Approfondimenti scientifici
Rooming-in 2.0: New frontiers in the birth pathway
Rooming-in—meaning the newborn’s continuous stay in the same room as the mother, 24 hours a day from the first hours of life—is a key approach for promoting both neonatal and maternal health. This practice is not limited to simply placing the baby physically next to the mother: it fosters early and constant contact that supports critical physiological, psychological, and behavioral processes during the postpartum period.
From a physiological perspective, continuous proximity stimulates the release of maternal oxytocin, which is essential not only for postpartum uterine contractions and bleeding control, but also for facilitating early milk “coming in” and sustaining milk production over time. For the newborn, direct contact with the mother regulates the autonomic nervous system, lowering cortisol levels, improving thermoregulation, and stabilizing heart rate and breathing. In addition, rooming-in helps mothers learn neonatal cues, improving their ability to recognize hunger and sleep signals—an essential element for initiating effective breastfeeding and building a secure emotional bond.
On a psychological level, continuous rooming-in strengthens perceived maternal competence (maternal self-efficacy), reduces postpartum anxiety and stress, and promotes sensitive, responsive caregiving behaviors. Clinical studies have shown that mothers who adopt rooming-in demonstrate greater confidence in newborn care, higher postpartum satisfaction, and better indicators of mother–infant interaction, with positive long-term effects on the newborn’s socio-emotional development.
Rooming-in and the promotion of breastfeeding
Rooming-in also fits within international strategies to promote breastfeeding, as outlined in the UNICEF/WHO “Ten Steps to Successful Breastfeeding,” where continuous mother–infant proximity is a cross-cutting component that directly influences early initiation, feeding frequency, and the duration of exclusive breastfeeding. Widespread adoption of rooming-in therefore represents not only an organizational measure, but a true clinical intervention supported by consolidated scientific evidence (Fig.1).
Despite its many benefits, rooming-in must be implemented with careful attention to safety—especially in the first hours of life and during the night—to prevent risks such as falls or episodes of sudden unexpected postnatal collapse, through appropriate protocols, staff training, and maternal education.
Physiological and behavioral benefits of rooming-in
- Neuroendocrine regulation
Continuous proximity increases maternal oxytocin release, promoting:
-
- effective postpartum uterine contractions,
- emotional stabilization,
- greater milk ejection.
In the newborn, contact with the mother modulates the stress axis (HPA), reducing cortisol and improving thermoregulation and cardio-respiratory stability.
- Early initiation and maintenance of breastfeeding
Rooming-in supports interpretation of neonatal cues (movements, rooting, hands to mouth), promoting feeding on demand, which is associated with:
-
- greater milk production,
- longer breastfeeding duration,
- fewer unnecessary supplements.
Clinical studies show that mother–newborn separation in the first hours of life compromises the start of effective sucking and reduces exclusive breastfeeding rates in subsequent weeks.
- Newborn physiological stability
Rooming-in contributes to stability in:
-
- blood glucose,
- temperature,
- cardio-respiratory function,
- immune function, thanks to increased skin-to-skin contact and early intake of colostrum.
- Strengthening the mother–infant relationship
Continuous interaction helps the mother develop competence and confidence in newborn care (maternal self-efficacy), a protective factor against postpartum anxiety and depression.
The “UNICEF Ten Steps to Successful Breastfeeding” and the central role of rooming-in
UNICEF and WHO define ten evidence-based steps that support breastfeeding and the mother–infant relationship. Rooming-in is directly linked to several of these steps:
- Have written breastfeeding policies that are known to all staff.
- Train healthcare staff to implement the necessary skills.
- Inform all mothers about the benefits and management of breastfeeding.
- Support the initiation of breastfeeding within the first hour of life.
- Show mothers how to breastfeed and how to maintain milk production even if they are separated from their baby.
- Do not give foods or fluids other than breast milk unless medically indicated.
- Enable continuous room-sharing between mother and newborn (rooming-in) 24 hours a day.
- Encourage feeding on demand.
- Do not give teats/nipples or pacifiers to breastfed newborns.
- Promote continuity of care through community networks and post-discharge support.
The link between rooming-in and the Ten Steps
Rooming-in is a cross-cutting element supporting multiple goals:
- Enables early initiation of breastfeeding (Step 4).
- Facilitates maternal learning about latch, sucking, and positions (Step 5).
- Promotes exclusive, on-demand breastfeeding (Step 8).
- Reduces unnecessary supplementation (Step 6).
- Improves parental competence and reduces unnecessary medicalization.
In this sense, it is not merely an organizational act, but an evidence-based clinical intervention that is essential for breastfeeding physiology (Fig. 2).
Rooming-in as a multidimensional strategy
Rooming-in is confirmed as a multidimensional strategy capable of positively influencing multiple maternal–newborn health outcomes. Beyond well-established benefits for breastfeeding and bonding, it contributes to consolidating parenting skills, supports the newborn’s physiological adaptation, and promotes a family-centered care environment. Continuous rooming-in also facilitates early observation of any clinical or physiological signs in the newborn, enabling timely interventions, and supports continuity of care between the hospital ward and discharge, integrating with community networks that support mothers and infants.
From a health policy perspective, systematic implementation of rooming-in is an indicator of the quality of postpartum care, as it reflects the system’s ability to combine safety, clinical effectiveness, and the promotion of psychological well-being. Widespread adoption of this practice can help reduce unnecessary interventions, encourage responsive caregiving behaviors, and create a model of care centered on the mother–infant relationship.
Finally, although scientific data confirm numerous advantages, areas remain where further research is needed: the impact of rooming-in on long-term outcomes, optimal strategies for nighttime surveillance, and its role in high-risk contexts (mothers with post-cesarean analgesia or complex medical conditions). Continued production of high-quality evidence may refine clinical guidelines, optimize safety protocols, and consolidate rooming-in as a standardized, universal practice capable of maximizing benefits for mothers, newborns, and healthcare systems.
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