The Lehigh Valley Health Network is currently in the process of becoming a Baby-Friendly Hospital, recognized for its full support of breastfeeding and mother-baby bonding. This process requires 4 phases: Discovery Phase, Development Phase, Dissemination Phase, and Designation Phase (Baby Friendly USA, Inc. 2012). LVHN is currently in the Development Phase and this requires most of the planning and data collection in regards to implementing the 10 Steps to Successful Breastfeeding—the guidelines for becoming Baby-Friendly. This research study focuses on Step 7 of the 10 Steps to Successful Breastfeeding: “Practice rooming-in, allowing mother and infants to remain together 24 hours a day” (BF USA, Inc. 2012). Data is collected to distinguish where the hospital stands in regards to rooming-in, what the barriers are to achieving this step, and what further steps need to be taken to accomplish this step. Through a series of time log sheets, observations, and surveys, the hospital is able to work towards being successful.
Breastfeeding is the natural biological course of life following pregnancy. For both the baby and the mother, it is scientifically proven to decrease the risk of certain diseases and have long-term health benefits (BF USA, Inc., 2012). The Lehigh Valley Health Network is on a journey to becoming Baby-Friendly Certified by Baby-Friendly USA, Inc. The Baby Friendly Hospital Initiate (BFHI) is a global initiative created by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) and implemented by Baby-Friendly USA, Inc. Its purpose is to gain support and encouragement of breastfeeding in hospitals throughout the world (BF USA, Inc., 2012). LVHN is currently developing a plan to implement and work towards becoming Baby-Friendly. The process takes many steps and one of the ways to begin is by collecting baseline data to see where they stand and what needs to be changed. Step 7 focuses on the practice of rooming-in—keeping the mother and baby together for > 23 hours a day while in the hospital. According to a study from the Journal of Tropical Pediatrics, rooming-in improves the feeling of motherhood, and the prolonged contact and exposure with their newborns results in a more positive light on breastfeeding and even a higher occurrence (Procianoy, Fernandes-Filho, Lazaro, Sartori, & Dresbes, 1983). Another study from the Cochrane Pregnancy and Childbirth Group, done by randomized controlled trials of separate care and rooming-in care, showed that breastfeeding rate at four days after birth was much lower for those in separate care than for those in rooming-in (Jaafar, Lee, & Ho, 2012). The authors also stated that rooming-in has other benefits, including better mother-newborn bonding, increased frequency of breastfeeding, and the reduction of newborn complications (Jaafar et al., 2012). Rooming-in also benefits the hospital as a more cost efficient-practice. It requires fewer tools and makes better use of labor force (Shrivastava, Shirvastava, P., Ramasamy, 2013).
Another interesting view of rooming-in deals with the Cold War. According to Yale’s Isabel Beshar (2014), rooming-in was a response weapon to the Soviet Union during the Cold War. Once psychologists discovered that mental stability in adulthood relates to infancy, hospitals started practicing rooming-in to lighten the mental health epidemic distinguished in World War II. It was meant to ensure mentally fit soldiers (Beshar, 2014).
All these studies confirm the benefits to rooming-in for both the mother and the baby. This study hopes to make LVHN more successful in rooming-in.
The research questions asked in this study are:
- How do we maximize the amount of time the baby spends with mom and limit the amount of time the baby spends out of the room?
- What percent of newborns are currently spending >23 hours rooming-in?
- What is the most common rational for taking the newborn out of the room?
- What barriers are there to making the necessary changes?
Through answering these questions, baseline data will be found and a change can begin to be made.
The study done is both a quantitative and a qualitative study. A rooming-in log sheet was developed that has columns for the date, the time the baby is taken out of the room, the time the baby is back in the room, the rationale for taking the baby out of the room, and the total time the baby spent out of the room. The Mother-Baby Nurses are required to fill out this log sheet for every newborn that comes through the Mother-Baby Unit. They fill out the chart every time the baby is taken out of the room—even if it is for 2 minutes. The study began June 10th and is currently still running in the unit. The study will run until 250 log sheets are collected. The population being studied is the newborns and the nurses. The sample size is currently 214 newborns and 55 nurses. Upon analyzing the log sheets two weeks in, a survey was developed for the nurses, which addressed common rationale and their view on certain processes that require taking the baby out of the room. The survey was sent out to the entire Mother-Baby staff and the answers were anonymous. The questions asked that gave us the most information about the barriers are the following:
- Do you think you should complete the newborn’s blood work by the patient’s bedside? (Instead of in the nursery)
- Do you think the patients should bring their baby to the discharge class? (Instead of dropping the baby off at the nursery before the class)
- Should the technical partner complete the newborn’s hearing screen at the patient’s bedside? (Instead of in the nursery)
The purpose of the survey is to determine the barriers to successful rooming-in in regards to the nurses’ practices. The statistical methods used in this study are data sheets and surveys.
# Mothers on MBU
June 10th-July 8th
# of hours Newborns were not in the mother’s room
% rate of newborns that roomed-in >23 hours
>1 to <3
>3 to < 5
What is found is that 72% of newborns have spent onlyday, with 24% spending onlyfollows:
- Blood work
- Hearing Screen
- Initial assessment/bath
- Per Mom’s request
- Discharge Class
The results to the survey questions are as followed:
- 78% of the staff responded “No” when asked “Should the technical partner complete the hearing screen by the patient’s bedside?” and “Do you think you should complete the newborn’s blood work by the patient’s bedside?”
- 89% of the staff responded “No” when asked, “Do you think the patients should bring their baby to the discharge class?”
These results show where the hospital stands in regards to their current rooming-in status and the barriers from the nurses for successful rooming-in. These results allow the research questions to be answered.
- The amount of time the baby spends with mom can be maximized and the amount of time the baby spends out of the room can be limited by making certain changes in routine based off the most common rationale. The hearing screen and blood work can be done at the bedside, in the room, with the mom. The mom can also take the baby to the discharge class with them—a 45 minute time span. These are simple changes that can be made to be more successful.
- The results showed that 24% of newborns are currently spending >23 hours rooming-in and this percentage needs to be improved.
- The most common rationale for taking the baby out of the room is for blood work, hearing screen, the initial assessment and bath, a circumcision, per Mom’s request, and for the discharge class.
- The barriers in staff are lack of support in regards to changing their practice—this depicts the culture of the hospital that needs to be changed and developed.
This study shows where the hospital currently stands and what needs to be changed. The changes made from this will not only further improve the breastfeeding rates but also the patient care quality. The nurses need to change their practices towards the most optimal patient care, even if that means changing their practices. The improvements coming from the study will move LVHN closer to becoming Baby-Friendly certified—the long term goal. The survey allowed for results from patient care and staff opinion, which highly demonstrates the current culture occurring. The culture is essential when it comes to the BFHI because the practices need to be self-motivated and come from genuine care within. Becoming Baby-Friendly does not just give another certification to put aside the name, but it means genuinely giving the best care to the mother-baby for their relationship which builds early on and their long-term health which comes from the benefits of successful breastfeeding. Rooming-in is an essential part of the initial beginnings to successful breastfeeding. It improves the breastfeeding rate and the breastfeeding occurrence, all which in turn decrease long-term health risks for mother and baby (BF USA, Inc., 2012). Not only is rooming-in beneficial physically, but it also improves the mother-baby bonding quality and allows the mother to get accustomed to the baby’s schedule and needs (BF USA, Inc., 2012). It also is cost-efficient and makes better use of the time and labor of the staff.
This study has certain limitations. First, there is inconsistency in the documentation between the day staff and the night staff on the log sheet. The dictation for rationale may have discretion or the night shift may neglect to fill out the sheet entirely. There is not a way developed to physically check that every person on staff is filling out the log sheet, so that leaves possible error. Another limitation is that some procedures are not able to be done in the room and should be exempt from time out of the room (i.e. circumcisions). This may lead to nurses keeping the baby out of the room for longer than the time that a circumcision takes, but covering up different rationale with the circumcision. Finally, for the staff survey, because it was an anonymous survey, there was no way to make the entire staff complete it, and not all staff may have answered each question honestly.
To study this further, it may be beneficial to look into the efficiency of the physician’s circumcision procedure to decrease the time the baby is out of the room for the circumcision and stuck in the nursery. It would also be helpful to research ways to change the dynamic of the discharge class to make it more newborn-friendly, after discovering the reason the nurses are so against having the baby in the class. Along those lines, it would be very beneficial to look further into the reasoning behind the nurses opinions against the other changes (blood work and hearing screen at the bed side) to make that change more easy and help to change the entire culture of the hospital.
Becoming Baby-Friendly is not a quick, simple change. It is a multi-year long process that requires more than just changes in routine. The motives towards the certification is to better the mother-baby bonding and feeding experience, which in turn betters both of their health. This is just one step in a long, rewarding process.
Baby-Friendly USA, Inc. (2012). Baby-Friendly USA. Retrieved from https://www.babyfriendlyusa.org/
Beshar, I. (2014). Rooming-In: Cold War Consumer Product? Retrieved from ojs.stanford.edu/ojs/index.php/intersect/article/download/605/475
Jaafar, Sarifah H., Lee, Kim S., Ho, Jacqueline J. (2012, July 23). Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006641.pub2/abstract;jsessionid=447FC161ABDB051DB8A67653D5D5E8CC.f01t02
Procianoy, R., Fernandes-Filho, P., Lazaro L., Sartori N., Dresbes, S. (1983, April 29). The influence of rooming-in on breastfeeding. Retrieved from http://www.popline.org/node/392433#stash.LIzIse1p.dpuf
Shrivastava, Saurabh R., Shirvastava, Prateek S., Ramasamy, Jegadeesh. (2013, August 5). Fostering the practice of rooming-in in newborn care. Retrieved from http://www.jhsci.ba/docs/archives/2013-2/17-Shrivastava.pdf
Published In/Presented At
Fradeneck, K., (2014, July, 25) Lehigh Valley health Network Roomin-In Practice. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters