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Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding

  1. Sharifah Halimah Jaafar1,*,
  2. Kim Seng Lee2,
  3. Jacqueline J Ho3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 12 SEP 2012

Assessed as up-to-date: 23 JUL 2012

DOI: 10.1002/14651858.CD006641.pub2


How to Cite

Jaafar SH, Lee KS, Ho JJ. Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD006641. DOI: 10.1002/14651858.CD006641.pub2.

Author Information

  1. 1

    Ipoh Specialist Hospital, Department of Obstetrics and Gynaecology, Ipoh, Perak, Malaysia

  2. 2

    Fatimah Hospital, Department of Pediatrics, Ipoh, Perak, Malaysia

  3. 3

    Penang Medical College, Department of Paediatrics, Penang, Malaysia

*Sharifah Halimah Jaafar, Department of Obstetrics and Gynaecology, Ipoh Specialist Hospital, Raja Dihilir Street, Ipoh, Perak, 30450, Malaysia. sharifah_65@yahoo.com. drsharifah65@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 12 SEP 2012

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This is not the most recent version of the article. View current version (26 AUG 2016)

 
Characteristics of included studies [ordered by study ID]
Bystrova 2008

MethodsThis is a randomised controlled trial with 4x2 factorial design. The factorial design takes into account 2 factors, i.e. infant location and apparel.

A table of allocation sequence was drawn up in advance of the trial. The randomisation, in blocks of 8 was stratified for time and parity. Sequentially numbered opaque envelopes containing information on group assignment were sealed and numbered in the order they should be used. The mother-infant pairs were assigned into 4 intervention groups. Both the researchers and the recruited women were blinded to the task.

Data were recorded in the delivery ward at 25-120 minutes postpartum and later in the maternity ward.


Participants176 (separate care: 44, rooming-in:132) healthy mother-infant dyads after normal spontaneous vaginal delivery. 23 participants excluded (separate care: 6, rooming-in: 17) leaving total of 153 (separate care: 38, rooming-in: 115) mother-infant pairs for study all of whom were included in the short-term outcomes up to 6 months. Data for breast feeding outcomes were available for 141 mothers.


InterventionsGroup 1 infants (n = 37) were placed skin-to-skin on their mother's chest 25-120 minutes after birth, while still in the labour ward and later were dressed in clothes and taken to the maternity ward for rooming-in with their mother.

Group 2 infants (n = 40) were dressed and placed in their mother's arm 25-120 minutes after birth and then taken to the maternity ward for rooming-in with their mothers.

Group 3 infants (n = 38) were dressed and kept in the cot at the labour ward nursery 25-120 minutes after birth and stay in the nursery while their mother was in the maternity ward until discharged from the hospital.

Group 4 infants (n = 38 ) were dressed and kept in the cot at labour ward nursery 25-120 minutes after birth and later were taken for rooming-in with their mothers.

We analysed group 3 as the experimental group (separate care) and group 1, 2 and 4 as the control group (rooming-in).

In the rooming-in group, the mothers were encouraged to breastfeed their infants on demand while in the separate care group, the infants were taken to their mothers' room in the maternity ward at a fixed schedule of 7 times a day for breastfeeding.


OutcomesPrimary breast feeding outcomes: breastfeeding parameters on day 4 postpartum, i.e. frequency of breastfeeding per day, duration of each feed (mins), volume of milk ingested (ml), infant weight changes (grams) and rate of exclusive breastfeeding at discharge.

Secondary outcomes: mean duration of 'nearly exclusive' breastfeeding, and mother-infant interaction 1 year later using The Parent-Child Early Relational Assessment (PCERA) Method.

'Nearly exclusive' breastfeeding is analysed as any breastfeeding in this review.


NotesThis thesis was reported in the total of 5 publications, 2 of which contributed data to this review. Due to skewing of the data the duration of breastfeeding was analysed as a median and interquartile range. The mean and SD was supplied by the author who warned a skewed distribution of data.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskA table of allocation sequence was drawn up in advance of the trial.

Allocation concealment (selection bias)Low riskThe mother-infant pairs were randomly assigned according to allocation sequence using sealed opaque sequentially numbered envelopes for primiparas and multiparas.

Blinding (performance bias and detection bias)
All outcomes
Unclear riskIt was reported that both 'the researchers and the recruited women were blinded to the task'. The method of blinding used for women and researchers was not stated. The blinding of the outcome assessors is not clear.

Incomplete outcome data (attrition bias)
All outcomes
Low risk23/176 (13%) of the mother-infant pairs excluded from the trial post randomisation, (6/38 (15%) from the separate care group and 18/138 (13%) from the rooming-in group. At 1. 3, 4 and 6 months follow-up there were 32 and 109 in the 2 respective groups (19.9%).

Selective reporting (reporting bias)Unclear riskThe methods section of one paper stated that breast feeding duration was studied at intervals up to 12 months however results were not reported in any of the study publications.

Other biasHigh riskBesides the intervention there was a difference in the way the 2 groups were treated. Infants in the separate care group were taken to the mother's room for breastfeeding at a fixed schedule of 7 times per day (instead of allowing the mother to freely visit their baby in the nursery for breastfeeding or bringing the baby to the mother when the baby is ready for feeding). On the other hand, infants in the rooming-in group were breastfed on demand.

 
Characteristics of excluded studies [ordered by year of study]

StudyReason for exclusion

Greenberg 1973This is a randomised controlled trial of 100 primiparous mothers who had an uncomplicated vaginal delivery. 50 mothers were assigned to room-in and the infant was brought to the mother within 12-36 hours after birth and remained in a cot from 9 am to 6 pm and later returned to the nursery. The other group of the mothers were assigned to a nursery care unit where their infants were placed in the open nursery. The outcomes measured in this study were mother's level of confidence and level of competence prior to leaving the hospital. Rooming-in in this study did not meet our defined rooming-in criteria and the study did not report any outcome measures relevant to our review.

Sousa 1974This trial reported only in abstract form, comparing separate care and rooming-in, is not clear how the mother-infant pairs were assigned. Two hundred mother-infant pairs were recruited after a normal vaginal delivery. 'Successful lactation' up to 2 months was measured.

Sosa 1976This is a randomised controlled trial of 160 primiparous mothers to determine the physical benefits of early mother-infant skin-to-skin contact. The mothers in the experimental groups had skin-to-skin contact with their infants at birth followed by rooming-in for only 45 minutes before the infants were placed in the nursery for their remaining hospital stay. The outcomes measured in this study were mean duration of breastfeeding in the first year, the rate of breastfeeding up to 1 year postpartum, affectionate behaviour, rate of infection and infant growth. Rooming-in in this study did not meet our pre-defined rooming-in criteria.

Hales 1977This is a randomised trial of 60 healthy primiparous mothers to assess the effect of mother-infant skin-to-skin contact after birth on mothers' affectionate behaviour towards the infants. The study did not meet our inclusion criteria.

Kantos 1978This non-randomised trial examined the effect of extended contact in the early postpartum hours and days on maternal attachment behaviour at 1 and 3 months. The study comparison group did not meet our pre-specified criteria of rooming-in.

O'Connor 1979This randomised trial only available in abstract form, examined the effect of rooming-in on enhancing mother-infant attachment. Seventy healthy mother-infant pairs were randomly assigned to receive separate care while the other 50 were assigned to rooming-in for the first 48 hours postpartum. Maternal-infant behaviour was observed up to 1 year. This study did not report any breastfeeding outcome.

Grossmann 1981This randomised controlled trial examined the effect of early and/or extended mother-infant tactile contact. This study did not meet any of our pre-specified inclusion criteria.

Ali 1981This randomised trial examined the effects on later behaviour of a 45-minute period of contact immediately after birth between a woman and her full-term healthy newborn. A total of 100 mothers from a low-income group were recruited after uncomplicated vaginal delivery. Half (50) of the mothers were randomly assigned to the study group where they were allowed contact with their infants for 45 minutes followed by separate care for 9 hours before re-establishing contact. Both the intervention and comparison did not meet our pre-specified inclusion criteria.

Keefe 1986This randomised trial compared the state of behaviour of newborns who were rooming-in with their mothers at night with those who were cared for in the traditional nursery at night. During the day all the infants were cared for in the nursery. The study comparison group did not meet our pre-specified criteria for rooming-in.

Elander 1986The design of this study is quasi-random. However, the authors did not fully comply with allocation in that some participants were allocated by convenience. A total of 29 infants undergoing phototherapy to treat jaundice were alternately selected into separated care and rooming-in. However, when there was no empty single room available for rooming-in the infant was assigned to the separate care group. The age of the infants at allocation and the type of care prior to allocation was not described. .

Lind 1986In this study 344 primiparas after uncomplicated vaginal delivery of term infants with birthweights of 3000 to 4000 grams were recruited and randomly selected to a rooming-in group (n = 172) where the newborns stayed with the mothers during the day time and returned to nursery during the night. The comparison group (n = 175) had separate care in the nursery until discharge. At discharge mothers completed questionnaires on duration of exclusive and any breastfeeding during the hospital stay. The study did not meet our pre-specified inclusion criteria for rooming-in.

Lindenberg 1990The study was carried out over 2 time periods. Women were assigned to separate care during the first time period and to rooming-in for the second time period. Women during the first period were randomised to two different types of separate care. The outcome reported measured was incidence of breastfeeding at 1 week and 4 months.

Perez-Escamilla 1992This trial was a non-random controlled comparison of rooming-in versus nursery care. 58 eligible women who delivered in Hospital A were assigned to nursery care and compared with 107 women assigned to rooming-in in Hospital B. The women in Hospital B were randomised to rooming-in and rooming-in with breastfeeding guidance. The outcome measured was duration of full and any breastfeeding.This study reported a significantly higher breastfeeding rate at 4 months among primiparae who had a childbirth at the rooming-in hospital and received breastfeeding guidance.

Segura-Millan 1994This randomised trial aimed to evaluate a maternity ward breastfeeding promotion programme and to identify factors related to perceived insufficient milk. Women were interviewed in the hospital, at 1 week, 2 months and 4 months postpartum for factors associated with perceived insufficient milk. This study did not meet our inclusion criteria.

Kastner 2005This randomised trial aimed to evaluate the impact of a first hour postpartum mother-infant contact on the mother-child relationship during the puerperium period. Immediately after delivery the mother-infant pairs were assigned either to a group where mother and child spent the first hour alone and the control group which follow labour room routine practice. This trial did not study rooming-in versus separate care of mother-infant pairs.

O'Connor 1980This randomised trial examined the effect of rooming-in on the incidence of measures of parenting inadequacy. A total of 301 mother-infant pairs were randomly assigned to rooming-in (n = 143) where the infants were roomed-in with their mothers 7 hours after birth up to 8 hours each day until discharge. The other 158 mother-infant pairs had separate care after a glimpse of their baby at birth. Parental inadequacy was measured after 17 months by the rate of infestations, rate of accident, exanthematous disease and hospitalisation. Rooming-in in this study did not meet our definition of rooming-in.

Ball 2006This randomised trial examined the effect of 3 rooming-in practices on the initiation of breastfeeding and infant safety. There was no separate care group.

Ball 2011This study compared the effect on breastfeeding duration of side-car cribs with stand alone cots in rooming-in mother infant pairs. There was no separate care group.

 
Comparison 1. Comparison between separate care versus rooming-in

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Proportion of infants exclusively breastfed at day 4 postpartum1141Risk Ratio (M-H, Fixed, 95% CI)0.58 [0.42, 0.81]