Article link:
Lori Feldman-Winter, Jay P. Goldsmith,
COMMITTEE ON FETUS AND NEWBORN, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME

Abstract
Skin-to- skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization’s “Ten Steps to Successful Breastfeeding.” SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to influence sleeping practices after discharge. Hospitals and birthing centers have found it difficult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies.

Milk Mob Comment by Anne Eglash MD, IBCLC, FABM

Rooming-in is a critical component for breastfeeding success in hospitals. If infants are in the nursery, they are not the drivers of nursing frequency, since mom cannot identify the infant’s feeding cues. Infants who room-in with their mothers nurse longer and more often, key behaviors for breastfeeding success at hospital discharge.

This American Academy of Pediatrics report addresses concerns regarding increased risk of dropping or suffocating the infant in bed as consequences of the infant rooming-in with mother. They review studies demonstrating that side-car bassinets, which attach securely to the side of mother’s bed, may be the most favorable method of keeping the baby safe and secure during rooming-in. In addition, they suggest sufficient nursing staff so that each mother-baby dyad can be observed closely, and responded to quickly, to avoid accidents. In addition, having sufficient staff, whether they are registered nurses, nursing assistants, doulas or others, will provide for more opportunities for psychosocial support and education before hospital discharge.