By Tom Debley
Director of Heritage Resources
Since this is National Breastfeeding Awareness Month, you may have read that 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 that is based on more than a half-century of tradition that began in the 1950s with Kaiser Permanente as one of the leaders in reversing early 20th century trends that led American women to more commonly bottle-fed their babies.
The story also is one of the most popular in Kaiser Permanente lore: The Baby in the Drawer.
The story begins one evening in the early 1950s when several doctors and their families were socializing at the home of Dr. John G. Smillie, 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.
Well, 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 three brand new hospitals for San Francisco, Los Angeles and Walnut Creek. He locked on to the rooming-in idea, adding the Baby in the Drawer.
Garfield arranged each mother’s maternity room in a circle around an adjacent 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.
Because Garfield believed strongly in research and innovation, the Baby in the Drawer proved to be one of the best illustrations of his further belief 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 reduced an estimated seven 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 at 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 did a special exhibition 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 I give a talk about this concept I’m almost always guaranteed that someone in the audience will come up to me afterward to 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.
I’m sure Dr. Garfield would be smiling if he could see the Kaiser Permanente News Center website item: Kaiser Permanente’s Care Delivery and Research Support Breastfeeding to Promote Healthy Families.