1. Simpson, Kathleen Rice PhD, RNC, FAAN

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Many perinatal patient safety efforts have focused on fetal well-being during labor and birth. Safety of the baby after birth requires equal vigilance. Evidence suggests newborns falling or being dropped while in the care of their parents in the hospital is an issue that needs our attention (Wallace, 2014).


Well-intentioned efforts to promote breastfeeding and maternal-infant attachment sometimes feature forced rooming in without family or support persons in attendance and/or inadequate nurse staffing for frequent assessment and assistance. Some hospitals have eliminated staffing for well-baby nurseries and some new hospitals have been built without well-baby nurseries. Nurse staffing for mother-baby couplet care is not always consistent with Association of Women's Health, Obstetric and Neonatal Nursing (2010) staffing guidelines.


After birth, the 2-hour recovery period requires careful nursing assessment to ensure safety of mother and baby. Medications given for pain after birth can cause drowsiness, especially those given for postop cesarean pain. Babies should not be left in mothers' arms alone in this context. Fatigue of labor coupled with pain medications increases risk of mothers falling asleep while holding their baby. Babies falling to the floor from mothers' bed and babies suffocating at the breast of the sleeping mother have been reported. Medications given for sleep are counter-productive to safe breastfeeding during the night. Ideally the new mother has someone to stay with her continuously during the hospitalization to help her care for the baby. But this isn't always the case; families and friends may live out of town; the woman's partner may need to be home to care for other children; the woman may not have a support person. Consider the physical and emotional state of women after 20 hours of labor, particularly after unplanned cesarean. Partners and support persons may be tired too. Babies can tumble from their arms when they fall asleep despite their best intentions. Some units offer beds or sleep chairs for partners. Babies can suffocate when the sleeping partner rolls over on the baby. Babies can fall off the bed/sleep chair. Expecting a new mother to get up and care for her new baby around the clock in the first few days postpartum without help may not be realistic.


Common sense approaches to newborn safety are listed in the box. Be sure to balance policies for keeping new mothers and babies together with principles of safe care.


Common Sense Approaches to Newborn Safety


* Assess each woman as an individual for her specific needs, fatigue, level of pain, pain medication status, physical presence of support person and their fatigue, knowledge of infant safety measures, and preferences for her postpartum and newborn care.


* Encourage, not force, mothers and babies to stay together. Discuss options based on individual needs, clinical and emotional status, and patient preferences. A strict policy does not work for all situations or all mothers and babies. Designate a nurse on each shift to staff the well-baby nursery if needed. Avoid making new mothers feel guilty if they ask for a nurse to care for their baby.


* The immediate recovery period after birth allows an opportunity for mothers and babies to be skin-to-skin. The nurse should be in constant attendance to care for mother and baby during this time to promote maternal-infant attachment and breastfeeding in a safe setting where the nurse insures the baby is warm and able to breathe without obstruction.


* Maintain a 1 nurse to 3 mother baby couplet ratio, especially during the night when mothers may require sustained nurse bedside attendance for safe holding and breastfeeding in the absence of a support person or a fully awake support person. Encourage new mothers to call for help of the nurse as needed.


* Explain to parents how to minimize risks of their baby falling/being dropped and the danger of baby injury. Emphasize importance of letting the nurse know if this happens (not all will do so for fear of appearing to be bad parents). Make sure parents know that the bassinet is the safest place for the baby when parents are tired/need to nap. Cosleeping with the new baby should be strongly discouraged.




Association of Women's Health, Obstetric and Neonatal Nurses. (2010). Guidelines for professional registered nurse staffing for perinatal units. Washington, DC: Author. [Context Link]


Wallace S. C. (2014). Balancing family bonding with newborn safety. Pennsylvania Patient Safety Advisory, 11(3), 102-107. [Context Link]