4 rooming in and breast feeding

Rooming in is important for Breast feeding

1. Rooming in and Breast Feeding
Dr. Varsha Atul Shah

2. Rooming in and breast-feeding
By Dr. Varsha Atul Shah

3. A hospital
arrangement where a
mother/baby pair stay
in the same room day
and night, allowing
unlimited contact
between mother and
infant
Slide 4.7.2

4. Rooming in
•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

5. Rooming-in. Why?
•Helps establish and maintain
breastfeeding
•Baby sleep better and cry less
•Reduced exposure to infection
•Helps mother to learn about her baby’s
feeding and behavioral patterns
•Reduces costs
Slide 4.7.3

6. Helps establish and maintain
breastfeeding
•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.

7. 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,
79:1019.
Slide 4.7.5

8. Determinants of lactation performance
across time in an urban population from
Mexico
Milkcame inearlier in the hospital with rooming-in where formula
was not allowed
Milk came in laterin the hospital with nursery (p<0.05)
Breastfeeding was positively associated with early milk arrival and
inverselyassociated with early introduction of supplementary
bottles, maternal employment, maternal body mass index, and
infant age.
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.

9. Effect of the maternity ward system
on the lactation success
of low-income urban Mexican women
Slide 4.5.5
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-
17
RI, rooming-in,
n=15
RIBFG, rooming-
in with
breastfeeding
guidance, n=22
NUR significantly
different from
RI (p<0.05) and
RIBFG (p<0.05)

10. Baby is exposed to less
infections
•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
al.).
•Average length of newborn hospitalization after
roomimg in is 1,8 days compared to 3.2 days for
babies not roomed in

11. Average length of newborn hospitalization
Sanglah Hospital, Indonesia3.2
1.8
0
0.5
1
1.5
2
2.5
3
3.5
Before rooming-in After rooming-in
Days
Transparency 6.11
1.4 days
0.8 days
Adapted from:Soetjiningsih and Sudaryat Suraatmaja. The advantages of rooming-in.
Paediatrica Indonesiana, 1986, 26:229-35.

12. 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.
Slide 4.7.40%
2%
4%
6%
8%
10%
12%
Acute otitis
media
DiarrhoeaNeonatal sepsisMeningitis
% of newborn babies
6 months before rooming-in
6 months after rooming-in
n=205
n=17
n=77
n=11
n=61
n=17
n=25
n=4

13. 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
cc/bottle).
•Number of days in the hospital was reduced from 4.2 to 1.8 days

14. Babies sleep better and cry less
•A study to compare the state behaviorof 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
nursery.
•Adapted from:Keefe MR,Nursing Research
(1987,36(3):140-144

15. Cost savings of rooming-in compared to separate recovery
rooms at the Clinical Hospital of the Catholic University of
Chile13.5
$3.57 $3.57
9
$2.35
$3.05
0
2
4
6
8
10
12
14
16
Full-time nurses
and aides
Personnel cost per
patient per day
Personnel + capital
costs* per patient
per day
Separate recovery
Rooming-in
Transparency 6.15
14% savings
34% 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.

16. Cost analysis of maintaining a newborn nursery at the
Dr. Jose Fabella Memorial Hospital
Transparency 6.16
Hospital Statistics:
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,
Philippines), 1990.

17. Summary of costs for maintaining a
newborn nursery
Transparency 6.17
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
(310,037 USD)

18. The impact of infant rooming-in on maternal sleep at night.
•A two-group comparison study was designed to investigate
differences in sleeppatterns 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 sleeplonger 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
Nursing(1988,17(2):122-126)

19. Mothers ask for their babies to be taken to
Nursery
•Explain to the mother why the hospital
encourages rooming-in
•Discuss the reason why the mother wants
the baby taken to the nursery
•Address the benefits of rooming-in during
antenatal contacts.

20. References
•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
Indonesia,1986, 26:229-23
•Yamauchi Y, Yamanouchi L.Breastfeeding frequency during the first 24 hours after birth in full term
neonates.Paediareics 1990,86(2):171-175