Goodbye Nursery, Hello Rooming-in

Hospital goes from 10 percent to 100 percent rooming-in in less than a year

April 16, 2013
By Cindy Hutter

The traditional hub of maternity floors, the baby nursery, is getting a makeover. The nursery is transitioning from the central place for doctors to evaluate babies and families to ogle at newborns to a specialty care area that rarely is used.

The new nursery identity is to support the practice of keeping mothers and babies together 24 hours a day, known as rooming-in. The practice helps mother and babies get acquainted, learn feeding cues and establish breastfeeding patterns. Rooming-in is one of the Ten Steps to Successful Breastfeeding External Link, as outlined by the World Health Organization. Birthing facilities who comply with these steps achieve Baby-Friendly External Link status, a designation indicating a commitment to supporting breastfeeding.

“It took a lot of teaching to get staff to understand that that we are not doing the mom a favor by taking the baby away from her during the night for her to sleep,” says Marianne Allen, a clinical nurse specialist for Women and Children’s Services at PinnacleHealth System in Pennsylvania. “It’s a change in the mindset of staff that we serve the mother best by teaching her the skills and giving her the confidence she’ll need to take care of her baby in the days to come once she goes home without the safety net of the hospital. The best way to do that is to have them together.”

PinnacleHealth is one of 89 hospitals participating in Best Fed Beginnings, a NICHQ-run nationwide project that aims to help hospitals improve maternity care and increase the number of Baby-Friendly designated hospitals in the United States.

A significant component to support rooming-in is providing couplet care, meaning the same staff takes care of the baby and the mother. In many hospitals baby nurses take care of the newborns and postpartum nurses take care of the mothers. Having one person take care of both the mother and baby helps promote family-centered care, which is shown to lead to more successful breastfeeding, higher patient satisfaction levels and improved nursing and medical staff communications, according to the Centers for Disease Control and Prevention.

“We had to change the whole culture of our unit in that all the postpartum nurses had to be trained for infant care. It was a yearlong process,” explains Teri Grubbs, BSN, director of Women’s Health Services at University Health System in Texas, another hospital participating in Best Fed Beginnings. “Also moving the lactation nurses out of the nursery and on to the postpartum unit helped to support rooming-in and boost our exclusive breastfeeding rates.”

What’s in a Name?

One challenge to rooming-in is changing the expectations of mothers who want to send their babies to nurseries, not realizing it can make breastfeeding more difficult later. How have these Best Fed Beginnings hospitals been able to deter moms from sending their babies to the nursery? It’s all in the name.

The University Health Center renamed its nursery the Neonatal Observation Unit. PinnacleHealth will call theirs the Holding Nursery (starting May 1), which will be a place for babies to get intervention, not care. Greenville Health System in South Carolina went a step further. They put a self-proclaimed “scary” sign on the nursery door that reads: “Authorized Personnel Only. This space is reserved for flu isolation, MRSA isolation, urgent evaluation for sick newborns and procedures. Healthy newborns are assigned to rooms on the Family Beginnings unit. Please see your nurse for more information.”

“Overnight the nursery became empty. I was astounded,” says Jennifer Hudson, MD, medical director for Newborn Services at Greenville. “Nurses said the sign really helped to define the space differently and made it look like a place people didn’t want to put their babies. It was the most effective intervention we had so far.”

Greenville’s rooming-in rate went from 10 percent in July 2012 to 100 percent in February 2013.

Chart showing the increase in the rooming-in rate from July 2012 to March 2013 at Greenville Health System. Credit: Greenville Health System.
Click image for larger version. Chart showing the increase in the rooming-in rate from July 2012 to March 2013 at Greenville Health System. Credit: Greenville Health System.

Mothers’ reactions to rooming-in has reportedly been overwhelming positive at the three hospitals, with some mixed reactions from second-time moms used to the nursery.

“It’s very empowering for families,” said Hudson. “It’s really a positive when it comes to security and safety. We emphasize that mothers get to watch everything we do for their babies, including the first bath, exams and screening tests. Hourly rounding by nurses will ensure that they get the help that they need while families learn about and bond with their newborns."

Terri Negron, RN, director of Nursing at Greenville Health System, adds, “While some second-time moms are apprehensive, first-time moms don’t know any different and when they come back, rooming-in will be an expectation.”

All three hospitals say the transition to rooming-in has been a team effort. It required support from nurses, doctors, unit leadership and executive management. Staff had to understand the evidence-based reasons for change, be committed to the idea and embrace the changes. It didn’t happen overnight for any of them.

“You have to have the nucleus of nurses that are supportive and believe in it,” says Grubbs. “You start with them and you train them and have success and then you train more and have more success. You continue to open the door.”