Today, families being cared for on maternity units are savvy consumers who expect to have input regarding all aspects of their care. It is not unusual for the mother-to-be and her partner to spend considerable time researching various options for their care before their baby’s birth. They come to the hospital with the belief they will have choices regarding their care. Their expectations align with patient and family-centered care principles being embraced by many healthcare institutions, including openly sharing timely and accurate information to allow the women and her family to become an active participant in decision making; planning for care that is flexible so preferences can be respected and honored; and empowering families by allowing them to identify their strengths and become confident in their ability to make healthcare decisions.
The standard for maternity care should be one that is centered on and adapts to the physical and psychosocial needs of the mother and her family. This should be the foundation for the definition of family-centered care.Many healthcare institutions practice mother-baby couplet care by requiring the newborn to remain in the mother’s room for the duration of the hospital stay. This interpretation of mother-baby couplet care disallows the family-centered care principle of respecting the patient’s preferences because with this model, there is no other available option. All clinical situations are unique, all families are different, and one strict policy does work in all cases. Forcing the mother to keep the baby in her mother room is a practice with concerns about the psychological well-being of the mother and infant safety. Regardless of the mother’s preparation and planning before giving birth, admission to the hospital is often synonymous with feeling a lack of control. The sensation heightens if the hospital has interpreted couplet care as rooming-in without the option of a separate nursery to use as the mother desires.
Sleep patterns are altered during the postpartum period. The unknown variable is the mother’s prenatal sleep patterns and predisposing factors for sleep deprivation, such as a long prodromal labor. Seep deprivation or sleep disruption often initiates cognitive deficits and increases risk for postpartum depression.Rooming-in without the option of a respite nursery limits the ability to meet the mother’s need for periods of quality sleep, and is a missed opportunity to provide flexibility in care preferences.Newborn safety may also be affected by the mother’s response to her sleep disruption.
Dangers of bed sharing are well documented, yet in reality bed sharing unintentionally occurs if a new mother falls asleep while breastfeeding. Skin-to-skin contact between mother and baby is often recommended to support breastfeeding. However skin-to-skin contact for the new mother and baby without safety measures can be a risk because a sleep-deprived breastfeeding mother may easily fall asleep with the baby at breast. Medical examiner cases have shown the mother fell asleep breastfeeding and upon waking assumed her baby was asleep, when in fact, this was not the case. The problem is compounded by lighting in many hospital rooms that makes it challenging for the nurse or parent to assess the baby accurately.
Ability of nurses to meet patients’ care preferences is challenging with implementation of exclusive rooming-in for couplet care. Extended family that can assist the new mother or care for her other children is no longer routinely available. Limited support networks result in the mother alone with her newborn, as her partner is either home caring for the older siblings or at work. The nurse provides support; yet, this too is often influenced by needs of other couplets. The end result of a strict policy is the principles of family-centered care are not met. The nurse is unable to offer flexible choices, and a new mother is not able to become empowered and confident in her ability to safely provide care for her baby. Therefore, I am unable to unequivocally endorse mother-baby couplet care that involves rooming-in for all mothers and new babies as the standard.