Article

Re-Conceptualizing the Hospital Labor Room: The PLACE (Pregnant and Laboring in an Ambient Clinical Environment) Pilot Trial

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Abstract

Nearly all hospitalized laboring women spend most of the time in bed. We made simple but radical modifications to a hospital labor room, which included the removal of the standard hospital bed and the addition of equipment to promote relaxation, mobility, and calm. We designed a pilot study, the objectives of which were to test the feasibility of a randomized trial and the acceptability of the modified labor room to women and their care providers. Women were assessed and invited to participate just before their admission to the labor and delivery suite. Sixty-two women at two Toronto teaching hospitals were randomly allocated to either the standard labor room or the "ambient room." Data about labor and birth events were abstracted from the medical records. Participants and their nurses and physicians completed questionnaires to elicit their views of their experiences with the labor rooms. Women's and practitioners' evaluations of the ambient room were generally very positive. Nineteen women (65.5%) in the ambient group, compared with 4 (13.3%) in the standard group, reported spending 50 percent or less of their hospital labor in the standard labor bed. Twelve women allocated to the ambient room had artificial oxytocin infusions, compared with 21 allocated to the standard room (X (2) = 4.73, p = 0.03). We conclude that the ambient labor room should be evaluated in an adequately powered randomized controlled trial.

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... Even animals are known to prefer an environment where they can be safe and lonely when they give birth 24 . In one study, Hodnett and colleagues [25] placed a mattress and pillow on the floor, dimmed the lights, played music during the labor process, and let the participants watch various videos on the nature of women, unlike the conventional labor rooms in hospital setting. In that study, they determined that women had an easier period of labor, had fewer medical applications and had less oxytocin requirements. ...
... Research also showed that loss of personal privacy and individual control in hospital environment caused stress to patients and patients kept some important information from health professionals because other patients overheard them during their treatment 26 . It is clear designing labor rooms that allow for the physical comfort of mothers in terms of the protection of the distance to ensure privacy reduces medical intervention and anxiety 25 . Social interaction with strangers is an important factor that negatively affects social privacy. ...
... The participants in our study expressed similar concerns about the physical structure and problems of health institutions. In one study where the subjects could move freely and go through the labor process in more traditional labor rooms, the women had an easier period of labor and need fewer medical interventions 25 . This result is another proof that providing women with labor rooms where they can be comfortable reduces medical intervention and anxiety. ...
Article
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Objectives:This aim of this study is to investigate the perceptions of privacy of mothers who received perinatal care and health professionals who provided these services. Methods:A qualitative content analysis method was used to explore the perceptions of privacy of mothers receiving perinatal care and health professionals providing these services. The study was conducted with 20 pregnant or postpartum women and 15 health professionals. The data were collected using semi-structured interviews. The sample size was determined when data saturation was reached through the purposeful sampling method. Results:The perception of privacy did not change for the mothers who benefited from perinatal services or for the health professionals, especially nurses who provided these services. Conclusions:The mothers and health professionals actually spoke a common language, but health professionals lack some skills in terms of practice. Patient privacy is an important issue that must always be addressed vigorously. Keywords:Perinatal, Nursing, Privacy, Qualitative.
... A pilot RCT in Canada found that it was feasible to perform an RCT comparing a more flexible birthing room to a regular one, and that fewer women who had given birth in the flexible birthing room received synthetic oxytocin for augmentation of contractions. The authors recommended a full RCT [46], but at the time of commencement of our planned study no full-scale RCT had been reported. We have found two ongoing RCTs comparing care in a specially designed birthing room with care in a regular room. ...
... The hypothesis has been inspired by and built on the mechanism of the effect of environment on birth [18][19][20][21][22][23][24][25], our own, unpublished systematic literature review, interviews with women some days after having given birth [50], aspects pinpointed by health care professionals at the study hospital and women from a user council (the agency Födelsehuset) information from the pilot study conducted in Canada [46], and from the ongoing study in Denmark [47]. ...
... The use of an RCT to test the rooms is a quite new approach in this field, which usually uses social science methodology. Only one pilot study conducted in Canada has been published earlier [46] and two studies are ongoing, in Denmark [47] and Germany [48]. The use of a qualitative ethnographic study will deepen understanding of the interaction between the woman and the room. ...
Preprint
Background: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences, and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/Design: Following ethical approval, a study design was developed and tested for feasibility in a pilot study which led to some important improvements for the conduction of the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour, who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centered approach and physical aspects (such as: light, silencer, media installator offering programmed nature scenes with sound, bath tub, birth support tools) that are adaptable as a woman wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding
... perceived control over physical environment; acoustics/music; lighting/colour; homelike aesthetics; and welcoming areas for family members/opportunities for positive distractions. Privacy Lothian, 2004;Singh & Newburn, 2006;Walsh, 2006) Perceived control over physical environment Singh & Newburn, 2006;Symon et al., 2008aSymon et al., , 2008b Acoustics/music Hodnett, Stremler, Weston, & McKeever, 2009;Singh & Newburn, 2006) Lighting/colour (Dalke et al., 2006;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) 'Home-like' aesthetics (Fahy & Parratt, 2006;Hauck, Rivers, & Doherty, 2008;Singh & Newburn, 2006;Walsh, 2006) Welcoming areas for family members/opportunities for positive distractions (Douglas & Douglas, 2004;Foureur, Leap, et al., 2011;Hauck et al., 2008;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) Each of the design elements in Table 1 (privacy, perceived control over physical environment, acoustics/music, lighting/colour, 'home-like' aesthetics, and welcoming areas for family members/opportunities for positive distractions) were ranked as important to preferred physical birth environment design by the 2,620 UK women who were surveyed about their preferred physical birth environment design-qualities (Newburn & Singh, 2003;Singh & Newburn, 2006). ...
... perceived control over physical environment; acoustics/music; lighting/colour; homelike aesthetics; and welcoming areas for family members/opportunities for positive distractions. Privacy Lothian, 2004;Singh & Newburn, 2006;Walsh, 2006) Perceived control over physical environment Singh & Newburn, 2006;Symon et al., 2008aSymon et al., , 2008b Acoustics/music Hodnett, Stremler, Weston, & McKeever, 2009;Singh & Newburn, 2006) Lighting/colour (Dalke et al., 2006;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) 'Home-like' aesthetics (Fahy & Parratt, 2006;Hauck, Rivers, & Doherty, 2008;Singh & Newburn, 2006;Walsh, 2006) Welcoming areas for family members/opportunities for positive distractions (Douglas & Douglas, 2004;Foureur, Leap, et al., 2011;Hauck et al., 2008;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) Each of the design elements in Table 1 (privacy, perceived control over physical environment, acoustics/music, lighting/colour, 'home-like' aesthetics, and welcoming areas for family members/opportunities for positive distractions) were ranked as important to preferred physical birth environment design by the 2,620 UK women who were surveyed about their preferred physical birth environment design-qualities (Newburn & Singh, 2003;Singh & Newburn, 2006). ...
... perceived control over physical environment; acoustics/music; lighting/colour; homelike aesthetics; and welcoming areas for family members/opportunities for positive distractions. Privacy Lothian, 2004;Singh & Newburn, 2006;Walsh, 2006) Perceived control over physical environment Singh & Newburn, 2006;Symon et al., 2008aSymon et al., , 2008b Acoustics/music Hodnett, Stremler, Weston, & McKeever, 2009;Singh & Newburn, 2006) Lighting/colour (Dalke et al., 2006;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) 'Home-like' aesthetics (Fahy & Parratt, 2006;Hauck, Rivers, & Doherty, 2008;Singh & Newburn, 2006;Walsh, 2006) Welcoming areas for family members/opportunities for positive distractions (Douglas & Douglas, 2004;Foureur, Leap, et al., 2011;Hauck et al., 2008;Hodnett et al., 2009;Singh & Newburn, 2006;Symon et al., 2011;Thompson & Wojcieszek, 2012) Each of the design elements in Table 1 (privacy, perceived control over physical environment, acoustics/music, lighting/colour, 'home-like' aesthetics, and welcoming areas for family members/opportunities for positive distractions) were ranked as important to preferred physical birth environment design by the 2,620 UK women who were surveyed about their preferred physical birth environment design-qualities (Newburn & Singh, 2003;Singh & Newburn, 2006). ...
Thesis
Full-text available
[Background] It is accepted that the physical environment of healthcare influences the perceptions and experiences of patients and staff. Research has explored how birth unit design influences the experiences of women and midwives during childbirth. However, although there is evidence that cooperative supporters are beneficial to labouring women, and that women desire such support, little attention has been paid to the impact of physical design on the experiences of a woman's chosen childbirth supporter. This thesis describes how the physical environment influences the behaviour, experiences and role navigation of birth supporters. [Aim] To gain an understanding of how physical birth environment design accommodates women’s supporters and facilitates their support roles. [Study Design] This childbirth supporter study presented in this thesis, is a research substudy of a larger Birth Unit Design (BUD) research project. Ethics approval was obtained for the BUD video-ethnographic study where six consenting women and their 11 supporters were filmed during labour at two different Australian hospitals (February/March 2012). The ‘childbirth supporter study’ (CSS) presented here is a single-case study design that was selected from the larger cohort of participants from the BUD study. One woman, her four supporters and three midwives provided the foundation for the ‘childbirth supporter study’ described in this thesis. Video footage and video-cued interviews with all participants and observational field notes provided data for analysis. Three-phase analysis cycle for both text and video included: descriptive, interpretive and selective coding (using an approach informed by Saldaña, 2013). Phase one, the descriptive coding cycle, consisted of identifying what would be filmed, viewing the video, reading the transcription text and interview field notes and becoming familiar with the data. Phase two, the interpretive/pattern coding cycle, consisted of condensing the data so that themes could begin to be identified, such as by selecting exemplar still images from the video footage. The third phase, the selective/codeweaving stage, consisted of data reconstruction and synthesis, to facilitate interpretation of the evidence into thematic findings. The ‘AEIOU’ framework (an analysis approach informed by Wasson, 2000) was utilised for the video data during the third phase of analysis. An extended, reflective cross-validation inquiry of the thematic findings, using the Birth Unit Design Spatial Evaluation Tool (BUDSET) as both criterion and building block, provided translation of the findings into practice. [Findings] The physical environments of typical birth units do not appropriately meet the needs of supporters, who may feel unsure of their role, behaviour or positioning, thus limiting the potential benefits of their support role. Key themes are: ‘Unbelonging Paradox’, ‘Role Navigation’ and ‘Supporting the Supporter’. Findings are supported by illustrative video footage stills and verbatim quotes. Viewing supporters as both individuals and part of a team dyad is the basis for the design recommendations. Examples of some of the recommendations are: spaces for both privacy and togetherness; informational support zones; transition space; positive distracters; easy access food, drink and toilet facilities; and the ability to personalise and adjust the space to increase the perception of agency. [Implications and Relevance to Practice] Knowing how the design of birth units can best accommodate the needs of women’s supporters may facilitate optimal birth experiences for women and increase opportunities for safe, satisfying birth. Designers and healthcare managers may benefit from understanding the birth environment’s influence on supporter’s behaviours.
... One systematic review [11] and five Cochrane reviews [6,[12][13][14][15] were retrieved. Additionally, three randomised controlled trials (RCTs) [16][17][18], a cohort study [19], a pilot study [20], a number of relevant qualitative studies [21][22][23][24][25][26][27][28] and a theoretical paper [29] were found. The findings are summarised below. ...
... The results are not yet available. The PLACE pilot trial, which specifically examined the effect of the immediate birthing environment (ambient birthing room) on VBs was evaluated positively by women and staff [20]. ...
... Further outcomes to be evaluated will be client-centred outcomes, adverse effects (AEs) and health economic implications [35]. The proposed study replicates the intervention suggested by Hodnett [20], additionally incorporating qualitative findings on the birth environment and birth unit design [14,21,24,25,27,[36][37][38] as well as recommendations for the birth environment and positions for labour and birth [31][32][33]39]. ...
Article
Full-text available
Background Caesarean sections (CSs) are associated with increased risk for maternal morbidity and mortality. The recommendations of the recently published German national health goal ‘Health in Childbirth’ (Gesundheit rund um die Geburt) promote vaginal births (VBs). This randomised controlled trial (RCT) evaluates the effects of a complex intervention pertaining to the birth environment, based on the sociology of technical artefacts and symbolic interactionism. The intervention is intended to foster an upright position and mobility during labour, which lead to a higher probability of VB. Methods/design This study is an active controlled superiority trial with a two-arm parallel design. The complex intervention involves making changes to the birthing room to encourage an upright position and mobility of women in labour and to relax them, which may help them to cope with labour and may increase self-determination. This may result in more VBs. Included in the study are primiparae and multiparae with a singleton foetus in cephalic presentation at term planning a VB. According to the sample size calculation, 3800 women in 12 obstetrical units are to be included. Randomisation will be performed centrally and controlled by an independent coordination centre. Blinding of participants and staff is not possible. Key outcomes are VB, episiotomy, perineal tears, epidural analgesia, critical outcome of newborn at term and maternal self-determination during birth. Additionally, a health economic evaluation will be performed. Discussion This is the first adequately powered multicentre RCT examining the effect of a redesigned birthing room on the probability of a VB and patient-centred physical and emotional outcomes. An increase in the number of VBs by 5% from a baseline of 74% to 79% would result in 21,000 women per year experiencing a VB rather than a CS in Germany. Expected benefits are greater self-determination during labour, improved physical and emotional client-centred outcomes, fewer medical interventions and a reduction in health-care costs. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00012854. Registered on 7 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2979-7) contains supplementary material, which is available to authorized users.
... MIDIRS gibt zu bedenken, dass Kreißsäle mit prodominantem Kreißbett den Frauen suggerieren, dass das Kreißbett der Ort sei, in dem sie sich überwiegend aufhalten sollten [15]. Eine eher liegende Haltung während der Geburt scheint auch durch Hebammen sowie Ärztinnen und Ärzte beeinflusst zu sein, weil das Ungeborene so in der Zeit der Wehenarbeit und schließlich der Geburt komfortabler überwacht werden kann [3,4,7,16]. Um innerhalb der seit 1955 durch Friedman [17] diskutierten zeitlichen Begrenzung der Austreibungsphase zu bleiben [18,19], wird eine zügige Entbindung angestrebt. ...
... genutzt. Auch Abbildungen von Schwangeren und Gebärenden in natürlichen aufrechten Positionen (zur Anregung, diese Positionen auch selbst einnehmen zu können), Musik und Videos (zur Ablenkung) und Zugang der Gebärenden zur Einstellung der Raumtemperatur und des Lichtes -durch Studien als hilfreich evaluiert [15,16,34] und durch ein validiertes Erhebungsinstrument für eine optimale Geburtsumgebung messbar gemacht [35] -sind eher nicht zu finden. So werden visuelle und taktile Aspekte der Verhältnis-und der Verhaltensprävention nicht genutzt. ...
... So werden visuelle und taktile Aspekte der Verhältnis-und der Verhaltensprävention nicht genutzt. Einer Pilotstudie in Kanada zufolge verändert sich bei entsprechender Umgebung nicht nur das Verhalten der Schwangeren, sondern auch das der Betreuenden [16]. Die Theorie des Birth Territory [36] beschreibt einen Erklärungsversuch zum Zusammenhang zwischen Geburtsumgebung und emotionalem und physiologischem Erleben der Gebärenden unter Beibehaltung der Selbstbestimmung. ...
Article
In German hospitals, three quarters of all low-risk pregnant women give birth in the supine position, despite the fact that German, British and WHO guidelines do not recommend a supine birthing position which is associated with a higher risk to the health of both mother and fetus. Based on 22 RCTs with 7,280 participants, a systematic Cochrane review (Gupta et al., 2012) revealed that an upright position - compared with a supine or lithotomy position - (1) has a positive impact on fetal heart rate patterns, (2) reduces the requirement for analgesic or anaesthetic medications in the second stage of labour, and (3) results in fewer episiotomies and (4) fewer instrumental deliveries. There is a lack of evidence regarding perceived maternal autonomy, self-efficacy and anxiety when giving birth. Furthermore, evidence on long-term effects is absent. Some studies indicate that the choice of an upright birthing position might be boosted by a supporting physical and social environment and by specially trained midwives. There is a need for a feasibility study and a subsequent cluster RCT in the German healthcare context in order to investigate the effects of the upright posture for birthing on perceived maternal autonomy, self-efficacy and anxiety, on the reduction of perinatal complications and on long-term complaints. The complex experimental intervention consists of (1) evidence-based and user-friendly information for women and their partners, (2) facilitating the choice for an upright labour position by special training for midwives and (3) providing a supportive physical and social environment. Within the first study phase, the exploration of feasibility in terms of access to the target group and acceptance of the intervention by pregnant women, their partners and midwives is recommended. Thereby, the implementation of guidelines for upright labour and birth, the documentation and collection of outcome and cost data could be evaluated. Non-German instruments for measuring benefits, harms and long-term effects could be adapted to and validated for the German context. Copyright © 2014. Published by Elsevier GmbH.
... First, satisfaction has been associated with interpersonal factors such as effective communication between women and care providers during labour and birth; providing opportunities to have an active say during labour and birth; being able to choose among options; deciding when certain actions will be done; and being given information as to why certain decisions are being made (Harriott et al., 2005;Rudman et al., 2007;Waldenström et al., 2006). Perceptions of support from care providers during labour are reported to improve childbirth outcomes and women's satisfaction (Hodnett et al., 2009). Second, satisfaction with intrapartum care has been linked to information-giving and participation in decision-making (Bazant and Koenig, 2009;Dencker et al., 2010;Gungor and Beji, 2012;Janssen et al., 2006;Martin and Fleming, 2011;Rudman et al., 2007;Waldenström et al., 2006). ...
... In most developed western countries, attempts have been made to make the labour and birth environment less clinical and more homelike (Sheehy et al., 2011). Satisfaction with the physical environment is a significant predictor of women's overall satisfaction and positive experience in labour and birth (Foureur et al., 2010;Hodnett et al., 2009 Statistics and Macro International Inc, 2010). Despite these improvements significant deficits in the provision of basic maternity services remain. ...
... In Middle Eastern countries, the main goal of care providers during labour and birth has been to ensure a safe and positive labour experience with minimal pain and discomfort (Abdel Ghani and Berggren, 2011). However, there is strong evidence from high income countries that women who have continuity of midwifery care, continuous support during labour, a good relationship with their caregiver, and good support during labour and birth are more likely to require less pain relief, have an intervention-free labour and birth, higher perception of control, and be more satisfied with their intrapartum care Hodnett et al., 2009;Leap et al., 2010a, b). However, in Jordan, continuity of care and support in labour are very difficult to achieve. ...
Article
Full-text available
Exploring patient satisfaction can contribute to quality maternity care but is not routinely conducted in many Middle Eastern countries. This study investigated the prevalence and factors associated with satisfaction during labor and birth among Jordanian women using a descriptive cross-sectional design. Women (n=298) were recruited from four maternal and child health centers in Al-Mafraq city, Jordan. Participants completed an intrapartum care scale which measured satisfaction with three areas of care: interpersonal, information and involvement in decision making, and physical environment. Overall, only 17.8% of women were satisfied with intrapartum care. Around 13% of women were satisfied with interpersonal care, 20.5% with information and involvement in decision making, and 18.8% with physical birth environment. Regression analyses revealed that low satisfaction was associated with experiencing an episiotomy, poor pain relief during labour, and vaginal birth. Health care professionals, policy-makers as well as hospital administrators need to consider the factors that contribute to low satisfaction with childbirth in any effort to improve care.
... MIDIRS gibt zu bedenken, dass Kreißsäle mit prodominantem Kreißbett den Frauen suggerieren, dass das Kreißbett der Ort sei, in dem sie sich überwiegend aufhalten sollten [15]. Eine eher liegende Haltung während der Geburt scheint auch durch Hebammen sowie Ärztinnen und Ärzte beeinflusst zu sein, weil das Ungeborene so in der Zeit der Wehenarbeit und schließlich der Geburt komfortabler überwacht werden kann [3,4,7,16]. Um innerhalb der seit 1955 durch Friedman [17] diskutierten zeitlichen Begrenzung der Austreibungsphase zu bleiben [18,19], wird eine zügige Entbindung angestrebt. ...
... genutzt. Auch Abbildungen von Schwangeren und Gebärenden in natürlichen aufrechten Positionen (zur Anregung, diese Positionen auch selbst einnehmen zu können), Musik und Videos (zur Ablenkung) und Zugang der Gebärenden zur Einstellung der Raumtemperatur und des Lichtes -durch Studien als hilfreich evaluiert [15,16,34] und durch ein validiertes Erhebungsinstrument für eine optimale Geburtsumgebung messbar gemacht [35] -sind eher nicht zu finden. So werden visuelle und taktile Aspekte der Verhältnis-und der Verhaltensprävention nicht genutzt. ...
... So werden visuelle und taktile Aspekte der Verhältnis-und der Verhaltensprävention nicht genutzt. Einer Pilotstudie in Kanada zufolge verändert sich bei entsprechender Umgebung nicht nur das Verhalten der Schwangeren, sondern auch das der Betreuenden [16]. Die Theorie des Birth Territory [36] beschreibt einen Erklärungsversuch zum Zusammenhang zwischen Geburtsumgebung und emotionalem und physiologischem Erleben der Gebärenden unter Beibehaltung der Selbstbestimmung. ...
Article
Health problem In German hospitals, three quarters of all low-risk pregnant women give birth in the supine position, despite the fact that German, British and WHO guidelines do not recommend a supine birthing position which is associated with a higher risk to the health of both mother and fetus. Corpus of evidence Based on 22 RCTs with 7,280 participants, a systematic Cochrane review (Gupta et al., 2012) revealed that an upright position - compared with a supine or lithotomy position - (1) has a positive impact on fetal heart rate patterns, (2) reduces the requirement for analgesic or anaesthetic medications in the second stage of labour, and (3) results in fewer episiotomies and (4) fewer instrumental deliveries. There is a lack of evidence regarding perceived maternal autonomy, self-efficacy and anxiety when giving birth. Furthermore, evidence on long-term effects is absent. Some studies indicate that the choice of an upright birthing position might be boosted by a supporting physical and social environment and by specially trained midwives. Implication for Research There is a need for a feasibility study and a subsequent cluster RCT in the German healthcare context in order to investigate the effects of the upright posture for birthing on perceived maternal autonomy, self-efficacy and anxiety, on the reduction of perinatal complications and on long-term complaints. The complex experimental intervention consists of (1) evidence-based and user-friendly information for women and their partners, (2) facilitating the choice for an upright labour position by special training for midwives and (3) providing a supportive physical and social environment. Within the first study phase, the exploration of feasibility in terms of access to the target group and acceptance of the intervention by pregnant women, their partners and midwives is recommended. Thereby, the implementation of guidelines for upright labour and birth, the documentation and collection of outcome and cost data could be evaluated. Non-German instruments for measuring benefits, harms and long-term effects could be adapted to and validated for the German context.
... A pilot RCT in Canada found that it was feasible to perform an RCT comparing a more flexible birthing room to a regular one, and that fewer women who had given birth in the flexible birthing room received synthetic oxytocin for augmentation of contractions. The authors recommended a full RCT [46], but at the time of commencement of our planned study no full-scale RCT had been reported. We have found two ongoing RCTs comparing care in a specially designed birthing room with care in a regular room. ...
... The hypothesis has been inspired by and built on the mechanism of the effect of environment on birth [18][19][20][21][22][23][24][25], our own, unpublished systematic literature review, interviews with women some days after having given birth [50], aspects pinpointed by health care professionals at the study hospital and women from a user council (the agency Födelsehuset) information from the pilot study conducted in Canada [46], and from the ongoing study in Denmark [47]. ...
... The use of an RCT to test the rooms is a quite new approach in this field, which usually uses social science methodology. Only one pilot study conducted in Canada has been published earlier [46] and two studies are ongoing, in Denmark [47] and Germany [48]. The use of a qualitative ethnographic study will deepen understanding of the interaction between the woman and the room. ...
Article
Full-text available
Background: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/design: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. Discussion: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. Trial registration: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
... Means of distraction, comfort, and relaxation. Some of the studies stressed the importance of incorporating means of distraction, comfort, and relaxation in the design of the hospital environment, showing the resulting positive effects on labor and pain (Hauck et al., 2008;Manesh et al., 2015;Strobel, 1985), the woman's heart rate, the neonate's 5-min Apgar score (Aburas et al., 2017), and the need for artificial oxytocin (Hodnett et al., 2009). Methods of distraction integrated into the room included patterns or pictures projected on the wall via a rotating wheel projector and fiber-optic lights with changing colors (Hauck et al., 2008;Manesh et al., 2015), nature images chosen by the woman and displayed on a TV (Aburas et al., 2017) or via a DVD (Hodnett et al., 2009), an aquarium containing tropical fish (Hauck et al., 2008;Manesh et al., 2015), relaxation music and aromatherapy (e.g., lavender essence) of the woman's choice, dimmed light or candlelight, and light music and sound (Aburas et al., 2017;Hauck et al., 2008;Hodnett et al., 2009;Manesh et al., 2015). ...
... Some of the studies stressed the importance of incorporating means of distraction, comfort, and relaxation in the design of the hospital environment, showing the resulting positive effects on labor and pain (Hauck et al., 2008;Manesh et al., 2015;Strobel, 1985), the woman's heart rate, the neonate's 5-min Apgar score (Aburas et al., 2017), and the need for artificial oxytocin (Hodnett et al., 2009). Methods of distraction integrated into the room included patterns or pictures projected on the wall via a rotating wheel projector and fiber-optic lights with changing colors (Hauck et al., 2008;Manesh et al., 2015), nature images chosen by the woman and displayed on a TV (Aburas et al., 2017) or via a DVD (Hodnett et al., 2009), an aquarium containing tropical fish (Hauck et al., 2008;Manesh et al., 2015), relaxation music and aromatherapy (e.g., lavender essence) of the woman's choice, dimmed light or candlelight, and light music and sound (Aburas et al., 2017;Hauck et al., 2008;Hodnett et al., 2009;Manesh et al., 2015). Silk flower arrangements and pictures were other ways to support distraction, leading to the women's experience of labor being more pleasant than expected (Strobel, 1985). ...
... Some of the studies stressed the importance of incorporating means of distraction, comfort, and relaxation in the design of the hospital environment, showing the resulting positive effects on labor and pain (Hauck et al., 2008;Manesh et al., 2015;Strobel, 1985), the woman's heart rate, the neonate's 5-min Apgar score (Aburas et al., 2017), and the need for artificial oxytocin (Hodnett et al., 2009). Methods of distraction integrated into the room included patterns or pictures projected on the wall via a rotating wheel projector and fiber-optic lights with changing colors (Hauck et al., 2008;Manesh et al., 2015), nature images chosen by the woman and displayed on a TV (Aburas et al., 2017) or via a DVD (Hodnett et al., 2009), an aquarium containing tropical fish (Hauck et al., 2008;Manesh et al., 2015), relaxation music and aromatherapy (e.g., lavender essence) of the woman's choice, dimmed light or candlelight, and light music and sound (Aburas et al., 2017;Hauck et al., 2008;Hodnett et al., 2009;Manesh et al., 2015). Silk flower arrangements and pictures were other ways to support distraction, leading to the women's experience of labor being more pleasant than expected (Strobel, 1985). ...
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Aim To summarize, categorize, and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes. Background The physical healthcare environment has significant effects on health and well-being. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce. Methods We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis. Results In total, 3,373 records were identified and screened by title and abstract; 2,063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: (1) means of distraction, comfort, and relaxation; (2) raising the birthing room temperature; (3) features of familiarity; and (4) diminishing a technocratic environment. Conclusions The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.
... 11 In comparison these researchers found 'home like' birth spaces resonated comfort, calmness, security and safety thus becoming a woman's 'sanctum'. Indeed Hodnett et al.'s 19 Cochrane review, which compared women using a standard hospital room vs a ambient clinical environment, found that 86% of women labouring in standard rooms spent at least 75% of their labour on the bed. Conversely, the majority of the women (65%) in the ambient room did not use the bed. ...
... The New Zealand midwives in Davis and Walker's study 18 articulated how the 'highly obstetric' space made them fearful, changing the way they practised. In the Cochrane review 19 comparing standard and ambient birth rooms', midwives were noted to spend more time with women in the ambient birth space. Similarly Canadian midwives, when comparing working with women at home as opposed to hospital, also acknowledged how the different birth environments influenced their practice. ...
Article
Background: There is a growing body of evidence to show that the birth environment can influence women's experiences of labour and birth as well as midwifery practice. A common feature of the modern birth space is the bed. Knowledge about how the use of the bed shapes clinicians' perceptions and attitudes is limited. Aim: The aim of this paper is to describe midwives' perceptions of the birth bed. Method: Qualitative descriptive design. Fourteen midwives from one Queensland maternity unit participated in digitally recorded and transcribed interviews. Thematic analysis was used to analyse the data set. Findings: Four themes were identified. The first, described beliefs that using the bed formed part of women's childbirth expectations. A second theme, captured midwives' perceptions that the bed was also an object required to safely undertake their work. The third theme described how others commonly worked to ensure the woman stayed off the bed. Lastly, there was evidence that whilst wanting to avoid the use of the bed, some were reluctant, fearing potential reprimand. Conclusion: The themes highlight differences in how the midwives conceptualised the use of a bed within a birth space. While some avoided the use of the bed altogether others would only conceive of women moving off the bed if everything was 'normal'. How the bed was culturally constructed appeared to dictate clinical practice. Reflecting on the meaning of an object, such as the bed, is important if clinicians are to fully understand how the birth environment influences their practice and thus women's experiences of labour and birth.
... Studies indicate that satisfaction with the physical environment is a signi cant predictor of women's overall satisfaction and positive experience of labour and delivery services [26,27]. Similar to the ndings of Lumadi and Buch [28], this study found higher rate of satisfaction with the cleanliness of the delivery environment (cleanliness of bed and beddings). ...
... Satisfaction has been associated with interpersonal factors such as providing opportunities to have an active say during labour and birth, deciding when certain actions will be done, and being given information as to why such decisions are necessary [19,25,27,31,34]. In this study, high rate of dissatisfaction was disclosed on whether permission was requested before any procedure and the degree of involvement in decision making. ...
Article
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Background Exploring patient satisfaction contributes to provide quality maternity care, but there is paucity of epidemiologic data in Eritrea. Objectives To determine the predictors of women's satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. Methods A cross-sectional study among 771 mothers who gave birth in three public Hospitals. Chi-square tests were done to analyze the difference in proportion and logistic regression to assess the predictors of satisfaction with intrapartum care. Results Overall, only 20.8% of the participants were satisfied with intrapartum service. The key predictors of satisfaction with intrapartum care were provision of clean bed and beddings (AOR = 18.87, 2.33–15.75), privacy during examinations (AOR = 10.22, 4.86–21.48), using understandable language (AOR = 8.72, 3.57–21.27), showing how to summon for help (AOR = 8.16, 4.30–15.48), showing baby immediately after birth (AOR = 8.14, 2.87–23.07), control of the delivery room (AOR = 6.86, 2.65–17.75), receiving back massage (AOR = 6.43, 3.23–12.81), toilet access and cleanliness (AOR = 6.09, 3.25–11.42), availability of chairs for relatives (AOR = 5.96, 3.14–11.30), allowing parents to stay during labour (AOR = 3.52, 1.299–9.56), and request for permission before any procedure (AOR = 2.39, 1.28–4.46). Conclusion To increase satisfaction with intrapartum care, maternity service providers need to address the general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients. Policy makers need to adopt strategies that ensure more women involvement in decision making and consideration of privacy and reassurance needs during the whole delivery process.
... However, despite these limitations, some physical elements are fully demonstrated and recur repeatedly. One example is the presence of a medical bed in the birth room which does not help the physiological process, or a bed that occupies the central space in the room (Bowden et al., 2016;Fahy & Parratt, 2006;Forbes et al., 2008;Foureur et al., 2011;Jenkinson et al., 2014;Lepori, 1994;McCourt, Rayment, Rance, & Sandall, 2016;Mondy, Fenwick, Leap, & Foureur, 2016;Walsh, 2006), or one that is visible (Hodnett, Stremler, Weston, & McKeever, 2009). Moreover, the bed is seen as being majorly responsible for layout inflexibility, thereby preventing midwives from finding the space to carry out tasks (Hammond, Foureur, & Homer, 2014). ...
... This category includes papers that investigated how some building spaces are correlated to intervention rates in childbirth: for example, less frequently required epidural analgesia (Duncan, 2011), the likelihood of using artificial oxytocin and shorter labor times (Hodnett et al., 2009), and the likelihood of having an emergency caesarean section (Singh & Newburn, 2006). ...
Article
Objectives, purpose, or aim: This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals. Background: Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users' health. Method: A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates. Results and discussion: The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people's behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives' hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements. Conclusions: The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers.
... Die Gestaltung des Gebärraums und der Arbeitsort der Hebamme haben einen Einfluss auf die Betreuung und die verwendeten Gebärpositionen [4][3] [22][23] [17]. Jedoch beeinflussen auch die Strukturen im Gesundheitssystem die Hebammen in diesem Zusammenhang: Hebammen sind die Expertinnen für die physiologische Geburt. ...
... Diese Hierarchiestruktur wird auch durch eine Aussage aus der Studie von Hodnett et al. bestätigt [17]. Dafür wurde das Kreißbett aus dem Gebärraum entfernt und untersucht, wie sich die veränderte Umgebung auf die Betreuung und die Gebärpositionen auswirkt. ...
Article
Obwohl aufrechte Gebärpositionen mit positiven Auswirkungen auf den Geburtsverlauf assoziiert werden, gebärt in deutschen Kreißsälen ein Großteil der Frauen in horizontalen Positionen. Hebammen haben einen Einfluss auf die Auswahl der Gebärhaltung und werden dabei von verschiedenen Faktoren beeinflusst. Die Autorin beleuchtet diese Einflussfaktoren näher und zieht Rückschlüsse auf die Praxis.
... Knowledge from evidence-based health care design has grown rapidly in the last decade, supporting the argument that more knowledge is needed about the effect of the design of the birth environment and design in hospitals in general [14,15]. Research from Australia and England have shown that the birth environment does not only have an impact on the birth experience and birth outcomes for women and neonates, but also on the woman's birth supporters and maternity care staff [15][16][17][18][19][20][21]. ...
... However, few experimental studies have been performed to evaluate whether the birth environment has an impact on birth outcomes. Results from three randomised controlled trials indicate that the birth environment may affect duration of labour, pain intensity, and use of augmentation, but sample sizes were small, and further adequately powered trials are needed [17,23,24]. ...
Article
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Introduction In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on birth outcomes. The birth environment might have an important role in facilitating the production of the hormone oxytocin that causes contractions during labour. Oxytocin is released in a safe, secure and confidence-inducing environment, and environments focused on technology and medical interventions to achieve birth may disrupt the production of oxytocin and slow down the progress of labour. An experimental “birth environment room” was designed, inspired by knowledge from evidence-based healthcare design, which advocates bringing nature into the room to reduce stress. The purpose is to examine whether the ‘birth environment room’, with its design and decor to minimise stress, has an impact on birth outcomes and the birth experience of the woman and her partner. Materials and methods A randomised controlled trial will recruit 680 nulliparous women at term who will be randomly allocated to either the “birth environment room” or a standard room. The study will take place at the Department of Obstetrics and Gynecology at Herning Hospital, with recruitment from May 2015. Randomisation to either the “birth environment room” or standard room takes place just before admission to a birth room during labour. The primary outcome is augmentation of labour, and the study has 80% power to detect a 10% difference between the two groups (two-sided α = 0.05). Secondary outcomes are duration of labour, use of pharmacological pain relief, mode of birth, and rating of the birth experience by women and their partners. Trial registration NCT02478385(10/08/2016).
... Enlightening the Fragility of the Psycho-Physical State of Natural Birth: Physiological, Psychological, and Environmental Disturbances Many recent studies have indicated correlations of the common disturbances to women to focus and retreat in the typical hospital environment and a high rate of instrument deliveries and unplanned cesarean sections (Aune et al., 2015;Buckley, 2015;Buckley & Dip, 2003;Crowther et al., 2014;Hodnett, Stremler, Weston, & McKeever, 2009;Jansen, Gibson, Bowles, & Leach, 2013;Lothian, 2004;Sakala, Romano, & Buckley, 2016;Stenglin & Foureur, 2013;Walsh, 2009). Dekel et al. (2019) suggest that because particular hormones are critical for the natural process of childbirth and crucial to the maternal mental state, it is likely to be an evolutionary adaptation. ...
... Anxiety during labor increases epinephrine levels, which correlates with prolonged births (Boucher et al., 2009). Accordingly, more solutions being offered refer to the birth environment, such as changing the architecture of delivery rooms (Foureur et al., 2010;Hodnett et al., 2009). Wrønding et al. (2019), found that alteration of lights in the delivery room could influence labor progression and outcome: delivery rooms with low irradiance and calming lights correlate with a substantial decrease in cesarean deliveries and the use of synthetic oxytocin infusions. ...
Article
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This paper focuses on the riddle of the extreme ends of the birth experience. On one end, are women who experience relatively successful childbirth as traumatic, and suffer from poor mental health during postpartum, varying from baby blues to postpartum depression and up to childbirth-related PP-PTSD. On the other, are women who experience childbirth as a highly positive, life-altering event. I offer that both extremes can be understood from the phenomenon of birthing consciousness and its fragility. When natural birth is uninterrupted, there are more chances for a natural birth process. At the end of an undisturbed natural delivery, women report ‘natural high’ sensations. However, even minor physical and environmental interruptions to the birthing woman stop the birth from progressing, thus requiring medical interventions. Out of analyzing the psycho-physical states during birth – natural and undisturbed versus highly medicated births – I claim that the fragility of birthing consciousness is the answer to the riddle of the extreme ends of the birth experience. Thus, the question ‘how does a low-risk woman get to a highly medicated birth?’ should be answered, not only in a physiological orientation, but also in a psycho-physiological and environmental context. Typical modern hospital birth environments often interrupt birthing consciousness, leading to a cascade of medical interventions and highly medicalized births with extremely negative birth experiences, which often results in poor mental health in postpartum. I argue that the first step to support a woman during a physiological birth, is to acknowledge the particular psycho-physical state of the birthing woman and its fragility, and not interrupt it unnecessarily.
... Although several studies [36][37][38] show that birth room environment positively influences labour experience and outcomes, how this occurs, and the implicit messages conveyed by environment, have not been fully explored. ...
... Future research could examine how pool availability impacts on demand for water immersion, and how midwives' attitudes influence their access to training and familiarity with equipment. Building on previous studies [36][37][38], the effect of the birth room environment on pool use could be investigated. In addition, while water immersion guidelines themselves have been extensively examined [21,22,44,45], further exploration of their implementation in practice is needed. ...
Article
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Background: Water immersion during labour can provide benefits including reduced need for regional analgesia and a shorter labour. However, in the United Kingdom a minority of women use a pool for labour or birth, with pool use particularly uncommon in obstetric-led settings. Maternity unit culture has been identified as an important influence on pool use, but this and other possible factors have not been explored in-depth. Therefore, the aim of this study was to identify factors influencing pool use through qualitative case studies of three obstetric units and three midwifery units in the UK. Methods: Case study units with a range of waterbirth rates and representing geographically diverse locations were selected. Data collection methods comprised semi-structured interviews, collation of service documentation and public-facing information, and observations of the unit environment. There were 111 interview participants, purposively sampled to include midwives, postnatal women, obstetricians, neonatologists, midwifery support workers and doulas. A framework approach was used to analyse all case study data. Results: Obstetric unit culture was a key factor restricting pool use. We found substantial differences between obstetric and midwifery units in terms of equipment and resources, staff attitudes and confidence, senior staff support and women's awareness of water immersion. Generic factors influencing use of pools across all units included limited access to waterbirth training, sociodemographic differences in desire for pool use and issues using waterproof fetal monitoring equipment. Conclusions: Case study findings provide new insights into the influence of maternity unit culture on waterbirth rates. Access to pool use could be improved through midwives based in obstetric units having more experience of waterbirth, providing obstetricians and neonatologists with information on the practicalities of pool use and improving accessibility of antenatal information. In terms of resources, recommendations include increasing pool provision, ensuring birth room allocation maximises the use of unit resources, and providing pool room environments that are acceptable to midwives.
... Results from two randomized controlled trials indicate that the physical birth environment may affect the duration of labor, pain intensity, and use of augmentation. However, sample sizes were small, and therefore adequately powered trials are needed [19,20]. The aim of this study was to examine whether a birth room using an immersive, carefully designed décor to minimize stress had an effect on the use of oxytocin for augmentation of labor and selected birth outcomes. ...
... In 2009, a Canadian pilot study including 62 nulliparous women found that fewer women needed oxytocin during labor in a socalled 'ambient birth room' (40% versus 68%, p = 0.03) [19]. Furthermore, one observational study, based on 789 nulliparous women birthing in another Danish hospital, examined the use of oxytocin in women giving birth in a sensory birth room compared to a standard birth room and observed a lower, but not statistically different, use of oxytocin (30% versus 35%, odds ratio 0.83; 95% CI 0.61-1.13) ...
Article
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Objective In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on midwifery practice and women’s birth experiences. This study is based on the hypothesis that the environment for birth needs greater attention to improve some of the existing challenges in modern obstetric practice, for example the increasing use of augmentation and number of interventions during delivery. Study design A randomized controlled trial was carried out to study the effect of giving birth in a specially designed “birth environment room” on the use of augmentation during labor. The study took place at the Department of Obstetrics and Gynecology, Herning Hospital, Denmark and included 680 nulliparous women in spontaneous labor at term with a fetus in cephalic presentation. Women were randomly allocated to either the “birth environment room” or a standard birth room. The primary outcome was augmentation of labor by use of oxytocin. Secondary outcomes were duration of labor, use of pharmacological pain relief, and mode of birth. Differences were estimated as relative risks (RR) and presented with 95% confidence intervals. Results No difference was found on the primary outcome, augmentation of labor (29.1% in the “birth environment room” versus 30.6% in the standard room, RR 0.97; 0.89-1.08). More women in the “birth environment room” used the bathtub (60.6% versus 52.4%, RR 1.18; 1.02-1.37), whereas a tendency to lower use of epidural analgesia (22.6% versus 28.2%) did not reach statistical significance (RR 0.87; 0.74-1.02). The chance of an uncomplicated birth was almost similar in the two groups (70.6% in the “birth environment room” versus 72.6% in the standard room, RR 0.97; 0.88-1.07) as were duration of labor (mean 7.9 hours in both groups). Conclusions Birthing in a specially designed physical birth environment did not lower use of oxytocin for augmentation of labor. Neither did it have any effect on duration of labor, use of pharmacological pain relief, and chance of birthing without complications. We recommend that future trials are conducted in birth units with greater improvement potentials.
... For example, there is a growing body of evidence indicating that doula support improves childbirth outcomes (Brisco & Small, 2017;Kozhimannil et al., 2016;Kozhimannil, Hardeman, Attanasio, Blauer-Peterson, & O'brien, 2013;Manning-Orenstein, 1998) and that practicing yoga during pregnancy has positive therapeutic effects during birth (Chuntharapat, Petpichetchian, & Hatthakit, 2008;Narendran, Nagarathna, Narendran, Gunasheela, & Nagendra, 2005). In addition, it is now accepted that the birthing environment can support or hinder birth physiologically (Sayiner et al., 2019;Stark, Remynse, & Zwelling, 2016); therefore, solutions also include redesigning labor rooms (Foureur et al., 2010;Hodnett, Stremler, Weston, & McKeever, 2009) and dimming the lights in the delivery room (Wrønding et al., 2019). These empirical findings indicate that interventions improving the mental wellbeing of birthing mothers, together with their physical surroundings, can optimize the chances of women undergoing natural childbirth. ...
... In other words, even the birth outcomes of mice drop when they are disturbed and removed from a familiar and safe place to an unfamiliar and unintimate place, a step that activates the neocortex (see also Newton, Foshee, & Newton, 1966). Likewise, lack of attention to a birthing woman's inherent need not to be disturbed in the typical hospital environment is correlated to a high rate of cesarean sections, routine use of epidurals in labor, and a high incidence of instrument deliveries (Aune et al., 2015;Buckley, 2015;Buckley & Dip, 2003;Crowther et al., 2014;Hodnett et al., 2009;Jansen, Gibson, Bowles, & Leach, 2013;Lothian, 2004;Sakala, Romano, & Buckley, 2016;Sayiner et al., 2019;Stenglin & Foureur, 2013;Walsh, 2009). ...
Article
In this article, I present the concept of “birthing consciousness,” a psychophysical altered state of women that can occur during natural and undisturbed birth. I demonstrate that this altered state of consciousness (ASC) has phenomenological and cognitive features of hypofrontality; thus, birthing consciousness probably shares a similar brain mechanism to that postulated by the transient-hypofrontality theory (THT). I argue that until recently (with the advent of modern medical intervention), in evolutionary terms, women lacking the proclivity for this specific brain mechanism had a lower chance of reproducing successfully. Hence, I suggest a general and preliminary hypothesis concerning THT: Birthing consciousness is one example of an adaptive pain-induced ASC associated with transient hypofrontality.
... This helps to promote the physiological birth ( Lothian, 2009 ). Some studies suggest that satisfaction with the physical environment is a significant predictor of women's overall satisfaction and positive experience with the labor and delivery process ( Foureur et al., 2010 ;Hodnett et al., 2009 ). ...
Article
Objective The objective of the study is to find out and assess satisfaction of Slovak women with psychosocial aspects of perinatal care. Design and setting The research was designed as a quantitative cross-sectional study. The research data were collected in five pediatric outpatient clinics in Slovakia. Participants The research sample consisted of 360 women within 0-1 year after natural delivery (average time in months from childbirth: 6.22 ± 3.64) who visited the selected pediatric outpatient clinic in the period from October 2016 to January 2018. Methods To collect the relevant data, the original Czech questionnaire measuring psychosocial climate in maternity hospitals – KLI-P (Cronbach α = 0.95) was used to investigate the satisfaction of women with care during labour and delivery as well as with psychosocial aspects. The following six factors were assessed: (1) helpfulness and empathy of midwives and (2) of physicians, (3) superiority and lack of interest, (4) physical comfort and services, (5) control of a woman in labour and her participation in decision-making, (6) providing information. The received data were analysed using descriptive statistics, the Shapiro-Wilk test, robust ANOVA, Post-hoc test, the Wilcoxon two-sample test, a G-test of independence and the Cochran-Armitage test of trend. Findings We found that most women (83.1%) were generally satisfied with their care during labour and delivery as well as with psychosocial support. In terms of psychosocial aspects, the highest level of satisfaction was attributed to the approach of the health professionals and the lowest one (61.5%) to the control and participation of delivering woman in decision-making. Both perception of the course of labour and delivery and skin-to-skin contact immediately after birth were shown to be statistically significant predictors of women's satisfaction. The aspect of age was found to be statistically significant in relation to the factor of control of a woman in labour and her participation in decision-making. Key conclusions and implications for practice It can be concluded that it is necessary to pay attention to the psychosocial aspects of health care during labour and delivery, with the emphasis on strengthening interventions in the field of participation of women in decision-making. Simultaneously, it is beneficial to emphasize and support the naturalness of childbirth so that women would associate childbirth with a positive experience. Finally, it is important to promote skin-to-skin contact right after birth.
... Care includes the detection and treatment of asymptomatic bacteriuria (9, 10) as well as blood tests to screen the patient for rubella, toxoplasmosis, hepatitis, syphilis and (with the patient's consent) HIV (11). In order to prevent neonatal infection from group B streptococcal infection, a sample of exudate is taken from the recto-vaginal orifices at 35−37 weeks of gestation (12). The prevalence of gestational diabetes in Spain ranges from 6% to 8%. ...
Article
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Introduction: Prenatal care is a key strategy to reduce maternal mortality. The aims of this work were to ascertain the level of satisfaction of new mothers with their pregnancy monitoring and with the medical professionals who provided prenatal care. Subject and methods: A descriptive study was conducted on 265 new mothers, 18-43 years of age, who had given birth at the Virgen de las Nieves University Hospital and the San Cecilio University Hospital in Granada (Spain) in April and May 2012. The data were collected with a questionnaire consisting of 28 items that elicited information from the subjects about their pregnancy, prenatal care activities, the healthcare professionals that provided the care, and those that they would like to monitor future pregnancies. There were also two open questions. The first was about the perceived needs of the participants and the second asked them to suggest ways that prenatal care could be improved. Results: The majority of the subjects (59.6%) had given birth for the first time. The midwife was the healthcare professional who performed most of the monitoring activities and resolved their doubts and problems (32.74%), gave the subjects tranquillity and security (37.86%) and listened to their worries (34.53%). The subjects' satisfaction with the healthcare professionals was generally high. This was particularly true of the midwife (90.75%). Half of the subjects surveyed said that they wanted the midwife, obstetrician and general practitioner to monitor their pregnancy. They also underlined the need for longer and more visits with the midwife as well as more consultations with the obstetrician and higher number of ultrasounds. Conclusions: The subjects were very satisfied with the work of the healthcare professionals that monitored their pregnancy, particularly with the midwife. However, they also highlighted expectations and needs that, if met, would increase their satisfaction.
... In birth centers, nurses focus on frequent touch and low-technology care and do not have the demands associated with the maintenance of competence in many procedures, such as epidural care and inductions of labor. A pilot study compared nurses' responses to caring for women in an ambient room and a standard labor room (Hodnett, Stremler, Weston, & McKeever, 2009). The same staff cared for women who were randomized to the standard labor room or the ambient room. ...
The birth environment can support or hinder physiologic birth. Although most births occur in hospitals, there has been an increase in requests for home and birth center births. Nurses can support physiologic birth in different environments by ensuring a calm environment that helps reduce stress hormones known to slow labor. In any birth setting, nurses can encourage the use of facilities and equipment that support a physiologic labor and birth and aid the transition of the newborn.
... Even if she wants to sit down, stand, or kneel on all fours, there is nothing in the visual landscape to suggest this is possible. Instead the visual cues suggest she will lie down, and assume a passive pose, allowing health care providers to watch and monitor her (Lepori et al., 2008;Hodnett et al., 2009;Hammond et al., 2014;Townsend et al., in press). The medical equipment that is presented as an intimate part of the childbirth process will also play a role. ...
Article
Objective: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. Design: a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form of discourse analysis. Setting/participants: forty images of birth rooms were collected in 2013 from Google Images, Flickr, Wikimedia Commons and midwifery colleagues. The images were from obstetric units, alongside and freestanding midwifery units located in developed countries (Australia, Canada, Europe, New Zealand, United Kingdom and the United States of America). Main findings: findings demonstrated three kinds of birth room images; the technological, the 'homelike', and the hybrid domesticated birth room. The most dominant was the technological birth room, with a focus on the labour bed and medical equipment. The visual messages from images of the technological birth room reinforce the notion that the bed is the most appropriate place to give birth and the use of medical equipment is intrinsically involved in the birth process. Childbirth is thus construed as risky/dangerous. Key conclusions and implications for practice: as images on the Internet inform and persuade society about stereotypical behaviours, the trends of our time and sociocultural norms, it is important to recognise images of the technological birth room on the Internet may be influential in dictating women's attitudes, choices and behaviour, before they enter the birth room.
... Women need to feel that they are in a safe and secure space during birth, both in terms of social support and the physical space (Carlsson, 2016;Hall et al., 2018;Stark et al., 2016). Accordingly, improvements to the physical environment, such as redesigning delivery rooms, are being implemented by hospitals (Foureur et al., 2010;Hodnett et al., 2009;Wrønding et al., 2019). The objective is to eliminate environmental and psychological factors that trigger interruptions to birthing consciousness by causing a physiological disturbanceeither a release of stress hormones or prevention of the release of birthing hormonesboth cases cause dystocia. ...
Article
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Birthing consciousness" is a psycho-physical state of focus and retreat into which a woman sometimes enters during physiological birth. When this state is initiated and continues uninterrupted, the probability of a natural birthing process increases. Adversely, interruptions to the state of birthing consciousness slow down or even stop the birth from progressing. In this theoretical examination, I claim that birthing consciousness was a useful adaptation in human evolutionary time. However, in current hospital settings there are various interruptions to birthing consciousness. I offer a critical insight: obstetrics has neglected to exploit evolutionary advantages. Moreover, attention to evolutionary adaptation in the hospital generally, or obstetrics specifically, will advance best medical practices, thus public health in general. The suggested evolutionary approach offers a new perspective concerning the cascade of interventions in the birth process. It also suggests a path for future research concerning the reduction in the rate of unscheduled cesarean births, on the rise in current obstetrical care.
... Care includes the detection and treatment of asymptomatic bacteriuria (9, 10) as well as blood tests to screen the patient for rubella, toxoplasmosis, hepatitis, syphilis and (with the patient's consent) HIV (11). In order to prevent neonatal infection from group B streptococcal infection, a sample of exudate is taken from the recto-vaginal orifices at 35−37 weeks of gestation (12). The prevalence of gestational diabetes in Spain ranges from 6% to 8%. ...
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Prenatal care is a key strategy to reduce maternal mortality. The aims of this work were to ascertain the level of satisfaction of new mothers with their pregnancy monitoring and with the medical professionals who provided prenatal care. A descriptive study was conducted of 265 new mothers, 18-43 years of age, who had given birth at the Virgen de las Nieves University Hospital and the San Cecilio University Hospital in Granada (Spain) in April and May 2012. The data were collected with a questionnaire consisting of 28 items that elicited information from the subjects about their pregnancy, prenatal care activities, the healthcare professionals that provided the care, and those that they would like to monitor future pregnancies. There were also two open questions. The first was about the perceived needs of the participants and the second asked them to suggest ways that prenatal care could be improved. The majority of the subjects (59.6%) had given birth for the first time. The midwife was the healthcare professional who performed most of the monitoring activities and resolved their doubts and problems (32.74%), gave the subjects tranquility and security (37.86%) and listened to their worries (34.53%). The subjects' satisfaction with the healthcare professionals was generally high. This was particularly true of the midwife (90.75%). Half of the subjects surveyed said that they wanted the midwife, obstetrician and general practitioner to monitor their pregnancy. They also underlined the need for longer and more visits with the midwife as well as more consultations with the obstetrician and higher number of ultrasounds. The subjects were very satisfied with the work of the healthcare professionals that monitored their pregnancy, particularly with the midwife. However, they also highlighted expectations and needs that, if met, would increase their satisfaction.
... Other studies have investigated the dynamics between places and nurseepatient decisions, ethics, interactions and relationships (Purkis, 1996;Malone, 2003;Bucknall, 2003;Peter and Liaschenko, 2004;Shattell et al., 2008;Seto-Nielsen et al., 2013). Finally, the dynamics between places and intra-and interprofessional interactions and relationships (West and Barron, 2005;Barnes and Rudge, 2005;Oandasan et al., 2009;Kitto et al., 2013), and those between places and the nature and outcomes of care (including through place-based clinical interventions) (McKeever et al., 2002;Angus et al., 2003;Hodnett et al., 2005Hodnett et al., , 2009Marshall, 2008;Mesman, 2012) have been a focus of constructivist/humanist scholars. ...
Article
Geographers have long grappled with how their research can positively impact individuals, communities and society. Demonstrating research impact is an increasingly important aspect of academic life internationally. In this paper we argue that agendas for encouraging 'impact' would be well-served if impact through teaching was identified and stimulated more explicitly, and if academics better recognised and seized the opportunities that already exist for such impact. We take engagement between health geography and nurse education as an example of how social scientists could demonstrate research impact through inter-disciplinary involvement in the education of health care professionals, and specifically student nurses. We begin by showing how the UK's Research Excellence Framework (widely regarded as the key reference point for research performance management regimes internationally) has tended to produce an undervaluation of impact via education in many disciplines. A comprehensive overview of international scholarship at the intersection between geography and nursing is then presented. Here we trace three 'waves of enquiry' that have focused on research interactions before calling for a fourth focused on critical pedagogy. To illustrate the possibilities of this fourth wave, we sketch a case study that outlines how engagement with research around blood donation could help provide a foundation for critical pedagogy that challenges student nurses to practice reflexively, think geographically and act justly. Finally, we call for closer engagement between health geography and nurse education, by encouraging educators to translate, teach, and transfuse ideas and people between health geography and nurse education. In so doing, we argue that work at this interface can be mutually beneficial and demonstrate impact both within and beyond research assessment rubrics. Hence, our ideas are relevant beyond nurse education and geography insofar as this paper serves as an example of how reframing research impact can recover the importance of impact through education.
... Studien zu physiologischen und biomechanischen Mechanismen bei einer Geburt in der tiefen Hocke demonstrieren vielfache positive Wirkungen dieser Körperhaltung auf die Erweiterung des kleinen Beckens, die Beugung und Drehung des kindlichen Köpfchens und die Wehenkraft bei der Geburt [12]. Eine Pilotstudie, die 2009 in Kanada durchgeführt wurde, generierte Hinweise darauf, dass eine veränderte Gebärumgebung (ohne Entbindungsbett) positive Auswirkungen auf die gebärende Frau sowie das betreuende Personal hatte [13]; dagegen erhöhte die Gegenwart eines Gebärbettes in der Kontrollgruppe die Zeit, die die Gebärende liegend darin verbrachten, und auch die Wahrscheinlichkeit eines Wehentropfs. International existierte keine klinische Studie, die eine ausreichende statistische Aussagekraft hatte, um den unabhängigen Effekt der Gebärumgebung auf den Geburtsmodus belastbar zu untersuchen [14]. ...
Article
Zusammenfassung Das 9. Nationale Gesundheitsziel „Gesundheit rund um die Geburt“ und evidenzbasierte Leitlinien fordern die Förderung der physiologischen Geburt. Das RCT „Be-Up: Geburt aktiv“ untersucht die Wirkung eines alternativ gestalteten Gebärraums auf die Rate vaginaler Klinikgeburten. Die Umsetzung des RCT und die Rekrutierung von 3.800 Studienteilnehmerinnen sind nur durch die Teilnahme der 17 Be-Up-Kliniken möglich. Die Ergebnisse werden für Klinikpersonal, Entscheidungsträger und die Hebammenwissenschaft von Interesse sein.
... Women were seeking a birth ambience characterised by compassion, warmth, nurture and love. In the intervening years some effort has gone into better understanding aspects of the environment that may facilitate the type of experience that women and their families want and need (see for example Davis-Floyd, 2001;Newburn and Singh, 2003;Fahy et al., 2008;Hauck et al., 2008;Hodnett et al., 2009;Stenglin and Foureur, 2013). As a result, in a variety of resource rich countries institutional maternity care settings have been reconstructed to reflect a sense of domesticity, characterised by the concepts of: 'reflecting home life', 'home making', 'to make domestic', 'to adapt', 'to train/tame', 'to make homely' (Collins, 2002;American Heritage, 2016). ...
... In our study, primi-and multiparous women more often stated that the caregiver took them seriously, or listened to them carefully (only multiparous women), or explained things in an understandable way (only primiparous women). This confirms reports that showed that environmental changes can influence the quality of interaction with the patient [31,32]. Hospital rooms that were associated with improved patient outcomes were those that offered privacy, promoted social support and were calming [33]. ...
Article
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Background The caregiver has an important influence on women’s birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver’ (scale from 1 to 10, with cut-off of below 9) and ‘quality of treatment by the caregiver’ (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Results Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for ‘general satisfaction with caregiver’ (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for ‘general satisfaction’ compared to those who planned a hospital birth and who had care transferred (1.44; 1.0–2.1). Furthermore, they significantly more often rated ‘quality of treatment by caregiver’ high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2–2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1410-9) contains supplementary material, which is available to authorized users.
... Across diverse clinical settings, facility design has been shown to impact patient safety, patient satisfaction, staff effectiveness, and overall care quality (Ulrich, Quan, Systems, Architecture, & Texas, 2004;Ulrich et al., 2008). While these impacts occur at multiple scales ranging from the patient room to the full facility, most prior research in childbirth has focused at the room scale (Aburas, Pati, Casanova, & Adams, 2017;Davis Harte, Sheehan, Stewart, Foureur, & Dip Clin Epi, 2016;Hauck, Rivers, & Doherty, 2008;Hodnett, Stremler, Weston, & McKeever, 2009). Research is lacking on how the design of the full clinical unit or facility impacts the way childbirth care is provided. ...
Article
Objective: To assess the feasibility of quantifying variation in childbirth facility design and explore the implications for childbirth service delivery across the United States. Background: Design has been shown to impact quality of care in childbirth. However, most prior studies use qualitative data to examine associations between the design of patient rooms and patient experience. There has been limited exploration of measures of unit design and its impact on care provision. Method: We recruited 12 childbirth facilities that were diverse with regard to facility type, location, delivery volume, cesarean delivery rate, and practice model. Each facility provided annotated floor plans and participated in a site visit or telephone interview to provide information on their design and clinical practices. These data were analyzed with self-reported primary cesarean delivery rates to assess associations between design and care delivery. Results: We observed wide variation in childbirth unit design. Deliveries per labor room per year ranged from 75 to 479. The ratio of operating rooms to labor rooms ranged from 1:1 to 1:9. The average distance between labor rooms and workstations ranged from 23 to 114 ft, and the maximum distance between labor rooms ranged from 9 to 242 ft. More deliveries per room, fewer labor rooms per operating room, and longer distances between spaces were all associated with higher primary cesarean delivery rates. Conclusions: Clinically relevant differences in design can be feasibly measured across diverse childbirth facilities. The design of these facilities may not be optimally matched to service delivery needs.
... The BE-UP trial (acronym for Birth environment -Upright position) is based on four Cochrane Reviews [28][29][30][31] and a pilot study from Canada [32] and is an active controlled superiority trial with a two-arm parallel design [33]. Its aim is to increase vaginal births (VB) and, speci cally, to test the effect of a redesigned birthing room (intervention) in hospitals on the probability of VB. ...
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Background: RCTs with complex interventions are methodically challenging. Careful planning under everyday conditions in compliance with the relevant international quality standard (ICH-GCP guideline) is crucial. Specific challenges exist for RCTs conducted in delivery rooms due to various factors that cannot be planned beforehand, such as “peak hours” of births and a high work burden for midwives and obstetricians. Moreover, in Germany as well as in other countries, midwives and obstetricians have frequently little experience as investigators in clinical trials. Methods: The randomised controlled trial “BE-UP” tests the effectiveness of an alternative birthing room on the rate of vaginal births and woman-oriented outcomes. In the process of implementing the trial in 17 obstetrical units and in the endeavour to reach the calculated sample size of 3,800 women, the research team encountered a variety of unexpected challenges. The aim is to describe in greater detail the methodical and organisational challenges and to inform about the research team’s strategies to overcome them. Results: The results are presented in five sectors: 1) Selection of and support for cooperating hospitals: they are to be selected according to predefined criteria and strategies to offer continuous support in trial implementation must be mapped out. 2) Establishing a process of requesting informed consent: a quality-assured process to inform pregnant women early on must be feasible and effective. 3) Individual, digital real time randomization: besides instructing the maternity teams appropriate measures for technical failure must be provided. 4) The standardized birthing room: the complex intervention is to be implemented according to study protocol, yet adapted to the prevailing conditions in the delivery rooms. 5) GCP-compliant documentation: midwives and obstetricians is to be instructed in high quality data collection, supported by external monitoring throughout the trial. Conclusion: Since not all potential challenges can be anticipated in the planning of a trial, study teams need to be flexible and react promptly to any problems that threaten recruitment or the implementation of the complex intervention. Thought should be given to the perspectives of midwives and obstetricians as recruiters and how clinic-intern processes could be adapted to correspond with the trial’s requirements.
... There is a significant body of literature linking the built environment with health care outcomes, both generally 1 and in maternity care specifically. 2,3 This knowledge has led to a growing interest in modifying the design of the birthing environment, such as in birth centres, to transform the experience of birth from an impersonal clinical encounter into a celebration of life for women and their families. 4 The physiological significance of the birth environment was first championed by Michel Odent 5 who argued that the release of oxytocin was highly dependent on environmental factors. ...
Article
Background: Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care. Aim: To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds. Methods: Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively. Results: Item-level content validity was achieved on 37 items for birth unit midwives (n=10); 35 items for Aboriginal or Torres Strait Islander women (n=6); 33 items for women who had anticipated a vaginal birth after a caesarean (n=6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n=20). Survey-level content validity was not demonstrated in any group. Conclusion: Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors.
... The BE-UP trial (acronym for Birth environment -Upright position) is based on four Cochrane Reviews [29][30][31][32] and a pilot study from Canada [33] and is an active controlled superiority trial with a two-arm parallel design [34]. Its aim is to increase vaginal births (VB) and, specifically, to test the effect of a redesigned birthing room (intervention) in hospitals on the probability of VB. ...
Article
Full-text available
Background Randomized controlled trials (RCTs), especially multicentric, with complex interventions are methodically challenging. Careful planning under everyday conditions in compliance with the relevant international quality standard (Good Clinical Practice [GCP] guideline) is crucial. Specific challenges exist for RCTs conducted in delivery rooms due to various factors that cannot be planned beforehand. Few published RCTs report challenges and problems in implementing complex interventions in maternity wards. In Germany as well as in other countries, midwives and obstetricians have frequently little experience as investigators in clinical trials. Methods The aim is to describe the key methodological and organizational challenges in conducting a multicenter study in maternity wards and the solution strategies applied to them. In particular, project-related and process-oriented challenges for hospital staff are considered. The exemplarily presented randomized controlled trial “BE-UP” investigates the effectiveness of an alternative design of a birthing room on the rate of vaginal births and women-specific outcomes. Results The results are presented in five sectors: 1) Selection of and support for cooperating hospitals: they are to be selected according to predefined criteria, and strategies to offer continuous support in trial implementation must be mapped out. 2) Establishing a process of requesting informed consent: a quality-assured process to inform pregnant women early on must be feasible and effective. 3) Individual digital real-time randomization: In addition to instructing maternity teams, appropriate measures for technical failure must be provided. 4) The standardized birthing room: The complex intervention is to be implemented according to the study protocol yet adapted to the prevailing conditions in the delivery rooms. 5) GCP-compliant documentation: midwives and obstetricians will be instructed in high-quality data collection, supported by external monitoring throughout the trial. Conclusion Since not all potential challenges can be anticipated in the planning of a trial, study teams need to be flexible and react promptly to any problems that threaten recruitment or the implementation of the complex intervention. Thought should be given to the perspectives of midwives and obstetricians as recruiters and how clinic-intern processes could be adapted to correspond with the trial’s requirements. Trial registration The BE-UP study was registered on 07/03/ 2018 in the German Register for Clinical Trials under Reference No. DRKS00012854 and can also be found on the International Clinical Trials Registry Platform (ICTRP) (see https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS0001285 ).
... However, there remains a gap in knowledge about the effect of the unit-or facility-level design structures on the ways care is provided. [19][20][21][22] As a result, there is limited understanding of how facility-level variation in the facility design structures may influence childbirth care provision. 23, 24 We conducted an exploratory study to identify key themes about the mechanisms through which facility design may influence the processes of childbirth care and to provide the basis for future investigation into the effect of design on care. ...
Article
Full-text available
Introduction Across health care, facility design has been shown to significantly affect quality of care; however, in maternity care, the mechanisms of how facility design affects provision of care are understudied. We aim to identify and illustrate key mechanisms that may explain how facility design helps or hinders clinicians in providing childbirth care. Methods We reviewed the literature to select design elements for inclusion. Using a modified Delphi consensus process, we engaged an interdisciplinary advisory board to prioritize these elements with regard to potential effect on care provision. The advisory board proposed mechanisms that may explain how the prioritized facility design elements help or hinder care, which the study team organized into themes. We then explored these themes using semistructured interviews with managers at 12 diverse birth centers and hospital‐based labor and delivery units from across the United States. Results The design of childbirth facilities may help or hinder the provision of care through at least 3 distinct mechanisms: 1) flexibility and adaptability of spaces to changes in volume or acuity; 2) physical and cognitive anchoring that can create default workflows or mental models of care; and 3) facilitation of sharing knowledge and workload across clinicians. Discussion Facility designs may intentionally or unintentionally influence the workflows, expectations, and cultures of childbirth care.
... (2) Intra and inter-professional exchanges and relationships (Sandelowski 2002;Leonard 2003, 2006a, b;West and Barron 2005;Barnes and Rudge 2005;Brodie et al. 2005;Oandasan et al. 2009;Mesman 2012;Kitto et al. 2013). (3) The nature and outcomes of care, including specific types of clinical and caring interventions Angus et al. 2003;Hodnett et al. 2005Hodnett et al. , 2009Marshall 2008;Mesman 2009Mesman , 2012. (4) Community practice and cared-for communities (Hall 1996;Pardo Mora and González Ballesteros 2007;Bender et al. 2007). ...
Chapter
This chapter reviews the contemporary geographical study of health care work. Initially it examines key ‘on the ground’ transformations in health and health care which are fundamentally geographical in their making, form and consequences; transformations which have demanded a geographical research perspective be taken as well-aligned vantage point with which to report and understand them. These include increasing spatial diffusion of health professionals and roles; the transition of health care settings; the role of technologies in overcoming spatial limitations; the increasing emphasis on community and the social model of health; the embeddedness of geographical scales and concepts in policy and administration, and the globalization of work roles and responsibilities. The chapter then moves on to examine how a number of academic developments—including in medical/health geography—have at the same time coalesced to provide an additional set of motivations and opportunities for geographical scholarship on health care work. Finally, it describes the main theoretical traditions and approaches which have constituted ‘geographies of health care work’ as a current multidisciplinary academic enterprise and field—including spatial science, political economy, social constructionist/humanist, and most recently non-representational theory, providing examples of recent empirical research which has been framed by each.
... Similarly, many recent studies have indicated correlations between the disturbed and unintimate environment in a typical modern birth setting (i.e. modern hospitals) with the rising rates of instrument births and unplanned cesarean sections (Aune et al., 2015;Buckley, 2015;Hodnett et al., 2009;Jansen et al., 2013;Sakala et al., 2016;Stenglin & Foureur 2013;Walsh, 2009). In a typical modern hospital setting, disturbing the natural birthing process might include loud voices, bright lights, strong smells, and other stressful actions that might release catecholamines and thus cause neocortical activity (Gavin-Jones & Handford, 2016, pp. ...
Article
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In this article, I argue that there is a lacuna in evolutionary psychological science. Women most likely adapted, via natural selection processes, to handle the birthing process successfully; not only physically and culturally, but also psychologically and behaviorally. However, current literature of evolutionary psychology largely ignores this reasonable assumption. A look at current prominent literature from the field revealed a consensus that women before and after birth are functioning subjects, shaped by natural selection to maximize success in reproduction. However, it appears that the same literature has little to say about the behavioral and psychological responses of women during birth itself. This is the lacuna discussed in the article. In other fields of research, different behaviors and mental processes have been found to correlate with a successful natural birth. Selection would likely have favored women who had such positive responses during birth because it is a process that all individuals must go through; natural childbirth was an integral part of reproductive success before modern obstetrics existed. Implications for resolving this lacuna vary widely and may contribute to our understanding of how selection might have shaped the human mind in general, as well as the female mind in particular.
... This dimension consists of two questions and one of them is negative. An environment that facilitates intimacy, silence, environmental warmth, and the absence of medicalized furniture contributes to the satisfaction of women [55,56]. However, in the qualitative study carried out by Jenkins et al. in the state of New South Wales (Australia), most women did not highlight the environment as one of the three most important aspects in their care [53]. ...
Article
Full-text available
The satisfaction of women with the birth experience has implications for the health and wellness of the women themselves and also of their newborn baby. The objectives of this study were to determine the factor structure of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) questionnaire on satisfaction with the attention received during birth delivery in Spanish women and to compare the level of satisfaction of pregnant women during the birth process with that in other studies that validated this instrument. A cross-sectional study using a self-completed questionnaire of 385 Spanish-speaking puerperal women who gave birth in the Public University Hospitals of Granada (Spain) was conducted. An exploratory factor analysis of the WOMBLSQ4 questionnaire was performed to identify the best fit model. Those items that showed commonalities higher than 0.50 were kept in the questionnaire. Using the principal components method, nine factors with eigenvalues greater than one were extracted after merging pain-related factors into a single item. These factors explain 90% of the global variance, indicating the high internal consistency of the full scale. In the model resulting from the WOMBLSQ4 questionnaire, its nine dimensions measure the levels of satisfaction of puerperal women with childbirth care. Average scores somewhat higher than those of the original questionnaire and close to those achieved in the study carried out in Madrid (Spain) were obtained. In clinical practice, this scale may be relevant for measuring the levels of satisfaction during childbirth of Spanish-speaking women.
... In other words, normal births seem more likely to occur in rooms that are not filled with medicalized objects and that do not display a clinical aesthetic. Although some studies have investigated the experiences and outcomes of women laboring in alternate birth environments (Duncan, 2011;Foureur et al., 2010;Hodnett, Stremler, Weston, & McKeever, 2009;Huack, Rivers, & Doherty, 2008), the effects of these environments on midwives and their practice have not yet been adequately investigated. In our analysis, midwives suggest that the designed environment could influence their facilitation of normal birth and future research in this area is recommended. ...
Article
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Objective: To explore the relationship between the birth environment and the practice of midwifery using the theoretical approach of critical realism. Background: The practice of midwifery has significant influence on the experiences and health outcomes of childbearing women. In the developed world most midwifery takes place in hospitals. The design and aesthetics of the hospital birth environment have an effect on midwives and inevitably play a role in shaping their practice. Despite this, knowledge about midwives' own thoughts and feelings regarding the design of hospital birth environments is limited. Methods: An exploratory descriptive methodology was used and 16 face-to-face photo-elicitation interviews were conducted with practicing midwives. Audio recordings were made of the interviews and they were transcribed verbatim. Thematic analysis, informed by the theoretical framework of critical realism, was undertaken. Results: Midwives identified cognitive and emotional responses to varied birth environments and were able to describe the way in which these responses influenced their practice. The overarching theme of "messages from space" was developed along with three sub-themes: messages, feelings, and behaviors. Midwives' responses aligned with the three domains of a critical realist world-view and indicated that a relationship existed between hospital birth environments and midwifery practice. Conclusions: The design of hospital birth rooms may shape midwifery practice by generating cognitive and emotional responses, which influence the activities and behaviors of individual midwives. Keywords: Hospital, midwifery, quality care, staff, women's health, work environment.
... However, many of the women in this study said the care strategies were "not effective", it is important to know that labor pain is a subjective multidimensional experience and not one specific technique or combination of interventions help all women or even the same woman throughout the labor experience (Brown et al., 2001). Evidence from high income countries have revealed that continuity of midwifery care, continuous support during labour, a good relationship with their care giver and good support during labour and birth are more likely to require less pain, have an intervention free labour and birth, higher perception of control and be more satisfied with their intrapartum care (Hatem et al., 2008;Hodnett et al., 2009;Leap et al., 2010) hence when all these factors are not present, the likelihood of achieving an effective intervention is very slim. ...
Article
In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,” published in The Journal of Perinatal Education, 16(3), 2007.
Technical Report
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This guide examines the key elements of the birth environment that may impact on women's ability to give birth and their experience of doing so. It is intended for use by architects, designers, policy makers, clinicians, and consumers involved in the planning of few birth environments or considering refurbishments. It can also inform women and clinicians about how to modify or augment existing birth spaces.
Article
Background Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. Aim To investigate the impact of the birth environment for women with complex pregnancies. Methods This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. Findings 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. Discussion Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. Conclusion Further research is needed investigating different users’ needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.
Chapter
This chapter focuses on approaches to care on the labor and birth unit—reviewing recent evidence and trends in birth care; the change process—discussing methods to implement change; and finally a vision of the new labor and delivery unit—descriptions of what the experience of labor and birth can look like on the new labor unit. To illuminate the possibilities by implementing evidence-based changes on the hospital labor unit, a case study in three parts is presented throughout the chapter. By assisting low-risk women to have a low-intervention birth in a home-like environment, a shorter and more satisfying labor, birth, and postpartum experience is possible for the mother, the infant, and the family. A similar approach to care can also be useful and appropriate for women with a more complex pregnancy or labor while also providing the required level of care.
Chapter
Pregnancy and birth is viewed by women and midwives as a transformative, life-changing event. It could therefore be considered surprising that there remains limited research around the spiritual aspects of having a baby. The focus of this chapter is to address how spirituality is understood within a holistic paradigm, considering the current focus on the need for greater dignity and compassion within health care. The limited research evidence that is available will be discussed and this will be applied to current practice in the UK and internationally. Further discussion will consider how spirituality is explored in order to educate future midwives. The chapter will include reference to the spirituality of the mother/baby dyad and the relevance of the awareness of the spirituality of the unborn. The need for more research and debate of spirituality within midwifery will be addressed.
Article
Spatial thought is undergoing somewhat of a renaissance in nursing. Building on a long disciplinary tradition of conceptualizing and studying 'nursing environment', the past twenty years has witnessing the establishment and refinement of explicitly geographical nursing research. This article - part one in a series of two - reviews the perspectives taken to date, ranging from historical precedent in classical nursing theory through to positivistic spatial science, political economy, and social constructivism in contemporary inquiry. This discussion sets up part two, which considers the potential of non-representational theory for framing future studies.
Article
Background: limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and environment of a birth space. Domestic aesthetics in a birth space are believed to be an important aspect of optimal birth unit design. Aim: to explore the concept of domesticity within the birth space. The specific objectives were to explore, describe and compare birth spaces with different domestic characteristics and subsequently, how laboring women worked within these spaces during the labour process. This project was situated within a larger ongoing body of work exploring birth unit design. Method: a qualitative approach, using the techniques of video ethnography and reflexive interviewing, was used. Video data consisted of films of the labours of six Australian women who gave birth in 2012. Filming took place in two different tertiary hospitals in Sydney NSW (n=5 women), as well as a stand-alone Birth Centre (n=1 woman). Video footage of a woman labouring at home was used to compare and contrast women's experiences. Latent content analysis was used to analyse the data set. In addition there were 17 one-hour video-reflexive interviews that were audio-taped and fully transcribed (nine interviews with women and/or their support people and eight with midwives). Field note data accompanied both the video recording as well as the reflexive interviews. Findings: in general, women labouring in conventional hospital labour and birth rooms acted and interacted with the environment in a passive way. The spaces clearly did not resemble homely or 'domestic' spaces. This forced women to adapt to the space. In essence all but one of the women labouring and birthing in these spaces took on the role of a 'patient'. One participant responded quite differently to the conventional hospital space. 'Domestication of the space' was the mechanism this woman used to retain a sense of ownership within the birth space. In contrast, in the domestic birth environments (Birth Centre and home) women effortlessly claimed ownership of the space, expressing their identity in a myriad of ways. In these domestic spaces, women were not required to change or modify their birth spaces as the design, furnishings and semiotics of the space openly encouraged them to be active, creative and take ownership of the space. Conclusion: the findings of this study add to the existing literature on birth unit design and more specifically contribute to an understanding of how the features of domesticity within the birth setting may shape the experience of labouring women and their care providers. The evidence gained from the study will assist in the ongoing movement to humanise birth spaces and develop further understandings of how home-like birth spaces should look. Those designing, building, furnishing, managing, accessing and working in Birthing Services could all benefit from the consideration of how environments designed for the care of birthing women, may be affecting the outcomes and experiences of women and their families.
Article
Many studies highlight how health is influenced by the settings in which people live, work, and receive health care. In particular, the setting in which childbirth takes place is highly influential. The physiological processes of women's labor and birth are enhanced in optimal ("salutogenic," or health promoting) environments. Settings can also make a difference in the way maternity staff practice. This paper focuses on how positive examples of Italian birth places incorporate principles of healthy settings. The "Margherita" Birth Center in Florence and the Maternity Home "Il Nido" in Bologna were purposively selected as cases where the physical-environmental setting seemed to reflect an embedded model of care that promotes health in the context of childbirth. Narrative accounts of the project design were collected from lead professional and direct inspections performed to elicit the key salutogenic components of the physical layout. Comparisons between cases with a standard hospital labor ward layout were performed. Cross-case similarities emerged. The physical characteristics mostly related to optimal settings were a result of collaborative design decisions with stakeholders and users, and the resulting local intention to maximize safe physiological birth, psychosocial wellbeing, facilitate movement and relaxation, prioritize space for privacy, intimacy, and favor human contact and relationships. The key elements identified in this paper have the potential to inform further investigations for the design or renovation of all birth places (including hospitals) in order to optimize the salutogenic component of any setting in any country.
Article
Women who use upright positions and are mobile during labor have shorter labors, less intervention, fewer cesarean births, and report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. The evidence for supporting physiologic childbearing for optimal birth fails to disrupt intervention intensive hospital practices that deny 60% of women mobility in labor despite calls by maternity care organizations to not restrict mobility for low risk women in spontaneous labor.
Article
To analyze the influence of maternal personality (big five personality, coping and childbirth expectations) on birth satisfaction. A longitudinal prospective design was used with 116 pregnant women during November 2014-December 2015 at a public hospital (Madrid, Spain) with three assessment stages: first trimester of pregnancy (personality factors), third trimester (childbirth expectations and coping strategies) and 48 hours after childbirth (labor satisfaction). The highest childbirth satisfaction scores were for professional support, support from partner and overall satisfaction. Higher childbirth satisfaction scores were found for vaginal births than for cesarean sections or instrumental births. Childbirth expectation dimensions showed the highest number of associations with childbirth satisfaction. Significant correlations were found between neuroticism and home assessment, agreeableness and environment, and openness to experience and overall satisfaction. Significant positive correlations were found between positive reappraisal and continuity, and negative correlations between avoidance coping and home assessment. Regression analyses showed the predictive role played by the type of birth, and the caregiving environment as childbirth expectation, and positive reappraisal and avoidance as coping strategies. These findings have important implications for health professionals who provide assistance to pregnant women through holistic models which include the assessment and adjustment of childbirth expectations.
Article
To introduce the sub-discipline of health geography and its developing interests, this paper initially reviews the different forms of arguments mounted by researchers. First, arguments on the nature and progress of inquiry that speak to directions, concepts, theories and methods. Second, using health care settings, public health and environmental health as illustrations, arguments that interpret and explain health and health care in different ways. A final series of discussions takes the theme of arguments further in terms of how they might affect change in the world. Specifically, health geography is situated within four broad movements currently unfolding in the larger disciplines to which it contributes. With regard to the parent discipline of human geography, the ‘policy turn’ and more generally the idea of ‘public geography’. With regard to the health sciences, Evidenced-Based Health Care and Knowledge Translation.
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With permission from Childbirth Connection, the “Executive Summary” for the Listening to Mothers II survey is reprinted, here. The landmark Listening to Mothers I report, published in 2002, described the first national U.S. survey of women's maternity experiences. It offered an unprecedented opportunity to understand attitudes, feelings, knowledge, use of obstetric practices, outcomes, and other dimensions of the maternity experience. Listening to Mothers II, a national survey of U.S. women who gave birth in 2005 that was published in 2006, continues to break new ground. Although continuing to document many core items measured in the first survey, the second survey includes much new content, exploring earlier topics in greater depth, as well as some new and timely topics.
Article
Childbirth is both an embodied and symbolic process, and the home and the hospital have been the shifting and contested sites of childbirth in contemporary discourses of birth in the United States. I argue that the economic and cultural imperatives of deregulation and downsizing of US health-care produce new spaces of domesticity and birthing bodies. Through an examination of the relatively recent transformations of hospital space into “homelike” birthing rooms, I propose a more nuanced understanding of how discursive and material shifts in the practices and sites of birth create new spatialities and subjectivities. The emergence of the “homelike” hospital room situates the production of birth spaces at the nexus of debates around domesticity, the body, the politics of reproduction, and the economics of health care in the United States.
Article
A prospective study of 32 normal, married primigravidas was conducted to determine the relationship between psychological factors in the third trimester of pregnancy and progress in two defined phases of labor. Data were analyzed for the total group and with five subjects deleted to control partially for the effect of medications. Psychological variables measured in pregnancy had significant correlations with variables measured at the onset of phase two labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase two labor variables with correlations of .39 with anxiety, .59 with plasma epinephrine, -.70 and -.52 with two adjacent Montevideo units, and .58 with length of labor in phase two (3-10 cm cervical dilation). Other pregnancy variables which significantly correlated with the labor variables were identification of a motherhood role, history of psychological counseling or psychiatric treatment, the trait scale of the State-Trait Anxiety Inventory, and fears related to helplessness, pain, loss of control, and loss of self-esteem. Several psychological variables measured in pregnancy also correlated significantly with length of labor in phase three and type of delivery. The results demonstrate that specific psychological factors in pregnancy are predictive of progress in labor.
Article
The relationships among maternal anxiety, selected stress-related biochemical factors, and progress in three defined phases of labor were determined for 32 married, normal, primigravid women, 20 to 32 years of age. Comparisons of plasma epinephrine, norepinephrine, and cortisol in third-trimester pregnancy, during labor, and after delivery are provided. At the onset of Phase 2 of labor (3 cm. of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine are significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels are significantly associated with lower uterine contractile activity at the onset of Phase 2 and with longer labor in Phase 2 (3 to 10 cm. of cervical dilatation). The relationship between epinephrine and progress in labor is explained by an adrenoreceptor theory.
Article
A proposal for a solution to reduce stress and anxiety in the hospital setting by combining the problems of excess noise in a hospital setting with the efficacy of music therapy is supported through an analysis of research in the field of noise, hospital noise pollution, and music medicine. Included in this overview are articles describing the effects of noise on health, the problems of noise pollution in the health care setting, and the benefits of replacing noise with music to reduce heart rate, blood pressure, breathing rate, emotional anxiety, and pain. By combining these areas of research, the authors propose the establishment of a department assigned to (1) control the amount of noise in a hospital and (2) provide a center of music therapy for all individuals in the hospital setting, including in-patients, out-patients, doctors, and staff. Due to the large specificity of these areas, this unifying source, or "Department of Sound," is suggested to aid in thoroughly addressing and combining these two concepts most effectively.
Article
North American cesarean delivery rates have risen dramatically since the 1960s, without concomitant improvements in perinatal or maternal health. A Cochrane Review concluded that continuous caregiver support during labor has many benefits, including reduced likelihood of cesarean delivery. To evaluate the effectiveness of nurses as providers of labor support in North American hospitals. Randomized controlled trial with prognostic stratification by center and parity. Women were enrolled during a 2-year period (May 1999 to May 2001) and followed up until 6 to 8 postpartum weeks. Thirteen US and Canadian hospitals with annual cesarean delivery rates of at least 15%. A total of 6915 women who had a live singleton fetus or twins, were 34 weeks' gestation or more, and were in established labor at randomization. Patients were randomly assigned to receive usual care (n = 3461) or continuous labor support by a specially trained nurse (n = 3454) during labor. The primary outcome measure was cesarean delivery rate. Other outcomes included intrapartum events and indicators of maternal and neonatal morbidity, both immediately after birth and in the first 6 to 8 postpartum weeks. Data were received for all 6915 women and their infants (n = 6949). The rates of cesarean delivery were almost identical in the 2 groups (12.5% in the continuous labor support group and 12.6% in the usual care group; P =.44). There were no significant differences in other maternal or neonatal events during labor, delivery, or the hospital stay. There were no significant differences in women's perceived control during childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons of women's likes and dislikes, and their future preference for amount of nursing support, favored the continuous labor support group. In hospitals characterized by high rates of routine intrapartum interventions, continuous labor support by nurses does not affect the likelihood of cesarean delivery or other medical or psychosocial outcomes of labor and birth.
The role of the physical environment in the hospital of the 21st century: A once-in-alifetime opportunity Available at: http://www.healthdesign.org/research/reports/physical_ environ
  • R Ulrich
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  • C Zimring
Ulrich R, Quan X, Zimring C, et al. The role of the physical environment in the hospital of the 21st century: A once-in-alifetime opportunity. 2004. Accessed September 3, 2008. Available at: http://www.healthdesign.org/research/reports/physical_ environ.php
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SAS Institute Inc. SAS System for Windows (computer program), version 8.02. Cary, North Carolina, SAS Institute Inc., 2007.
Women's views about the design and facilities in maternity units: A national survey
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  • D Singh
Newburn M, Singh D. Women's views about the design and facilities in maternity units: A national survey. London, UK: National Childbirth Trust, 2003.
Hospital facilities as work environments: Evaluation studies in the operating, radiology, and emergency departments in seven Finnish General Hospitals
  • M Teikari
Teikari M. Hospital facilities as work environments: Evaluation studies in the operating, radiology, and emergency departments in seven Finnish General Hospitals. Espoo, Finland: Helsinki University of Technology Research Publications, Faculty of Architecture, 1995.