Healthy mothers and babies should not be separated after birth or during the early postpartum days. Interrupting or delaying the time that a mother and baby spend together can have a negative impact on bonding and breastfeeding success.
Rooming in is associated with improved breastfeeding outcomes: mothers make more milk sooner, breastfeed longer and are more likely to breastfeed exclusively. Rooming in is associated with babies who cry less and are more easily soothed. Studies show that mothers who room in throughout the day and night get as much sleep as mothers whose babies are in the nursery. Mothers and babies who room in together sleep more peacefully.29, 30
Routine exams can be done while rooming in. This provides an opportunity for the parents to ask questions and receive information that reinforces normal newborn behaviors which increases mothers’ confidence.
The Ten Steps to Successful Breastfeeding
Mothers who give birth at Baby-Friendly hospitals and birthing centers are more likely to initiate exclusive breastfeeding and are more likely to sustain breastfeeding at six months and one year of age. This is perhaps because of the institutional support for breastfeeding at these facilities. Adherence to the Ten Steps to Successful Breastfeeding31 is associated with increased rates of breastfeeding around the world. In the United States, new mothers exposed to at least six of the Ten Steps were 13 times more likely to continue breastfeeding at six weeks postpartum when compared to mothers who had not been exposed to any of the Ten Steps during their birthing hospitalization.32 Additionally, adherence to the Ten Steps decreases racial, ethnic, and socio-cultural disparities in breastfeeding rates in U.S. hospitals.33
The Ten Steps to Successful Breastfeeding are:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breastmilk, unless medically indicated.
- Practice rooming in – allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
Because the process of attaining Baby-Friendly designation compels facilities to examine, challenge and modify longstanding policies and procedures, the process also strengthens the organization by enhancing leadership skills, increasing staff competence, and improving patient satisfaction. Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery.
Training of staff is an important part of creating a culture in the hospital that is supportive of breastfeeding. Patients listen to their doctors. Mothers reporting that physicians and hospital staff who had no preference or favored formula were less likely to breastfeed at six weeks than mothers who reported that the staff favored breastfeeding 25
Overall, the importance of creating supportive hospital environments for mothers who want to breastfeed cannot be overstated. The mothers who choose to breastfeed need to have as many supportive practices and resources available to them given the lifelong impact of this health behavior on the infant and the mother.
Breastfeeding and The Joint Commission
All Joint Commission-accredited hospitals that have 300 or more births per year are required to collect data and report on all six measures in the PC core measure set.