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Mother Baby Separation



The separation of mothers and infants during hospitalizion is common. This article looks at three phases of separation, impact, and alternatives.

The term "non-separation" has been used over the last few decades to describe the movement to keep hospitalized mothers and babies together after birth. Surprisingly, there is some confusion over the term even though the concept is quite simple. The term may mean different things in different regions, different hospitals, and even to different parents or health care givers in the same hospital. These differences in meaning of the word "non-separation" can be understood according to the times hospitals often separate the infants and mothers. In general, it appears that there are three different ways the term is used, depending on the period of time in which infants may be separated from their parents.

Periods of Separation of Mothers and Babies

  1. Separation for initial procedures immediately after birth
  2. Separation for observation by nursery staff
  3. Extended separation

Initial Separation vs Skin to Skin Contact

Skin to skin contact has tremendous value immediately after birth; though the value of touch does not disappear as the hours tick by. It was the work of researchers in the first hour of life that began to wake the birth community up to the immense value of skin to skin contact; and conversely to potential damage by separation in that first hour. In that first hour, separation is often done for the purpose of initial screens and mandated procedures. Most of those procedures can be done with the mother and infant in contact.

Research done in 1977 by de Chateau and Wiberg showed that infants who were allowed to stay skin to skin with their mothers cried less and breastfed longer. At three months of age, these infants smiled more, were less fussy, and their mothers described their behaviors and personalities more positively. Differences between infants who were not separated and those who were separated were documented for several years.

In 1990 Righard and Adelade documented through research and on video the process of self-attachment. Babies who were unmedicated and not separated immediately after birth were able to find the breast on their own and latch on to the nipple without assistance. Babies who were separated were unable to do so.

Studies in 2002 and 2004 continued to document increased breastfeeding success for infants who were not separated immediately at birth.

Recommendations
  • Keep mother and baby skin to skin for the first hour of life
  • Request the cord not be cut until it is done pulsating
  • Delay eye ointment, weight, finger-printing until the infant has nursed the first time.

Nursery Observation vs. Bonding, Breastfeeding, Initiating Wake/Sleep Cycles

The next period of routine separation may occur if the infant is removed from the mother's room to be monitored by health care staff in the nursery. Depending on the hospital, this may be as early as five minutes after delivery or as late as three hours. This routine period of observation away from the parents may be as short as twenty minutes or as long as five hours. Regardless of the initiation and duration of this period of monitoring, it is unnecessary for a healthy infant.

In fact, Nils Bergman MD, a neonatologist who specializes in the care of premature and ill infants, has extensively researched the impact of keeping mothers and babies together. He states that it is unnecessary and harmful even for premature babies to be separated from their mothers and put into incubators.

There are four major reasons given for the separation of the infant who is now or will soon be several hours old. The first is for the completion of the routine procedures not done in the room the birth took place in. As has been stessed in the past, such procedures can be done not only at the mother's bedside, but preferably skin to skin with the mother.

The second reason given for this period of nursery care is to monitor and control the baby's body temperature. This is best done, however, by the mother and not an infant warmer. Babies who are skin-to-skin with their mothers have a decreased incidence of hypothermia and have warmer body temperatures.

The third reason for separation may be to monitor the glucose level of the infant, which may be done if the mother is diabetic or received IV solutions with glucose during labor. But again, where should this take place?

And finally, it is often stated that the mother needs rest and should send the baby to the nursery. After all, mothers are often tired after birth and no one would want to deny them rest. This overlooks the fact that mothers rest very well, and in fact – often better – when their babies are close at hand. Shortly we will look at the infant wake/sleep cycle and how the mother can get into a rhythm with the baby to best meet the needs of both of them.

Finally, nurses have stated that the reason the infant needs to be observed is that a few infants have developed respiratory or cardiac problems that did not show up in the first minutes of life, and it would be fatal if they were to develop such difficulties if not in the presence of trained personnel. Three facts can dispel this fear, for obviously no parent wants to think their baby may die just because they kept them at their bedside.

First, numerous hospitals have done away with this mandatory separation, and some have even closed the newborn nursery for healthy babies. These hospitals do not have a higher mortality rate, or this practice would have changed long ago. Second, parents will notice if the infant starts gagging or stops breathing, and in a hospital setting help is only a call button away. And finally, infants in the nursery are not being watched over constantly by the staff. In fact, the staff has numerous infants to care for, and it may actually take longer for the distress of an infant to be recognized than if he or she were in the arms of the parents.

The difficulty in changing this practice lies in the convenience of having multiple infants in the care of one health care provider. "We don't have enough nurses to provide one-on-one care," is frequently stated. We recognize that there is a national shortage of nurses and it impacts newborn care as well as other departments in the hospital. However, let's not take babies away from their natural caregivers in order to "monitor" them by overworked staff members.

Extended Separation vs. Rooming In

The practice of allowing the baby to spend days and nights in the mother's room actually began four decades ago, and is commonly referred to as "rooming-in."

Rooming in has multiple advantages. It allows the parents to get to know their infant, to begin the Mother/Baby Rhythm, to establish the coordinated wake/sleep cycle, to gain experience in performing infant care duties like diaper changes, and to establish a milk supply. Conversely, separating the infant from the mother except for scheduled "visits" decreases her milk supply, decreases parental confidence in infant care, prevents the establishment of a coordinated cycle, and ultimately sends parents home with an infant they do not know very well.

It is interesting to note that the acceptance of the practices of keeping mothers and babies together have been in reverse order than chronicled here. That is, the policy of "rooming-in", or allowing an infant to spend the night in the room without mandating they be sent back to the nursery was promoted by breastfeeding advocates in the 1960's, joined by an increasing number of childbirth educators and a few hospitals in the 1970's, requested by the general population and provided by a growing number of hospitals in the 1980's, and available across this country in most hospitals by the 1990's. It took almost two generations to convince the medical community that babies could spend the nights with their mothers without detriment.

A similar, but later, movement supported the practice of keeping the infant at the mother's bedside for the first hours after birth instead of sending them to the nursery for bathing, screening, and observation. Numerous hospitals have proven that mothers, indeed, are the best caregivers of their hours-old infant, just as they were found to be the best caregivers of their days-old infants over the past decades. As a benefit, nurses have noted that infants are more content and breastfeeding gets off to an easier start.

The movement to keep the minutes-old newborn skin-to-skin with mothers is in its own infancy.

"We don’t do that here," is a common response to parent's inquiries in many hospitals. It is pretty hard to defend the refusal to provide this practice medically, in that the caregivers and medical equipment are already in the same room.

"It gets too crowded with so many people around the mother's bed," is another explanation that is given, though considering the advantages of skin-to-skin contact it's not a great one.

"Change takes time" is probably the more accurate explanation, though still not sufficient. It has been two decades since Righard’'s groundbreaking work documenting infants maneuvering their way to the mother’s breast and latching on. Research has continued to demonstrate the importance of skin to skin contact and the potential harm of separation.



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By Karen Newell Copyright 2011 - 2012 Better Childbirth Outcomes - All Rights Reserved
Camp Hill, Pennsylvania, USA