What is the issue?
Keeping mother and infant together (rooming-in) or separating them after birth are both traditional practices seen in many cultures. During the early 20th century when hospitals became the centre for birthing in industrialised countries, the practice of separate care became established. Newborns were placed in a nursery separated from their mothers and brought to their mother only for breastfeeding. The practice of mother-infant rooming-in became less practised. Mother-infant proximity during the early postpartum period might directly influence mother-infant interaction, which might impact on the duration of breastfeeding.
Why is this important?
Separating infants from their mothers after birth may reduce the frequency of breastfeeding and hence the amount of breast milk a mother produces. Whereas, infants staying together with the mother throughout their hospital stay would have more frequent suckling of the breast and thus promote closeness and bonding. Separate care might allow the mother to rest and reduce stress, which also might improve milk production. Many hospitals have now started to keep the mother and baby in the same room, particularly since the advent of the WHO/UNICEF Baby Friendly Hospital Initiative in 1991. This systematic review aimed to establish from randomised controlled trials whether rooming-in or separate care after birth resulted in a longer duration of exclusive breastfeeding once they had returned home.
What evidence did we find?
The latest search was done on 30th May 2016. No new studies were identified. Only one study is included in the review.
One trial (involving 176 women) was analysed which provided information on the rate of exclusive breastfeeding on discharge from hospital. We found that there was low-quality evidence that keeping mother and infant together in the same room after birth until they are discharged from the hospital increased the rate of exclusive breastfeeding at four days after birth. There was no difference between the groups in the proportion of infants receiving any breastfeeding at six months of age.
What does this mean?
We found little evidence to support or refute the practice of rooming-in after birth. A randomised controlled trial is needed and it should report all important outcomes, including breastfeeding duration.
We found little evidence to support or refute the practice of rooming-in versus mother-infant separation. Further well-designed RCTs to investigate full mother-infant rooming-in versus partial rooming-in or separate care including all important outcomes are needed.
Mother-infant proximity and interactions after birth and during the early postpartum period are important for breast-milk production and breastfeeding success. Rooming-in and separate care are both traditional practices. Rooming-in involves keeping the mother and the baby together in the same room after birth for the duration of hospitalisation, whereas separate care is keeping the baby in the hospital nursery and the baby is either brought to the mother for breastfeeding or she walks to the nursery.
To assess the effect of mother-infant rooming-in versus separation on the duration of breastfeeding (exclusive and total duration of breastfeeding).
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies.
Randomised or quasi-randomised controlled trials (RCTs) investigating the effect of mother-infant rooming-in versus separate care after hospital birth or at home on the duration of breastfeeding, proportion of breastfeeding at six months and adverse neonatal and maternal outcomes.
Two review authors independently assessed the studies for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for accuracy. We assessed the quality of the evidence using the GRADE approach.
We included one trial (involving 176 women) in this review. This trial included four groups with a factorial design. The factorial design took into account two factors, i.e. infant location in relation to the mother and the type of infant apparel. We combined three of the groups as the intervention (rooming-in) group and the fourth group acted as the control (separate care) and we analysed the results as a single pair-wise comparison.
Primary outcomes
The primary outcome, duration of any breastfeeding, was reported by authors as median values because the distribution was found to be skewed. They reported the overall median duration of any breastfeeding to be four months, with no difference found between groups. Duration of exclusive breastfeeding and the proportion of infants being exclusively breastfed at six months of age was not reported in the trial. There was no difference found between the two groups in the proportion of infants receiving any breastfeeding at six months of age (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.51 to 1.39; one trial; 137 women; low-quality evidence).
Secondary outcomes
The mean frequency of breastfeeds per day on day four postpartum for the rooming-in group was 8.3 (standard deviation (SD) 2.2), slightly higher than the separate care group, i.e. seven times per day. However, between-group comparison of this outcome was not appropriate since every infant in the separate care group was breastfed at a fixed schedule of seven times per day (SD = 0) resulting in no estimable comparison. The rate of exclusive breastfeeding on day four postpartum before discharge from hospital was significantly higher in the rooming-in group 86% (99 of 115) compared with separate care group, 45% (17 of 38), (RR 1.92; 95% CI 1.34 to 2.76; one trial, 153 women; low-quality evidence). None of our other pre-specified secondary outcomes were reported.