For more detailed discussion and information on this issue, please see the Academy of Breastfeeding Medicine’s Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate. The ABM’s guidance aligns with BFUSA’s position on individualized care and provider responsibility, stating that “These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care.”
Rooming-in is an evidence-based practice where the baby is kept in the mother’s room as much as possible during the hospital stay, optimizing the opportunity for the parents to get to know their baby during the precious first days. Keeping mother and baby together as much as possible enhances bonding and allows the mother to learn about her baby’s feeding cues under the expert guidance of trained staff. While the mother is rooming-in with her infant, hospital staff are expected to provide ongoing support, discuss safety issues, and explain how to request help when needed.
BFUSA’s Guidelines and Evaluation Criteria call for rooming-in to be the routine standard of care. We have never called for closing newborn nurseries, although some facilities have chosen to go this route. Ultimately, we recognize that some circumstances necessitate mother-baby separation and leave it to each facility to determine how to best address this need on a case-by-case basis.
Skin-to-Skin care has also been shown to have numerous benefits for both mothers and infants. It is physiologically stabilizing for both, helps soothe an upset infant, and facilitates breastfeeding.
As with all protocols, proper implementation and support is critical. Parents should be taught how to safely practice skin-to-skin care. A component of excellent breastfeeding care is to help the mother understand that sleepiness is a normal, hormonally-driven, physiological response to breastfeeding for both the mother and infant. As a component of safe skin-to-skin care and breastfeeding, she should be encouraged to ask for help from hospital staff and, when at home, from her support person, to place the baby on his/her back in the bassinet/crib whenever sleepiness sets in.
An excellent resource on the safe practice of skin-to-skin care and rooming-in is an article from the September 2016 issue of Pediatrics entitled “Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns.” Authors Lori Feldman-Winter, MD, MPH, and Jay Goldsmith, MD, provide excellent guidance for facilities to assist in the establishment of appropriate skin-to-skin care and safe sleep policies.
Another important resource is the AAP’s Neonatal Resuscitation Program (NRP), which offers a flow diagram for assessing infant stability and care, an excellent protocol for initiating skin-to-skin care immediately following birth.