Step 7: Practice rooming-in—allow mothers and infants to stay together—24 hours a day. The mother and her baby are roomed in together 24 hours a day
When baby needs to be taken for some procedure such as blood taking or phototherapy as in the case of jauncice, staff should try to facilitate mother’s access to her baby as much as possible . All reasons for mother and baby separation should be clearly documented
Rooming in enables mother to feed as and when the baby requires with no restriction on duration. This will facilitates and maintain breastfeeding and milk supply. Being fed on time will help baby to sleep better and cries less. Being roomed in with mother alone means baby will not be exposed to other babies. Mothers learn to observe and recognize baby’s early hunger cues and feeding patterns. Hospitals will also saved on cost of employing more staff to man the nursery
A study done on effects of Rooming in on breastfeeding frequency for the first 24 hours . The findings is that rooming in infants breastfed more frequently than non rooming -in babies
A graph to demonstrate the effect of rooming – on frequency of breastfeeding per 24 hours
A study done in Mexico on the effect of maternity ward system on breastfeeding success rate of low income urban women such as rooming in and breastfeeding education
A study to demonstrate the positive impact of rooming in in minimizing infectious diseases in newborns as compared to those not roomed in. It was found that the average length of hospitalization afyer rooming in is 1.8 days compared to 3.2 days of those not roomed in
Graph to demonstrate the difference in length of hospitalization of newborns roomed in and not roomed in
A study in Indonesia on the morbidity of newborn babies before and after rooming in
This study examined prospectively the effect of rooming in on morbidity and mortality due to infectious diseases in newborns.
The findings of a study done to compare the behaviour of newborns who roomed in and those not roomed in with their mothers. It was found that babies sleep better and cry less when roomed in with their mothers
A study of cost saving in staffing when rooming in compared to separate recovery rooms at one hospital in Chile
The is hospital statistics showing the cost of maintaining a newborn nurseryin manila
Summary of costs for maintaing a newborn nursery as well as extra cost for bottle feeding
A study on the impact of rooming in on maternal sleep at night in a children’s Hospital in Denver. This study shows that mothers did not sleep longer or better if their babies did not room in with them.
Although it is true that mothers tend to ask for their babies to be taken to the nursery for any reason, staff should explain to them the benefits of rooming in
4 rooming in and breast feeding
Rooming in and Breast Feeding
Dr. Varsha Atul Shah
Rooming in and breast-feeding
By Dr. Varsha Atul Shah
arrangement where a
mother/baby pair stay
in the same room day
and night, allowing
between mother and
• Routine separation should be avoided.
• Separation should only occur for an
individual clinical need.
• If separation of a mother and her infant is
required because of a medical situation,
document the reason for this separation in
the mother/baby record
• Helps establish and maintain
• Baby sleep better and cry less
• Reduced exposure to infection
• Helps mother to learn about her baby’s
feeding and behavioral patterns
• Reduces costs
Helps establish and maintain
• Study on effects of Rooming in on breastfeeding
frequency for first 24 hours.
• Findings: The frequency of breastfeeding per 24 hours
was significantly higher in rooming-in than non-rooming-
in infants from day 2 to day 7 (p<0.01).
• This study demonstrated that rooming-in infants had
significantly higher breastfeeding frequencies than non-
rooming-in infants during the first week of life.
Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding
variables. Acta Paediatr Scand, 1990, 79:1019.
Effect of rooming-in on frequency
of breastfeeding per 24 hours
Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-
in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990,
Determinants of lactation performance
across time in an urban population from
Milk came in earlier in the hospital with rooming-in where formula
was not allowed
Milk came in later in the hospital with nursery (p<0.05)
Breastfeeding was positively associated with early milk arrival and
inversely associated with early introduction of supplementary
bottles, maternal employment, maternal body mass index, and
Adapted from: Perez-Escamilla et al. Determinants of lactation
performance across time in an urban population from Mexico. Soc
Sci Med, 1993, (8):1069-78.
Effect of the maternity ward system
on the lactation success
of low-income urban Mexican women
From: Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. Effect of the
maternity ward system on the lactation success of low-income urban Mexican
women. Early Hum Dev., 1992, 31 (1): 25-40.
NUR, nursery, n-
RI (p<0.05) and
Baby is exposed to less
• Study on positive impact of rooming-in policy on
prevention of infectious disease when infants
rooming-in were compared to newborns not
rooming-in with their mothers (Soetjiningsih et
• Average length of newborn hospitalization after
roomimg in is 1,8 days compared to 3.2 days for
babies not roomed in
Average length of newborn hospitalization
Sanglah Hospital, Indonesia
Before rooming-in After rooming-in
1.4 days 0.8 days
Adapted from:Soetjiningsih and Sudaryat Suraatmaja. The advantages of rooming-in.
Paediatrica Indonesiana, 1986, 26:229-35.
Morbidity of newborn babies at Sanglah
Hospital before and after rooming-in
Adapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in.
Pediatrica Indonesia, 1986, 26:231.
Diarrhoea Neonatal sepsis Meningitis
6 months before rooming-in
6 months after rooming-in
Morbidity of newborn babies at Sanglah Hospital
before and after rooming-in
• Prospective study in Bali, Indonesia, over one year in which this study
examined morbidity, mortality, amount of milk formula and IV fluid consumed,
and length of hospital stay in the maternity ward and newborn nursery for the 6
months pre and post rooming in policy instituted
• Diarrhoeal diseases, otitis media, neonatal sepsis, and meningitis decreased in
low-birthweight and normal full-term infants
• Mortality due to infection decreased (41 or 2.21% vs. 16 or 0.81%); whereas
deaths due to other causes did not greatly change during this period (58 or
3.13 % versus 51 or 2.59%).
• Need for milk formula decreased from 105.6 tins to 25.6 tins per month (400 g
tin of powdered milk formula).
• Need for IV fluid dropped from 135.8 bottles to 74.1 bottles per month (500
• Number of days in the hospital was reduced from 4.2 to 1.8 days
Babies sleep better and cry less
• A study to compare the state behavior of newborns who
roomed-in with their mothers at night with those who
were cared for by the traditional nursery-at-night method.
• Infants in the mother's room had significantly, p less
than.001, more quiet sleep (33% vs. 25.4%), less
indeterminate (4.8% vs. 11.2%), and less crying (0.6%
vs. 7.5%) states than infants who remained in the
• Adapted from:Keefe MR,Nursing Research
Cost savings of rooming-in compared to separate recovery
rooms at the Clinical Hospital of the Catholic University of
Personnel cost per
patient per day
Personnel + capital
costs* per patient
14% savings34% savings
Adapted from Valdes et al. The impact of a hospital and clinic-based breastfeeding
promotion programme in a middle class urban environment. Journal of Tropical
Pediatrics. 1993, 39:142-151.
Cost analysis of maintaining a newborn nursery at the
Dr. Jose Fabella Memorial Hospital
Average daily deliveries: 100 babies
Daily newborn census: 320 babies
Adapted from: Gonzales R. Cost Analysis of Maintaining a Newborn Nursery at Dr. Jose
Fabella Memorial Hospital, Manila. (Transparencies presented in meeting in Manila,
Summary of costs for maintaining a
Feeding bottle sets/year
124,800 x 20 P = 2,496,000 P
Milk formula cans/year
17,521 x 36 P = 630,720 P
Salary of nursing staff/year
900 x 3,000 P x 12 = 3,240,000 P
Salary of formula room staff/year
6 x 2,000 P x 12 = 144,000 P
Total 6,510,720 P
The impact of infant rooming-in on maternal sleep at night.
• A two-group comparison study was designed to investigate
differences in sleep patterns for a group of mothers who
roomed-in with their infants at night as compared with a group
who was separated from their infants at night.
• The data collected from the mothers in the study indicated that
mothers did not sleep longer or better when their infants were
returned to the nursery during the night.
• Keefe MR ,Children's Hospital, Denver, CO 80218-1088.Journal of Obstetric,Gynecologic and Neonatal
Mothers ask for their babies to be taken to
• Explain to the mother why the hospital
• Discuss the reason why the mother wants
the baby taken to the nursery
• Address the benefits of rooming-in during
• Keefe M. R. Comparison of neonatal nighttime sleep-wake patterns in nursery versus
rooming-in environments. Nursing Research. 1987;36(3):140–144. [PubMed]
• Keefe M. R. The impact of infant rooming-in on maternal sleep at night. Journal of
Obstetric, Gynecologic, and Neonatal Nursing. 1988;17(2):122–126.
• Flores-Huerta S, Cisneros-Silva I. Mother-infant rooming-in and exclusive breast feeding.
Salud Publica de Mexico. 1997;39(2):110–116. [PubMed]
• O'Connor S, Vietze P. M, Sherrod K, Sandler H. M, Altemeier W. A. Reduced incidence of
parenting inadequacy following rooming-in. Pediatrics. 1980;66(2):176–182. [PubMed]
• Yamauchi Y, Yamanouchi I.Acta Paediatr Scand. 1990 Nov;79(11):1017-22. PMID: 2267917
[PubMed - indexed for MEDLINE]
• Reference: Soetjiningsih and Suraatmaja S. The advantages of rooming-in. Pediatrica
• Yamauchi Y, Yamanouchi L.Breastfeeding frequency during the first 24 hours after birth in full term
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