Guest Post: Baby-Friendly Isn’t Always Mother-Friendly

This guest post is from Hannah Holt–a mom with a great head on her shoulders, a creative mind, and four young kids. Her twins are almost one year old. Hannah writes books for kids and shares great ideas over at her site Lightbulb Books.

***

On a cold but beautiful day last January, I became a mother twice over.

Because having twins put me at a higher risk for C-section, the hospital staff wouldn’t let me eat or drink during labor. I labored for twelve hours. As you might imagine, I arrived in postpartum recovery that night feeling more than a little hungry, thirsty, and exhausted. After breastfeeding my babies, I called for the nurse…

Me: Would you take the babies, so I can get some rest?
Nurse: I can’t do that.
Me: What do you mean?
Nurse: Well, we’re a baby-friendly hospital. We practice rooming-in here.
Me: But I don’t want to room-in. You have a nursery. It’s right over there.
Nurse: The nursery is only for babies with medical needs.
Me: I need a break. Can’t you take them for a little while?
Nurse: I’m really sorry. We aren’t staffed to do that.

d

Well, that sounded like a staffing problem to me. Of course, at the moment I was too overwhelmed to do anything about it.

However as my twins first birthday approached, I decided it was time to call the hospital and discuss their staffing issue. In my conversations, I learned this:

  • Baby-friendly isn’t just a nice term. It’s a special designation by UNICEF and the World Heath Organization (WHO).
  • Being baby-friendly made it impossible for the nursing staff to take my babies to the nursery. Babies have to remain with Mom for at least 23 hours a day, unless medically necessary.
  • Fatigue alone isn’t considered a good enough reason for separation.

So far baby-friendly didn’t sound very mother-friendly to me. Were UNICEF and the WHO conspiring to keep new mothers up at night? That seemed unlikely.

I wanted to know more. So I contacted 10 baby-friendly and 17 non-designated hospitals nationwide. Each answered questions about their night-nursery policies. Here are the results:

Clearly, you can be baby-friendly and have night-nursery staff. At the same time baby-friendly hospitals are four times more likely to offer rooming-in only. As near as I can tell, here’s why:

  • Baby-friendly hospital nurses are required to complete paperwork every time the infant is removed from the mother.
  • New mothers must justify why they need a break. Feeling exhausted? Let’s have a nice long chat about why you really should stay with Baby. Guilt trip included: “I guess we’ll have to pull a nurse out of her regular rotation for that…”
  • Several nurses commented on the taxing workload of bringing babies back and forth from the nursery for demand feedings.
  • Smaller hospitals don’t have the resources to keep up with night-nursery babies and baby-friendly requirements.
  • Some larger hospitals choose not to have night-nurseries because “evidence-based research suggest that mothers sleep better when babies room-in.” (a St. Joseph’s* postpartum charge nurse,** Denver).

Some mothers might balk at that last statement. “Ain’t no way Momma sleeps better with Baby in the roost.” But it’s true. At least a dozen scientific studies point to this conclusion: Rooming-in mothers are often better breastfeeders, sleepers, weight losers, parents… you name it.

However, there will always be exceptions. Take me: I sleep better with Baby in the room next door. Put Baby in the same rooms as me, and I obsess over her breathing… all night. (BTW, I breastfed all four of my children for the first year, so non-roomers do it, too.)

I told the nurse at St. Joseph’s…

Me: I don’t sleep better with Baby in the room.
Nurse: There will always be individual needs and adaptations.
Me: So you could accommodate my request [to not sleep in the same room as my baby].
Nurse: No, sorry.

d

Why so inflexible? After talking to a few dozen nurses this past week, I’ve decided it’s this:

A well meaning desire to convince all mothers that rooming-in is the best option, regardless of personal experience.

A Good Samaritan lactation nurse in Lafayette, Colorado summed it up nicely, “We feel like it’s the right thing to do for moms and babies.” [“We” being the hospital staff.] She continued, “Just like we would council someone to put down a cigarette, we would encourage a new mother to stay with her baby.”

But I’m not the only addict out there. I took an anonymous poll of 33 moms*** and this is what I found:

  • 63% of mothers prefer some level of night-nursery care
  • 15% want a break for an hour or two
  • 45% want babies in the nursery all night, but brought back for feedings
  • 3% want babies in the nursery all night, no exceptions

I can understand both sides. My oldest son was born at Salt Lake Regional Medical Center (a non-designated hospital). After delivery, the baby suddenly disappeared. I sent my mother looking for him, and she found him in the nursery surrounded by nursing students, who were practicing their shots (on HIM).

I didn’t authorize this. I didn’t even know where he went. Obviously there need to be better guidelines for keeping mothers with babies. The guidelines provided by the baby-friendly designation are a great start, but they go too far. They don’t leave enough room for individual adaptation. There needs to be some accounting for mother preference… Because good mother care is good baby care.

And HELLO, I had twins!

What do you think is a good balance? How do you feel about rooming-in? Did you have an experience with required rooming-in? Would love to hear your thoughts!

***

You might like Hannah’s other guest posts on Momsicle (the first one is my favorite): Happiness or Perfection: Choose One, and Sanity Travel Tips: Games to Play in Tight Spaces.

***
NOTES:
*St. Joseph’s in Denver is a non-designated hospital.
**You might have noticed I don’t name any of the nurses I interviewed. That’s not because they requested anonymity. Rather I wanted to focus on policies rather than personalities.
***Mostly middle-class, Caucasian women.
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22 responses to “Guest Post: Baby-Friendly Isn’t Always Mother-Friendly

  1. Whenever I read other people’s experiences, I become ever more grateful of my own!
    I gave birth to my daughter (my first child!) in December, also at a baby-friendly designated hospital. They not only do rooming-in, but they have parents at the weighing/measuring, which takes place hours after delivery. They do immediate skin-to-skin and even forgo apgar scores. In most cases, the baby is still attached via placenta when they try to get it to latch on the boob (though my child pooped during labor, and procedures for a meconium baby are obviously different).
    Still, the second night in the hospital, after a 68 hour labor and the first night/day insisting (me insisting despite their offers) she stay with us in the room, my night nurse (they do paired nursing, so you always get the same nurses for a few days straight) (oh and one on one nursing for delivery, so you get the same person all labor) finally convinced us to do a respite. They brought her back for demand feeds and offered to let her stay in the room after each one, but it was such a blissful break! The first break we got actual sleep (which we hadn’t had in almost a week); the second break we took advantage of their special TV station that had lessons on how to care for newborns. After the third feeding, we kept her in room again. They only have space for a handful of babies at a time in the nursery (like 5), so they basically require rooming-in unless it is asked for by the parents (or offered by the nurses to parents too sleep deprived to realize it is a good idea). Babies who require medical attention are on a different floor, as are their mothers, and while they do rooming-in on the special needs floor as well, not every baby qualifies and their nursery is much bigger. Considering the hospital does 5000 some-odd births a year, that they can only accommodate 5 typical babies at a time in their nursery is somewhat astounding.

    For a hospital with a god-awful c-section rate (almost 40%), a huge med and nursing school, and a huge research component, they had surprisingly mother-centered care. I’d really recommend Yale-New Haven to any pregnant women in Connecticut.

  2. Thanks for the research Hannah! I’m so sorry you didn’t get to rest. I know lots of moms who see their birthing stay in the hospital as a vacation, so they will probably be looking for hospitals that offer rest without baby. Your story about the disappearing baby sounds familiar. Since I was heavily drugged and asleep when I had my first baby, I don’t remember the delivery. However, I do remember moving rooms 5 hours later and having the nurse ask me, “Is there anything else I can get you?” My answer, “Yes, my baby.” Seeing as I don’t remember seeing baby after birth, I’m glad he was the only one born that night, or I could easily have carried home the wrong one! Just shows how much research like yours is important to the expectant mother!

  3. How about a family friendly hospital policy?

  4. Kate- Wow, you did have a great experience. It always makes me happy to hear another mom was well attended. Good job Yale-New Haven!

    Bridgit (viewsfromthebackpew)- I’m so sorry you also experience the disappearing baby trick. Why do they do that? I had a harder time nursing my first son than my second, and I think it was the immediate separation. (Nursing the twins was still the hardest of all, but there’s no helping that.)

  5. Pingback: Out of the Bubble « Holthaven

  6. I think these hospitals should make their rooming-in policies explicit so that anyone giving birth in them is aware of what she’s signing up for. I loved rooming in but I would always want to be able to choose either way, as each labor and delivery and aftermath is unique.

  7. In defense of the hospital and disappearing baby trick, I couldn’t have held my head up, much less held a baby. It was still pretty strange to wake up after everything. Baby was pretty groggy too, having ingested all the sleeping pills I took. Baby didn’t nurse for at least 10 hours. That being said, they could have skipped the sleeping pills. The next night Baby was taken too, and it was super-sad. I liked having Baby 2 with me, but I couldn’t get him out of the hospital cradle without help. Every time he cried, I had to call the nurse. She must have been tired, but so were we.

  8. I agree with Sara, I always want the option because each one of my 7 children’s births was different, I was different and the circumstances were different. While I almost always choose to have the baby in the room with me I think it is important to have the option for nursery care because there are times when you need to be able to get some good rest. I have always had that option, 4 different hospitals in Portland, Or or surrounding vicinity. Only once, when Blake was born (5th) did I have a less than ideal experience. Delivered in a beautiful birthing room and right after they moved me to a closet or so it seemed. He was very fussy, born late at night, I was exhausted even before the delivery and I needed them to take him so I could rest. They did but then brought him back with in the hour because he was too fussy and they didn’t have enough nurses to care for a fussy baby. Other than that one experience if I needed some rest they would take the baby for a few hours so I could sleep. Like I said I rarely did it, but I think all hospitals should have the option, especially with twins!! When on earth are you supposed to recover with two babies?

  9. I love hearing other moms’ experiences! It’s very validating. Jacque, congrats on 7 kids. That is totally amazing! I also always had the option of a little nursery time (only twice, but still). 🙂 With Baby Woww, I LOVED having the option to send him to the nursery for a couple hours. However, with both babies I wanted them at my side practically the whole time. They had a ton of skin-to-skin and have been great nursers (rooming in is not the only factor there for sure, but I feel like it is a major one for me because I let them nurse so much right after birth and into the night). But having the option to get some rest while baby goes to the nursery–even if you don’t use it–is such a pressure release. Welcoming a newborn into the world is so emotionally overwhelming. It’s nice to know that the support team is looking out for Mom’s well-being, too.

    BTW: At Providence here in Portland they have a very limited nursery, but there are enough spots so that you can sign up your newborn for a little bit on an availability basis. That worked just fine for us!

  10. Hannah (& Ev) this is an amazing piece of work and so enjoyed reading it. After three experiences each a ltitle different – I can definately see both sides. When my first was born they demanded he be with me and I was so tired and scared and they sent my husband home (we were in a room share in NYC). This can not be the best idea to take care of the ltitle one – and actually said no to pain killers because was worried about his care (so a rookie right?). For my second and third deliveries we were at a hospital in NJ which we compare to the Ritz after our first experience. They offer nursery care if you want it and bring baby in for feedings. Did this the second night both nights knowing what was ahead of me once we were all home…. Think smart balance is called for and you are so right they need to think of “Mommy Care” as well. Think they should also think of people with other very little ones at home like us (boys were almost four and two when out little one was born). It is nice to have some Mommy time with them with baby in nursery before you throw the new little guy into the mix….. Come on people help a Mama out….. Happy Birthday to the babes – they are so beautiful. XOXOXOXO

    • Thanks for the great comment, Donna! I agree about the Mommy Time with the new baby. It’s such a pleasure to get that alone time with the newborn at the hospital before you integrate the whole family. It feels like such a treasure to have time with the baby when you’re not worried about siblings, and also a little time to rest before the full-on crazy begins!

      • Thanks for the kind words Donna. So sorry you had to pull the first night solo. I like the term “Mommy Care.” You should trademark it and take royalties.

  11. Sara and Jacque, I like the idea of having hospitals rooming policies explicit. At my hospital with the twins they said their policy was to “encourage rooming-in”, but obviously it’s more than encouraged. I talked to several other moms in my area and they were also under the impression that you could send your baby to the nursery if you needed to. Seems a little deceitful to me.

    Also since hospitals are often chosen more by geography and insurance than personal preference, I’d like to see more hospitals have both options.

    Evelyn (momsicle), sounds like you had the best of both worlds. 🙂

  12. I gave birth in a small local hospital. Our son was in the room with us, which was my preference. My problem arrived with breastfeeding. Despite education, etc., we couldn’t do it. The nurses were awful. Turns out I had a spinal leak from the epidural. So after we were released, both my son and me had to return — him for jaundice and me for a blood patch. Hospitals should be flexible. I think sometimes the nurses are like “I know what to do and what is best …”

    • You bring up a good point Stacy–sometimes what is happening to you isn’t simple “textbook,” and it’s often up to the mother (who is exhausted) to advocate for herself and for baby. I understand that it’s difficult for a hospital to be super responsive to all individual needs, but a mother who just had a baby isn’t in the best position to stick up for herself. Flexibility is key!

    • Right! I think nurses (well meaning as they are) can sometimes get into a routine that doesn’t fit. Yikes! You both had to return to the hospital. How scary. I hope it was over quickly for both of you.

    • Good point, in some places hospitals are chosen by geography or insurance (I hadn’t thought along these lines). That being the case, I think hospitals should always offer the nursery option. In most aspects of life, we aren’t allowed to limit people’s choices just because they might not be best practice. So why should anyone be allowed to do that in motherhood?

  13. Wow, what a great discussion. I had my baby at a fairly traditional academic hospital. To be honest, I didn’t pay attention to whether or not it had the baby-friendly designation, but I’m guessing that it didn’t. I didn’t pay much attention to it because I thought that – maybe naively – the staff would be flexible enough that I could get the time I needed with my baby for skin-to-skin, breastfeeding, etc. I was planning to breastfeed, knowledgeable about it, and had good family support for it. I think the baby-friendly designation is more helpful for moms that aren’t as aware of the pitfalls and need more guidance getting off on the right track. For this reason, I think baby-friendly is a great standard, but hospitals should rethink the rooming-in policy. Before my delivery, I assumed that I would keep the baby with me and everything would be all snuggly and milky and sleepy. I was SO exhausted after it all that after nursing my baby, I turned her over to the nurse and went into a deep sleep for at least a couple of hours. I woke up, had a coffee, and said, “alright, let’s see this baby girl!” This is shocking to me even now – that I could just turn that baby over to a stranger after a 9-month pregnancy and 2-day labor, but I needed the break. We sent baby to the nursery for a few hours at night, too. Our first night at home, baby and I had plenty of time together, trust me:)

  14. Interesting discussion. I do not have a choice of hospitals due to my insurance. I am delivering in 2 months & just went for the hospital tour last week. I was not happy to hear about their ‘no nursery care’ policy. I did not use nursery care with my first two…but I still liked knowing it was there if I felt I needed it.

  15. Pingback: Mother UNFRIENDLY hospitals | Just saying

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