PRO
I have seen many changes over my career in maternal child nursing. One very positive change is the movement toward family-centered care, which has evolved into mother-baby couplet care as the standard for high-quality postpartum nursing. Various terms are found in the literature describing this practice: mother-baby care, couplet care, rooming-in, and family-centered maternity care, among others. What I am advocating for is implementation of family-centered maternity care as defined by Celeste Phillips, which is safe, quality care founded on the physical and psychosocial needs of the new mother and baby and her family (Phillips, 2003). Philips (2003) outlined 10 Principles of Family-Centered Maternity Care; 2 are of particular importance on this topic: encouraging mothers to keep the baby with them at all times, and having the same person caring for the mother-baby couplet as a single family unit.
Although most maternity units advertise family-centered care, many units continue to have different nurses caring for mothers and babies and having the couplet separated at times during the hospital stay. Mothers and babies were cared for together until the early 20th century. As hospitals, instead of homes, became the usual place to give birth, separation of mothers and babies became the norm. This type of hospital-centered care is slowly being eliminated, but not in all hospitals. Nurses should be embracing mother-baby couplet care because evidence shows benefits not only for mothers, babies, and families, but for nurses as well. Patient satisfaction is one reason to support couplet care. One hospital noted a significant rise in their satisfaction scores after the introduction of couplet care (Mullen, Conrad, Hoadley, & Iannone, 2007). Women reported having a great experience with couplet care and loved having the baby with them at all times. The hospital saw an increase in birth volume, as word spread in the community about the positive experiences women were having with the change to couplet care (Mullen et al., 2007). Women have a more positive attitude toward mother-baby couplet care than other care models (Phillips, 2003; Waller-Wise, 2012).
The higher satisfaction women report with mother-baby care could be because they feel that nurses are spending more time with patient teaching, resulting in the mothers feeling a higher level of competence in caring for themselves and their newborns (Waller-Wise, 2012). Mothers feel more nursing time is devoted to helping with feeding, contributing to lower rates of supplementation of breastfed babies in couplet-care units (Waller-Wise, 2012). Advantages for breastfeeding mothers of this model of care are numerous. Increase in breastfeeding frequency has been seen, resulting in less hypoglycemia, large weight loss, and jaundice, in addition to increased milk supply and a greater likelihood of continuing breastfeeding at 4 months (Hurst, 2013). Some mothers report they sleep better when the baby remains in their room, instead of the nursery (Hurst, 2013). Abrahams et al. (2007) found that opioid-exposed newborns needed less treatment of neonatal abstinence syndrome and a shorter length of stay, when they were not separated from their mothers. Not only are new parents more satisfied with couplet care but nurses are as well. Nurses using the couplet-care model had significantly higher job satisfaction scores compared to nurses using the traditional care model and couplet-care nurses reported being better able to meet patient needs for care and education (Waller-Wise, 2012).
Hospital leaders must implement changes in policy and provide education for patients, healthcare providers, patient educators, and staff nurses to realize all the advantages of couplet care. Adequate staffing is another approach required to support the role of nurses in caring for two patients in one couplet. By working closely with hospital administrators to endorse and fully implement mother-baby couplet care throughout the hospital stay, nurses will contribute to not only increased breastfeeding rates and greater patient satisfaction with the maternity care experience, but also greater job satisfaction.
References
Abrahams R. R., Kelly S. A., Payne S., Thiessen P. N., Mackintosh J., Janssen P. A. (2007). Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Canadian Family Physician, 53(10), 1722-1730. [Context Link]
Hurst A. (2013). Rooming-in for newborns: Implementing. In D. Pravikoff (Ed.), CINAHL nursing guide (pp. 1-5). Ipswich, MA: EBSCO Publishing. [Context Link]
Mullen K., Conrad L., Hoadley G., Iannone D. (2007). Family-centered maternity care: One hospital's quest for excellence. Nursing for Women's Health, 11(3), 282-290. doi:10.1111/j.1751-486X.2007.00166.x [Context Link]
Phillips C. (2003). Family-centered maternity care. Sudbury, MA: Jones and Bartlett. [Context Link]
Waller-Wise R. (2012). Mother-baby care: The best for patients, nurses and hospitals. Nursing for Women's Health, 16(4), 273-278. doi:10.1111/j.1751-486X.2012.01744.x [Context Link]
CON
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 (Kuo et al., 2012).
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 (Kuo et al., 2012). 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 (Dorheim, Bondevik, Eberhard-Gran, & Bjorvatn, 2009). 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 (Kuo et al., 2012). 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 (Thach, 2014). 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 (Thach, 2014). 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. <
References
Dorheim S. K., Bondevik G. T., Eberhard-Gran M., Bjorvatn B. (2009). Sleep and depression in postpartum women: A population-based study. Sleep, 32(7), 847-855. Retrieved from http://www.journalsleep.org/ViewAbstract.aspx?pid=27505[Context Link]
Kuo D. Z., Houtrow A. J., Arango P., Kuhlthau K. A., Simmons J. M., Neff J. M. (2012). Family-centered care: Current applications and future directions in pediatric health care. Maternal and Child Health Journal, 16(2), 297-305. http://dx.doi.org/10.1007/s10995-011-0751-7[Context Link]
Thach B. T. (2014). Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards. Journal of Perinatology, 34(4), 275-279. http://dx.doi.org/10.1038/jp.2013.184[Context Link]