Step 7. I love step seven. Put 2 fingers up on one hand, and then take your other hand and wrap it around. That’s step 7—tuck families in together. Step 7 is probably the most practice-altering piece of Baby-Friendly for us. We have had some success, but in order to consistently live out step 7, we have more work to do. The answers on our self-appraisal are “no,” because while some of these elements may be available or even encouraged some of the time, they are not yet part of our routine practice.
Step 7. Practice rooming-in—allow mothers and infants to remain together—24 hours a day.
7.1 Do mothers and babies stay together and/or start rooming–in immediately after birth? No
7.2 Do mothers who have had cesarean sections and/or other procedures (including those with general anesthesia) stay together with their babies and/or start rooming-in as soon as they are able to respond to their babies’ needs? No
7.3 Do mothers and infants remain together (rooming-in) 24 hours a day, except for a period of up to one hour for hospital procedures or if separation is medically indicated? No
7.4 Do staff explore reasons and provide education to mothers who request their infants be cared for in the nursery? No
7.5 Are routine procedures conducted at the mother’s bedside whenever possible in order to avoid mother/baby separation? No
Below are the concerns I hear about rooming-in. I think these are typical concerns that other Baby-Friendly hospitals have had to work through. In other words, we’re not dealing with anything unique, and we will figure out how to make this work, just like 134 U.S. hospitals that are already Baby-Friendly and the 373 U.S. hospitals working toward Baby-Friendly just like us. I’m throwing these out for everyone to discuss. Let’s find solutions!
Concern #1: Mom just had a cesarean and there are no family members in the room to help care for her and the baby. The mother can’t lift the baby out of the bed, and we’re afraid if we put the baby in mom’s arms, she will fall asleep. (It seems like this would fall under 7.2 and may be a justified reason for taking the baby to the nursery.)
Concern #2: Baby is a “silent choker.” If I leave the baby with the sleeping family, no one will notice when his mouth or nose needs to be bulb syringed.
Concern #3: The baby is retracting (sign of breathing problems) and his coloring is even dusky at times. (This seems to clearly fall under 7.3 “or if separation is medically indicated.”)
Concern #4: The mom is exhausted, and I want to help her.
Concern #5: The mom requests for the baby to go to the nursery.
Concern #6: We don’t have enough nursing staff to do all admissions in the room when we are busy. (For those of you reading outside of Memorial, we have labor-delivery-recovery rooms, then patients are transferred to a separate unit for postpartum.)
Concern #7: Sometimes I do all the admission tasks in the room and then the mom asks me to take the baby to the nursery anyway.
Concern #8: If we don’t offer to take babies to the nursery, our customer satisfaction scores will suffer.
OK. There are the concerns I’ve heard. Are there others? Let’s get them out there and start moving toward solutions together!