July 31, 2019

‘Baby in the drawer’ helped turn the tide for breastfeeding

This innovation in rooming-in allowed newborns to stay close to mothers while also being under direct medical supervision.

The "baby in the drawer" hospital room from 1953 was featured a half-century later as a replica in a 2004 Oakland Museum of California special exhibit on the life and impact of Henry J. Kaiser.

Kaiser Permanente believes that one of the most important ways a mother can promote the health of her baby is to choose to breastfeed exclusively.

That’s a position based on more than a half-century of experience that began in the 1950s when Kaiser Permanente was one of the leaders in reversing a trend of American women to more commonly bottle-feed their babies.

Which leads us to one of the most popular stories in Kaiser Permanente lore: the baby in the drawer.

The tale begins one evening in the early 1950s when several doctors and their families were socializing at the home of John G. Smillie, MD, an early Permanente Medical Group pediatrician. Smillie told founding Kaiser Permanente physician Sidney R. Garfield he had read an interesting article about the now famous Yale University School of Medicine research experiments with rooming-in for mothers and babies.

This was a prime example of the kind of innovation Garfield fostered, always scanning the environment for new ideas or research findings and quickly applying them to the care of his growing Kaiser Permanente patient population. Garfield was in the process of designing 3 new hospitals for San Francisco, Los Angeles, and Walnut Creek. He locked on to the rooming-in idea, adding the baby-in-the-drawer concept.

Garfield arranged each mother’s maternity room in a circle around a nursery. A bassinet for the infant was set in an ordinary metal file drawer built into the wall separating the mother’s room and the nursery.

“When the mother wanted to take care of the baby,” Garfield explained, “she'd pull the drawer out and there was the baby. If she wanted to put it back in the nursery, she could put it back in. That was a great hit.”

This allowed a newborn to be adjacent to its mother while also being under the direct supervision of the medical staff. A simple light signal would tell the nurse whether a baby was in the nursery or in its mother’s room.

Garfield believed strongly in research and innovation, and the baby in the drawer proved to be one of the best illustrations that these principles could keep care cost-effective, bring better patient outcomes, and make Kaiser Permanente a better place to work. The reasons: the baby in the drawer eliminated an estimated 7 out of 10 steps for the maternity nurses, large numbers of mothers chose to breastfeed as a result of the system, and it improved bonding between baby and mother.

That it was, as Dr. Garfield put it, “a great hit” has been borne out by history.

When Ora Huth, an oral historian in the Regional Oral History Office at the University of California, Berkeley, interviewed Dr. Smillie in 1985 as part of a series with Kaiser Permanente pioneers, he told her the baby in the drawer story. Huth interrupted him to announce she had used the baby in the drawer system in San Francisco.

“I thought it was such a great idea,” Huth says in the published oral history.

“Now you know where the idea came from,” the late Dr. Smillie responded.

In 2004, when the Oakland Museum of California organized a special exhibit on the life of Henry J. Kaiser, co-founder of Kaiser Permanente with Dr. Garfield, it included a life-size replica of the baby in the drawer hospital room.

Today, whenever we talk about this concept, it’s almost always guaranteed that someone will announce, “I was a baby in the drawer.” It’s equally likely that the person was breastfed as an infant because Dr. Garfield was helping to turn the tide away from bottle feeding after World War II.