EXPANDED HOSPITAL POLICY #9:

INTERVENTION / MANAGEMENT

RATIONALE

RESOURCES

9.1 Babies should be cared for at their mothers’ bedside. Both the mother and family should be encouraged to assist with infant care.

9.1 Bonding, adaptation to extra-uterine life, and attachment are facilitated by the infant being with the mother.

9.1.1 If mother and infant are separated there is increased potential for supplementation with artificial milk.

9.1.2 Caring for mother and baby together provides the opportunity for individualized teaching and enhances the mother’s ability to learn her baby’s cues. 1,4,6,7,8,12

Academy of Breastfeeding Medicine:
Co-sleeping and Breastfeeding Protocol

Example of a patient handout that addresses safe sleeping areas:

• Solano County Health and Social Services: “Your Baby Matters" (PDF)
• “Sharing a Bed with Your Baby” (PDF)from UNICEF in the UK

9.2 Both the mother and the family should be educated that rest and recovery for the mother and infant is vital.

9.2.1 The nurse’s role is to protect the dyad from disturbances that impact their ability to recover.

9.2.2 Night feeding should be explained as a normal and healthy pattern for the infant.

9.2 Rest is an important physiologic and psychological need for all postpartum, lactating mothers.

9.2.1 With liberalized visiting hours, there may be limited time for mothers to rest unless naps are planned. 2,3,4,9,10,11

9.2.2 Often mothers anticipate their infant will “sleep through the night” long before the infant is physiologically ready. This can create conflict between the mother’s beliefs and the infant’s behavior.

Website resources:

A website with an excellent series of pictures showing infant states and feeding cues following the first few hours and days after birth: www.breastbabyproducts.com/firstdays.html

From Childbirth Graphics:
Bilingual Tear pads:

• How to Tell if Your Baby is Hungry Tear Pad
• Waking a Sleeping Baby Tear Pad

Feeding Cues and other educational tools and packets: Growing With Baby

9.3 If, after encouragement to room in, the mother requests the baby to stay in the nursery at night, the infant should be brought to the mother to breastfeed when the baby displays hunger cues or every three hours, whichever comes first. If the mother chooses not to breastfeed at night, she should be educated on the potential for breast engorgement...

9.3 Prolactin levels are highest at night and may contribute to optimal breastfeeding. Rooming-in provides additional opportunities for mothers and babies to establish effective nursing patterns prior to discharge. 3,4,6,9,10,12

9.4 Evidence of patient teaching and professional recommendations should be documented in the patient’s chart.

9 4.1 An informed consent for supplementation plus a statement indicating the mother’s request not to breastfeed during the night should be included in the patient chart.

9.4 The mother needs to clearly understand the risks of the introduction of artificial nipples, early introduction of artificial infant milk, and failure to optimally provide colostrum to the newborn

9.4.1 Due to potential complications for mother and baby related to early supplementation of the breastfed infant, informed consent is essential.

Patient Information:

• Sample Consent Form (Word)

9.5 If the mother is unable or refuses to feed her infant during the night, the infant should be fed in a manner that is consistent with preserving breastfeeding and reflects the skills and knowledge of the perinatal caregivers in consultation with the infant’s physician. Alternative feeding methods such as cup, finger, or tube feedings should be used to provide adequate calories to the newborn. Alternative feedings should include colostrum or breastmilk, if available. The use of pacifiers, bottles with artificial nipples and water feedings are discouraged (note policies #7 and #8).

9.5.1 Mothers who receive sedative drugs, are out of the room for surgical procedures, or have an altered state of alertness should not bed-in with their newborn.

9.5 California law and hospital regulations, require a safe place for the infant to be during the hospital stay. If the mother chooses not to participate in rooming-in or chooses not to breastfeed her baby during the night, it is the responsibility of the nurses, in consultation with the patient’s physician, to provide care that will best promote the long-term health of the mother and infant.5,7,10

9.5.1 The safety of the infant is paramount.