth and have immediate skin-to-skin. Step 7, the rooming-in requirement, specifies that hospitals should have at least 80 percent of healthy moms and babies rooming-in 24 hours a day, regardless of whether they intend to breast or formula feed. If a mother asks for her baby to go to the nursery, hospital staff are to explore the reasons behind her request, and to inform her of the advantages of rooming-in. 

And one of those advantages is simply that more time together equals more chances to breastfeed, says Trish MacEnroe, executive director of Baby-Friendly USA. “It’s about mom learning to care for that baby, and what that baby’s cues are,” she told The Huffington Post. “[Rooming-in] is about breastfeeding, it’s about bonding and it’s about learning what a baby’s needs are. It’s not about hospitals abandoning babies and mothers.”

Yet stories covering rooming-in have tied the practice to the demise of traditional well-baby nurseries. “Women seeking a few hours of rest after hours of labor or a caesarean section often are surprised to learn that Massachusetts hospitals are increasingly restricting nursery access or, in some states, have closed the nurseries altogether,” said a story in the Boston Globe piece last winter. A Today Parents said many hospitals are doing away with nurseries. 

But MacEnroe insists the guidelines do not call for hospitals to close their nurseries. For some perspective: The CDC reports that rooming-in is the norm in less than half of all maternity hospitals in the U.S. And less than 18 percent of births in this country take place in Baby-Friendly designated facilities.

“The way it has been characterized is not accurate, in my opinion,” said MacEnroe. “Here’s what’s happening: There needs to be a place [for hospitals] to care for a baby if there is mother-baby separation. So, of course we expect there’s a place for the baby to be safely and properly cared for. But what hospitals are finding is that the majority of moms are liking rooming in when they’re prepared for it beforehand.”

Boston Medical Center, one of the hospitals highlighted in the Boston Globe piece, has been Baby-Friendly since the late 1990s, and recently received a waiver from the State Department of Health to reduce the number of cribs in its well-baby nursery. Barbara Philipp, MD, medical director of Boston Medical Center’s Well Baby Unit, said that the reduction isn’t about cutting women’s options; it’s about getting away from what she described as the old “paternalistic” model where women were made to feel like nurses and doctors knew more about their babies than them.

The primary knock against rooming-in is that it means women can’t get the sleep they desperately need without hovering over their newborn’s bassinet to watch every breath. Proponents of rooming-in point to research suggesting that moms and babies do not sleep better when they’re apart, but many moms who’ve actually lived through it are skeptical. 

“I think the physical break is important. It may not be a full night’s sleep, but I think even just having a little bit of rest ― where you can rest knowing your baby is being watched ― can make a world of difference,” said Katie Clark, a mother of two and a blogger who has written about her decision to send her child to the nursery. 

“The first night with my second son Oliver, I was exhausted beyond description,” she said. “I was worried about asking them to take him ... [and then] I was so grateful that the nurse could tell I needed rest ― even if it was just a few hours uninterrupted ― to recoup a little bit.”

In an op-ed for Forbes, mother of two Kavin Senapathy wrote about her experience delivering babies in Baby-Friendly hospitals. With her first, she spent the night “hopping in and out of bed” to comfort her crying baby, “all while cringing at the stinging of stitches” ― an experience she describes as “excruciating.” She insisted her second be taken to the nursery so she could recover, but was told “in no uncertain terms that had this been my first baby, I would not have been allowed to use the nursery because otherwise how would I learn to care for my child?”

But Philipp argued that Baby-Friendly hospitals recognize that it rooming-in is not an all-or-nothing proposition.

“Let’s say a mom says, ‘You know what? I’ve had it. I really, really need some rest. In that case, [staff] would talk about it with her, they’d note it in her chart... and then they’d honor her choice,” Philipp said. 

The ideal, then, may simply be for the two to co-exist: For hospitals to continue moving toward a model of keeping healthy moms and babies together as much as possible, while at the same time empowering mothers to ask for a break if they’re exhausted, sore or just need a few moments to recover.

That way, everyone can get what they need.