Hailey Tran
The number of hospitals with newborn nurseries is declining. Hospitals are increasingly adopting the World Health Organization's Baby-Friendly Hospital Initiative (BFHI), which promotes practices that encourage breastfeeding and strengthens the mother-child bond. While some parents appreciate the benefits of rooming-in, such as increased confidence and protection against stress, others face challenges, including sleep disruption and the full responsibility of caring for their newborns 24 hours a day. Some hospitals still maintain neonatal and intensive care nurseries for premature or ill babies, and a few allow formula feeding and have a nursery for healthy newborns.
| Characteristics | Values |
|---|---|
| Percentage of babies born in "baby-friendly" hospitals in 2022 | 27% |
| Number of babies born in "baby-friendly" hospitals since 1996 | 10 million |
| Number of hospitals that no longer use nurseries | At least 2 (Emory University Hospital Midtown in Atlanta and Dartmouth-Hitchcock in New Hampshire) |
| Hospitals that still have nurseries | Community Memorial Hospital, Los Robles Regional Medical Center in Thousand Oaks, Santa Paula Memorial Hospital |
| Types of nurseries | Level I (newborn or well-baby nursery), Level II (neonatal intensive care unit), Level III (most intensive care) |
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What You'll Learn
Baby-friendly hospitals and the push for breastfeeding
In 1991, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI), a global program to encourage hospitals and birthing centers to promote breastfeeding. The initiative was developed in response to declining breastfeeding rates worldwide and aimed to provide mothers with the information, confidence, and skills necessary to initiate and continue breastfeeding. Since its inception, the BFHI has transformed maternity wards, moving away from commercial interests and towards evidence-based care, free from commercial influences.
To become certified as "baby-friendly," hospitals must adopt the Ten Steps to Successful Breastfeeding, which includes skin-to-skin care, rooming-in (where mother and baby stay together 24 hours a day), no pacifiers, and support for mothers to initiate and maintain breastfeeding. According to the CDC, the percentage of babies "ever breastfed" in the US increased from 74% to 82% as the number of Baby-Friendly designated facilities rose.
While the Baby-Friendly initiative has been successful in increasing breastfeeding rates, it has also received some backlash. Some parents have shared their negative experiences in Baby-Friendly hospitals, citing a lack of support and inflexibility. For example, some hospitals strongly discourage formula feeding, even in cases where it may be medically necessary. This has led to concerns about newborn malnutrition and instances where babies have ended up in intensive care. Additionally, the push for exclusive breastfeeding can exacerbate postpartum depression and leave mothers feeling frustrated and exhausted.
To address these concerns, some hospitals are offering flexible options, such as quiet times with dimmed lights and more frequent check-ins by nurses. Dr. Karp has also been working with hospitals on a solution called the SNOO bassinet, which soothes babies by mimicking the sensation of being in the womb. This bassinet has been shown to increase sleep duration and reduce crying frequency, providing a potential win-win solution for both babies and parents.
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The impact on new parents' sleep and recovery
The presence or absence of newborn nurseries in hospitals can have a significant impact on new parents' sleep and recovery. While some parents may prefer to have their newborns close by in the hospital room, others may opt for nursery care to get some rest. Rooming-in policies vary across hospitals, with some recommending rooming-in but offering on-site nursery care if needed.
The absence of nurseries in hospitals can place a significant burden on new parents, who are then responsible for their babies 24 hours a day, even as they recover from childbirth. This can lead to disrupted sleep and unsafe sleep situations, as exhausted parents may accidentally fall asleep while holding their newborns. Additionally, parents may experience increased stress and a lack of confidence due to the constant demands of newborn care.
On the other hand, rooming-in can provide benefits such as improved breastfeeding outcomes and increased confidence in some parents. It can also facilitate bonding and promote the development of "right" mothering habits. However, the closure of hospital nurseries may limit parents' options and spread the belief that new parents should independently care for their babies full-time, only receiving support if they actively seek it.
The availability of nursery care can provide new parents with much-needed time to rest and recover, particularly after a complicated birth or C-section. It allows parents to recuperate physically and mentally, reducing exhaustion and delirium caused by sleep deprivation. Nursery care can also benefit parents with multiple children, providing them with time to pay attention to their older children and adjust to their expanding family.
Some hospitals have implemented solutions to support new parents' sleep and recovery while still adhering to baby-friendly initiatives. These include flexible options, such as quiet times with dimmed lights and minimal procedures, as well as the use of innovative bassinets, such as the SNOO bassinet, which soothes infants and promotes longer sleep periods.
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The rise of rooming-in and its benefits
The practice of rooming-in, or keeping newborns in the same room as their parents instead of in a hospital nursery, has been on the rise since the World Health Organization's Baby-Friendly Hospital Initiative (BFHI) in 1991. This global program promotes hospital practices that encourage breastfeeding and recommends rooming-in as the standard of care for healthy newborns.
The rise of rooming-in can be attributed to the initiative's success in improving breastfeeding rates and its associated benefits for both mothers and infants. Rooming-in makes breastfeeding more accessible, allowing mothers to breastfeed whenever and for as long as they want, which can help increase breast milk production. This practice also aligns with the initiative's goal of supporting new parents in breastfeeding, as infants who room-in are less likely to receive breast milk substitutes.
In addition to the breastfeeding benefits, rooming-in has gained popularity due to its positive impact on parent-child bonding. By having their newborn in the same room, parents have more opportunities for skin-to-skin contact, also known as kangaroo care, which has been associated with a range of short- and long-term benefits. These include a lower mortality rate, decreased neonatal sepsis, and improved growth and development in preterm infants. Rooming-in also enables parents to learn their baby's behavior and cues more quickly, increasing their confidence in caring for their newborn.
Another advantage of rooming-in is improved sleep for both parents and infants. Contrary to expectations, having a newborn in the room can provide better sleep for parents due to increased peace of mind and less stress. The presence of the baby can also help the infant develop a healthy sleep-wake cycle.
While rooming-in has become more prevalent, it is important to note that it is not the only option. Hospitals may offer partial rooming-in, where the baby stays with the parents during the day but sleeps in the nursery at night, or they may provide flexible options for parents who need more support. The decision to room-in or utilize other options is a personal choice, and hospitals should work to support parents in making the best decision for their family.
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The closure of nurseries and the loss of viewing areas
The closure of nurseries in hospitals has been a growing trend in recent years, with hospitals shifting their focus to the "baby-friendly" model of maternal care. This model emphasizes rooming-in, where healthy mothers and babies are kept together in the same room, promoting breastfeeding and strengthening the mother-child bond. While this approach has its benefits, the closure of nurseries and the loss of viewing areas have also had some drawbacks.
The baby-friendly initiative, supported by organizations like Baby-Friendly USA and the World Health Organization's Baby-Friendly Hospital Initiative (BFHI), has led to a significant decrease in the number of hospital nurseries. Many hospitals have abandoned the traditional nursery model, where newborns are cared for separately from their mothers, in favor of rooming-in. This shift is based on research that highlights the benefits of keeping mothers and babies together, including increased breastfeeding rates and improved bonding opportunities.
However, the closure of nurseries has also presented challenges for some new parents. One of the main concerns is the added responsibility and exhaustion that comes with caring for a newborn 24 hours a day, especially for mothers who are recovering from childbirth. In some cases, parents may desire a brief respite from their newborn, particularly if they are struggling with breastfeeding or simply need rest. The lack of a nursery option can place an additional burden on already tired and overwhelmed parents.
The loss of viewing areas or nursery windows, which were once a common feature of maternity wards, is another consequence of the changing landscape of hospital nurseries. These windows offered a glimpse into the peaceful world of sleeping newborns, providing joy and comfort to visitors, family members, and even fathers, who traditionally did not meet their babies until they returned home. The iconic image of a father gazing at his newborn through a nursery window has been immortalized in art, advertising, and countless family photographs. However, with the shift towards rooming-in and the closure of nurseries, these viewing areas have largely disappeared, depriving people of the simple pleasure of witnessing the beauty of birth.
While the baby-friendly movement has brought about positive changes in maternal care, the complete absence of nurseries in some hospitals has sparked backlash. There is a growing recognition that flexibility and support for new parents are essential. Hospitals are now exploring alternative solutions, such as implementing quiet times, providing more frequent nurse check-ins, and offering innovative products like the SNOO bassinet, which mimics the sensation of being in the womb to soothe newborns and promote longer sleep periods. These adaptations aim to strike a balance between the benefits of rooming-in and the need for rest and support for exhausted parents.
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The different types of nurseries and their care
Hospital Nurseries
Hospital nurseries, also known as newborn or well-baby nurseries, are for healthy babies who don't require any special monitoring, oxygen, or intravenous tubes. Many babies born between 35 and 37 weeks are typically cared for in these nurseries. However, in hospitals without a Level I nursery, healthy babies stay in a bassinet in the room with their mothers.
Neonatal Intensive Care Units (NICU)
Neonatal intensive care units, or Level II nurseries, provide care for babies who are moderately ill but expected to recover quickly. Babies in this nursery are typically 32 weeks old or more and weigh over 1,500 grams. They may have an intravenous catheter, receive oxygen, and be tube-fed.
Intensive Care Nurseries
Level III nurseries offer the highest level of intensive care for the tiniest and most critically ill babies. This includes babies who require mechanical ventilation, or the assistance of a breathing tube and machine, for more than 24 hours. Level III nurseries are further subdivided into Level IIIA, Level IIIB, and Level IIIC based on the degree of critical care they can provide.
Baby-Friendly Hospitals
Baby-friendly hospitals do not have nurseries and instead practice rooming-in, where healthy mothers and babies are kept together. This initiative aims to promote breastfeeding and support new parents. While this approach has benefits, it has also received backlash, as some parents struggle with the 24-hour responsibility of caring for their newborns while recovering from childbirth, which can lead to sleep deprivation and unsafe sleep situations.
Agricultural and Horticultural Nurseries
Agricultural and horticultural nurseries are spaces dedicated to propagating plants and providing initial care until they are robust enough to be transplanted. These nurseries play a vital role in agriculture, environmental conservation, the pharmaceutical industry, and landscaping. Different types of nurseries include fruit plant nurseries, ornamental nurseries, and temporary nurseries that are only open during certain seasons.
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Frequently asked questions
Hospitals are shifting their focus to strengthening the mother-child bond in the first days of life. Research shows that keeping a mother and baby together creates a healthier environment for both. This is also known as "rooming-in".
Newborn nurseries allow new parents to get some rest, especially after a traumatic birth. They also allow parents to recover from childbirth without shouldering the responsibility of their babies 24 hours a day.
Infants kept in hospital nurseries are more likely to receive less breast milk and more breast milk substitutes. Rooming-in makes breastfeeding easier and allows more time for the mother and child to bond and attach.
Yes, as of 2022, there are still hospitals that operate newborn nurseries. Some parents have reported using nurseries in hospitals designated as "baby-friendly". However, it is becoming increasingly rare, with many hospitals moving away from the trend.
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