Minimizing Mother-Baby Separation to Promote Breastfeeding Exclusivity: Closing the Gap in Nursing Practice

Objective:   Professional organizations and regulatory agencies world-wide recognize breast milk as the ideal food for newborns recommending exclusive breastfeeding for its health benefits.  Research has identified that hospital practices affect breastfeeding duration and exclusivity throughout the first year of life.  At our hospital, mothers and newborns were separated during the first two hours of birth, for newborn assessments and procedures, and at mother’s request. Separating mothers from their newborns creates missed opportunities for recognizing feeding cues in which a nurse could be readily available to teach and provide support for breastfeeding. The purpose of this evidence-based quality improvement project was to implement strategies to increase the time mothers and newborns spend together during postpartum hospitalization and ultimately increase the rate of breastfeeding exclusivity.

Design: Research evidence supports that newborns who room-in with their mother are more likely to be exclusively breastfed at discharge compared to newborns that have been separated from their mothers. Rooming-in of mothers and newborns has been found to improve breastfeeding, produce milk sooner and in more abundance, and improve mother’s attention to their newborn needs resulting in less newborn crying.  A pre- post-intervention design was used to measure rate of breastfeeding exclusivity, breastfeeding immediately following birth, and time newborns spent in the nursery before and after implementation of strategies to minimize mother-baby separation.

Sample:  This project was implemented in a regional perinatal and neonatal referral center of a Magnet designated community teaching hospital. Care is provided to over 3,000 mother-newborn dyads per year.

Methods:  Nursery census was monitored during the hours of 11:00 PM and 7:00 AM pre- and post-implementation to determine progress toward non-separation. Breastfeeding exclusivity and time to first feeding were also evaluated for improvement pre- and post-implementation.  

Implementation Strategies: A multidisciplinary perinatal team used Lean Six Sigma methodology to decentralize newborn care:  1) portable equipment was purchased for assessing newborns at mother’s bedside; 2) change in documentation providing more detail about newborn feeding methods; and 3) mandatory education was provided to nurses about the change in clinical practice.   

Results: There has been an overall increase (54%) in rooming-in during hospitalization.  Newborns breastfeeding within one hour post vaginal birth has steadily increased to 96%.  Breastfeeding exclusivity rate has shown an increase of 38%.

Conclusion/Implications for nursing practice: Decentralizing newborn care to support non-separation provides the opportunity for nurses to close the gap and champion breastfeeding exclusivity during hospitalization.

Keywords: Breastfeeding, rooming-in, non-separation