After giving birth by cesarean section — a major abdominal surgery — Kristine Coogan felt like she wasn't the ideal person to care for her infant that first night.
But to her surprise, Coogan said, the nurses declined to take her newborn to the nursery so she could rest and recover. Instead, her daughter "roomed in," a practice designed to keep mothers and babies in close contact immediately after birth.
Though snuggling up together can enhance breast-feeding and bonding, Coogan said she worried about her newborn's safety.
"After having a C-section, you need help," said Coogan, whose support system — her husband — was at home taking care of their 3-year-old twins. "You have limited ability to get up and around, and they hand you a baby to take care of? That safety net (the hospital nursery) has to be there."
Once the hub of the maternity floor, transitional or well-baby nurseries are now rarely used in some hospitals because of the rising popularity of rooming in. Some research suggests that constant skin-to-skin contact in the first 48 hours following birth can be beneficial for moms and babies, even for women who do not nurse.
But the shift away from nursery care has sparked a backlash among some mothers who don't plan to breast-feed or simply want some time to rest after the trauma of childbirth and before taking up the responsibilities of child care.
Some women say their recovery should take priority so they can better care for the baby when they go home. They feel rooming in can raise safety issues at the hospital. And they don't like being characterized as bad mothers who are shirking their duties.
"It's not that I wanted a break for a few days; it's that I didn't feel safe having my baby in the room with me and no other adult present," Coogan said.
Some mothers whose babies do room in also question hospital charges for "nursery care" when it seems they are the ones doing the work.
It used to be common for healthy newborns to be taken to a hospital nursery at night. A well-rested mother, it was thought, would be better able to care for her baby. A woman who wanted to keep her child in the room at night simply needed to ask.
But some hospitals now present rooming in as the norm to help mothers learn the infant's feeding cues and make it easier to start breast-feeding. Some research suggests that babies cry less and soothe more quickly when with their mothers and that new moms don't necessarily get better-quality sleep while separated from their newborns.
Women can still ask for the nursery, but some nurses now are trained to push back.
"Our nurseries haven't closed," said Malika Shah, medical director of Prentice Newborn Nursery at Northwestern Memorial Hospital in Chicago. "What has changed is that the nurse won't say, 'Oh sure, get some rest; I'll take the baby to the nursery and we'll work on breast-feeding tomorrow.' "
Instead, Shah said, nurses explain that the baby needs to feed frequently in the first few hours, a process that helps the mother's milk come in. "There are some women who don't know that," she said.
Prentice, like more than a dozen Chicago-area hospitals, now emphasizes rooming in as part of its effort to earn a "baby-friendly" designation offered by the World Health Organization and the United Nations Children's Fund. The global Baby Friendly Hospital Initiative, which was launched in 1991 but has recently been gaining momentum in the Chicago area, aims to improve breast-feeding rates and encourage mother-infant bonding.
The drive to become baby-friendly is in part sparked by the Illinois Infant Feeding Bill of 2012, which requires hospitals to have policies that optimize breast-feeding success, Shah said. Also, the Surgeon General, Centers for Disease Control and Prevention and the Joint Commission, which accredits hospitals, have all issued statements urging hospitals to step up these efforts.
Advocate Illinois Masonic Medical Center, which is also pursuing baby-friendly status, has been rooming moms and babies together for at least 15 years. New moms are encouraged to arrange for support from friends or family members who can help care for the baby, said Sarah Hoekwater, a labor and delivery registered nurse at Illinois Masonic in Chicago.
"If the nurse were to bring the baby from the nursery already crying and frantic, the mom isn't learning the cues to be able to breast-feed," she said.
At Northwestern's Prentice, the largest birthing center in Illinois and the Midwest, "the culture did not previously promote togetherness," Shah said. With the recent changes, 71 percent of babies born at the hospital in August were breast-fed without formula supplementation, up from 34 percent in September 2012, Shah said.
First-time mom Katie Bambacht, of Forest Park, said she wanted to room in at Prentice and didn't realize the overnight nursery was even an option. When she needed help, she said, she called the nurse.
"It put my husband and I into immediate caregiver mode," said Bambacht, who delivered her daughter Evie at 1:47 a.m. Oct. 19. "You do start to learn the baby's cries. The recognition of what she needed started earlier than had she been in another room. It definitely helped."
Other expectant mothers are wary of the trend. Chicago's Shellane Mulcahy delivered twins at Prentice in 2011 and happily slept for two nights while her babies were in the overnight nursery. A general policy may ignore the needs of the patient — who is the mother, not the baby, said Mulcahy, who is due again in December.
"Giving birth is the hardest thing I've ever had to do with my body," she said. "Afterward, it's like, 'Just let me sleep for eight hours.' I feel strongly that if you have the resources at hand, you should allow the body to recover from the fact that you've just given birth."
The overnight nursery has been controversial ever since childbirth moved out of the home. Hospitals began recruiting maternity patients in the 1920s, stressing that a hospital birth meant a week's vacation from domestic responsibilities, said birth historian Elizabeth Temkin, whose paper "Rooming-In: Redesigning Hospitals and Motherhood in Cold War America" appeared in the Bulletin of the History of Medicine in 2002.
In the late 1940s, however, rooming in became more common because of two factors: post-World War II nursing shortages and nursery epidemics of infectious diarrhea, impetigo and respiratory illness.
As rooming in became more popular, mothers who used the nursery faced increasing criticism, Temkin said. According to her research, one obstetrician wrote in 1949 that "there will probably always be women who will wish to avoid the responsibility of care of their babies and who will prefer to look upon their hospital stay as a vacation."
"Rooming in has always been accompanied by guilt — the implication that mothers who don't room in are bad mothers," Temkin said.
In the 1960s, nurseries made a comeback as the nursing shortage ended and new studies suggested that nurses were not, in fact, causing epidemics. A Memphis maternity unit built in 1963 "had cameras installed in the nursery so mothers could observe their infants from their own rooms," Temkin said.
Then came the natural birth movement, which flourished in the 1970s, and, more recently, research suggesting that immediate mother-infant bonding enhances breast-feeding. The pendulum swung back again toward rooming in.
But caring for a newborn can be particularly difficult for moms who labor for days or are foggy from lack of sleep. Others who tend to need extra help include mothers of multiples, those who have had C-sections, women who suffer from early-onset postpartum depression, or those who are single and have little support.
Rooming in isn't necessarily a good idea "if a mom is not capable of caring for herself along with the baby," said Joan Schiller, a coordinator of perinatal education at Advocate Health Care's Good Shepherd Hospital in Barrington. "When a mother has unmet needs — physical or emotional — she may not be the best person to care for her baby right away."
On the other hand, it's important for women to know that the first 48 hours are a crucial learning time for moms and babies, she said. "Separating a mom and baby without a valid reason can make a typically easy transition into breast-feeding very stressful for both the mom and baby," said Schiller, who added that rooming in also helps a mom learn her baby's cues and begins a lifelong connection.
Coogan said she was pre-approved for a five-day hospital stay at Loyola University Health System in Maywood where she delivered in June, but she was so frustrated that she went home after two nights. "I figured if I was going to have to take care of the baby myself, I might as well do it for free at home," she said. At home, she could also enlist the support of family members.
Coogan said she received a bill for nursery care. Outraged, she fought it and said she ultimately had it reduced. "Not only do they not take your baby to a nursery so you can rest, but they charge you, even though you are the one actually caring for the baby," Coogan said.
Dianne Shanabruch, Loyola's director of women and children's services, said she couldn't comment specifically on Coogan's situation but said such nursery charges generally are related to services a baby receives. "We assess every baby no matter where it is located, in the room or the nursery," she said.
Shanabruch also said it would be unlikely that a nurse would refuse to bring a baby to the nursery. "I can't see a nurse flat out saying, 'No, I won't do that,'" she said. Moreover, "all bets are off with rooming in if the mom is not well," she said.
"If the mom is tired, sometimes babies go to the nursery," Shanabruch added. "But the emphasis is on mother-baby bonding and helping the mother really learn the baby's cues."
During her checkups at Prentice, Mulcahy has discussed with her obstetrician the pros and cons of rooming in; she still hasn't decided whether she plans to breast-feed and whether to keep her new baby with her during the night.
Having delivered before, she thinks her experience will be an advantage. "I'll probably get tougher with the nurses than a new mom would," she said. She's also considering checking out of the hospital right away so she can care for her baby in the comfort of her home, as long as she doesn't have delivery complications.
"If I decide to send him to the nursery (rather than rooming in), I don't want a team of baby-wearing attachment parent-style moms hunting me down and telling me that my kids are going to grow up hating me because we didn't bond properly on those first few nights that we spent apart," Mulcahy said. "That should be my decision alone."
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