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Eidhammer A, Glavind J, Skrubbeltrang C, Melgaard D. Healing Architecture in Birthing Rooms: A Scoping Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241238439. [PMID: 38591577 DOI: 10.1177/19375867241238439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
AIM The purpose of this scoping review is to map the knowledge about the multisensory birthing room regarding the birth experience and birth outcomes. BACKGROUND The concept of multisensory birthing rooms is relatively novel, making it relevant to explore its impact. METHODS Five databases were searched. The search was limited to articles in English, Danish, Norwegian, and Swedish. There were no time limitations. Fourteen relevant articles were identified providing knowledge about multisensory birthing rooms. RESULTS Eight articles focused on birth experience, six articles focused on birth outcome, and one on the organization of the maternity care. Seven of the studies identified that sensory birthing rooms have a positive impact on the birth experience and one qualitative study could not demonstrate a better overall birth experience. Five articles described an improvement for selected birth outcomes. On the other hand, a randomized controlled trial study could not demonstrate an effect on either the use of oxytocin or birth outcomes such as pain and cesarean section. The definition and description of the concept weaken the existing studies scientifically. CONCLUSIONS This scoping review revealed that multisensory birthing rooms have many definitions and variations in the content of the sensory exposure; therefore, it is difficult to standardize and evaluate the effect of its use. There is limited knowledge concerning the multisensory birthing room and its impact on the birth experience and the birth outcome. Multisensory birthing rooms may have a positive impact on the birth experience. Whereas there are conflicting results regarding birth outcomes.
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Affiliation(s)
- Anya Eidhammer
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Denmark
| | | | - Dorte Melgaard
- Department of Clinical Medicine, Aalborg University, Denmark
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Denmark
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Soman DA, Joseph A, Moore A. Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241227601. [PMID: 38379226 DOI: 10.1177/19375867241227601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups. BACKGROUND Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth. METHODS The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities. RESULTS Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels. CONCLUSIONS Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.
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Affiliation(s)
- Devi A Soman
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, Clemson University, SC, USA
- School of Architecture and Industrial Engineering, Clemson University, SC, USA
| | - Arelis Moore
- Community Health and Spanish, Department of Languages, Clemson University, SC, USA
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Harte JD, Sheehan A, Stewart S, Foureur M. Application of the Childbirth Supporter Study to Advance the Birth Unit Design Spatial Evaluation Tool. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:148-163. [PMID: 37340757 DOI: 10.1177/19375867231177304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Translational research to advance design criteria and apply the Childbirth Supporter Study (CSS) findings to practice. BACKGROUND The physical design of birth environments has not undergone substantial improvements in layout or ambiance since the initial move to hospitals. Cooperative, continuously present childbirth supporters are beneficial and are an expectation for most modern birth practices, yet the built environment does not offer support for the supporter. METHODS To advance design criteria, we use a comparative case study approach to create translational findings. Specifically, CSS findings were used as indicators to advance the Birth Unit Design Spatial Evaluation Tool (BUDSET) design characteristics in pursuit of better support for childbirth supporters in the built hospital birth environment. RESULTS This comparative case study provides eight new BUDSET design domain suggestions to benefit the supporter-woman dyad, and subsequently the baby and care providers. CONCLUSIONS Research-informed design imperatives are needed to guide the inclusion of childbirth supporters as both a supporter and as an individual in the birth space. Increased understanding of relationships between specific design features and childbirth supporters' experiences and reactions are provided. Suggestions to enhance the applicability of the BUDSET for birth unit design facility development are made, specifically ones that will better accommodate childbirth supporters.
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Affiliation(s)
- J Davis Harte
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Boston Architectural College, MA, USA
| | - Athena Sheehan
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia
| | - Susan Stewart
- School of Design, Faculty of Design, Architecture and Building, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Chen LL, Pan WL, Mu PF, Gau ML. Birth environment interventions and outcomes: A scoping review. Birth 2023; 50:735-748. [PMID: 37650526 DOI: 10.1111/birt.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The physical environments in which women give birth can contribute positively to meeting both physiologic and psychosocial needs during labor. Most studies on the labor and delivery processes have focused on mitigating pain and providing psychological support. Fewer have explored the influence of the physical birth environment. In this study, we performed a scoping review to compile and examine qualitative and quantitative studies related to the characteristics of physical birth environments and their effects on labor outcomes. METHODS We searched the PubMed, CINHAL, Cochrane, Web of Science, and MEDLINE databases from inception to May 2022. A total of 13 studies met the criteria for inclusion in our review. Two reviewers screened the titles and full-text articles and extracted data from the included studies. We used summary statistics and narrative summaries to describe the study characteristics, intervention implementation guidelines, intervention selection and tailoring rationale, and intervention effects. RESULTS In previous research, several elements of birth environments have been shown to provide physical and psychological support to birthing people and to improve outcomes related to the experience of care and pain management. We identified five main themes in the included studies: (1) "hominess;" (2) whether spaces are comfortable for activity; (3) demedicalization of the birth environment; (4) accommodations for birth partners; and (5) providing women with a sense of control over their birth environment. CONCLUSIONS Birth environments should be designed to promote positive birthing experiences, both physiologically and psychologically. Facilities and those who manage them can improve the experiences and outcomes of service users by modifying or designing spaces that are "homey," comfortable for activity, demedicalized, and include natural elements. In addition, policies that allow the birthing person to control her own environment are key to promoting positive outcomes and satisfaction with the birth experience.
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Affiliation(s)
- Li-Li Chen
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Wan-Lin Pan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, ROC
- Taiwan Evidence Based Practice Center: A Joanna Briggs Center of Excellence, Taipei, Taiwan, ROC
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- Core staff of the Taiwan Holistic Care Evidence Implementation Center, a JBI-Affiliated Center, Taipei, Taiwan, ROC
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Goldkuhl L, Tistad M, Gyllensten H, Berg M. Implementing a new birthing room design: a qualitative study with a care provider perspective. BMC Health Serv Res 2023; 23:1122. [PMID: 37858103 PMCID: PMC10585888 DOI: 10.1186/s12913-023-10051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology. METHODS This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome. RESULTS The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice. CONCLUSION Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT03948815, 14/05/2019.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
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Wangler S, Simon A, Meyer G, Ayerle GM. Influence of the birthing room design on midwives' job satisfaction - A cross-sectional online survey embedded in the 'Be-Up' study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100867. [PMID: 37295182 DOI: 10.1016/j.srhc.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Job satisfaction is an important factor influencing work performance, personal well-being, commitment and retention. The working environment influences job satisfaction. The design of the birthing room could influence the practice of midwives and their satisfaction. This study investigates whether the alternative design of the birthing room implemented in the randomized controlled trial 'Be-Up' (Birth environment-Upright position) has an impact on job satisfaction of midwives. METHOD A cross-sectional survey using an online questionnaire with 50 items addressing job satisfaction and birth room design was performed. The sample (n = 312) consists of midwives whose obstetric units participated in the Be-Up study and, as comparison group, midwives working in non-study obstetric units. These two independent groups were compared using t-tests; correlations and impacts were examined. RESULTS The results of the T-tests revealed statistically significant higher global job satisfaction and higher satisfaction with team support of midwives in the Be-Up room. However, midwives working in customary birthing rooms were more satisfied with the design of the room. The most important predictors of job satisfaction were team factors and understaffing in both groups. CONCLUSION Reasons for diminished satisfaction with the working environment in the Be-Up study may be assumed in uncertainties about emergency management in a new and unfamiliar environment. Furthermore the impact of a single redesigned room within a customary obstetric unit on job satisfaction seems small, as the room is embedded in the ward and hospital environment. More comprehensive concepts on the potential of the work environment influencing midwives' job satisfaction are needed.
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Affiliation(s)
- Sonja Wangler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; School of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW), Stuttgart, Germany.
| | - Anke Simon
- School of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University (DHBW), Stuttgart, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gertrud M Ayerle
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Migliorini L, Setola N, Naldi E, Rompianesi MC, Iannuzzi L, Cardinali P. Exploring the Role of Birth Environment on Italian Mothers' Emotional Experience during Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6529. [PMID: 37569069 PMCID: PMC10418452 DOI: 10.3390/ijerph20156529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
The physical environment is one of the factors that affect mother's experience of childbirth and psychological health. A woman's childbirth experience has been found to influence not only the mother's own health and future births but also the well-being of her child and family. The present study's objective was to investigate mothers' perceptions of spatial-physical humanization, affective quality of place, and emotions during childbirth. To achieve this goal, the first part of our work was dedicated to selecting two birth environments (hospital and birth center) with different degrees of humanization. The methods include observations and field survey which mainly concerned the environmental quality of the spaces and the layout of the birth unit, and self-report questionnaire about perceived environment, affective quality attributed to place, and delivery experience. Participants are 66 low-risk women, choosing hospital or birth center. The findings indicate an enhanced perception of both the spatial-physical aspects and the social and functional aspects of the care unit among mothers who give birth at the birth center. These same mothers also report a more positive perception of the childbirth experience. In conclusion, this study contributes to the understanding of the role of birth environments in shaping mothers' emotional experiences during childbirth.
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Affiliation(s)
- Laura Migliorini
- Department of Education Sciences, University of Genoa, 16121 Genoa, Italy
| | - Nicoletta Setola
- Department of Architecture, University of Florence, 50121 Florence, Italy
| | - Eletta Naldi
- Department of Architecture, University of Florence, 50121 Florence, Italy
| | | | - Laura Iannuzzi
- Centre for Midwifery and Women’s Health, Bournemouth University, Bournemouth BH12 5BB, UK
| | - Paola Cardinali
- Department of Economics, Universitas Mercatorum, 00186 Rome, Italy
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Nilvér H, Berg M. The Birth Companions' Experience of the Birthing Room and How It Influences the Supportive Role: A Qualitative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:156-167. [PMID: 37113053 PMCID: PMC10328140 DOI: 10.1177/19375867231163336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM To explore birth companions' experience of the birthing room and how it influences their role supporting the woman during labor and birth. BACKGROUND Although support from a birth companion positively affects the outcome of labor and birth, limited research explores how the birthing room influences the companion. This study identifies elements of the birthing room essential for the birth companion to offer optimal support to the woman during labor and birth. METHODS Fifteen birth companions were individually interviewed 2 weeks to 6 months after birth using a semi-structured interview guide. Transcribed interviews were analyzed based on reflexive thematic analysis. RESULTS The findings are captured by one overall theme: creating a supportive birth space in an unfamiliar environment. This creation process is further described by three subthemes: not being in the way, finding one's role, and being close to the birthing woman. CONCLUSIONS The findings illustrate how the birthing room was an unfamiliar environment for the birth companions, but one that they needed in order to give the required support. With slight changes in physical design, the birthing room can become calmer and more private and better help the birth companion fulfill the supportive role.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
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Hine R, Krakouer J, Elston J, Fredericks B, Hunter SA, Taylor K, Stephens T, Couzens V, Manahan E, DeSouza R, Boyle J, Callander E, Cunningham H, Miller R, Willey S, Wilton K, Skouteris H. Identifying and dismantling racism in Australian perinatal settings: Reframing the narrative from a risk lens to intentionally prioritise connectedness and strengths in providing care to First Nations families. Women Birth 2023; 36:136-140. [PMID: 35487864 DOI: 10.1016/j.wombi.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily. OBJECTIVE The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women. DESIGN Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated. RESULTS First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care. CONCLUSIONS AND RELEVANCE The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery.
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Affiliation(s)
| | - Jacynta Krakouer
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University.
| | - Jacinta Elston
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University; William Cooper Institute, Monash University, Australia
| | | | | | | | | | | | | | - Ruth DeSouza
- College of Design and Social Context, RMIT University, Australia
| | | | - Emily Callander
- Public Health and Preventative Medicine, Monash University, Australia
| | | | | | - Sue Willey
- Nursing and Midwifery, Monash University, Australia
| | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University and Warwick Business School, University of Warwick, Coventry, UK
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Goldkuhl L, Gyllensten H, Begley C, Nilsson C, Wijk H, Lindahl G, Uvnäs-Moberg K, Berg M. Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:200-218. [PMID: 36239523 PMCID: PMC9755691 DOI: 10.1177/19375867221124232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the effect of the birthing room design on nulliparous women's childbirth experience up to 1 year after birth. BACKGROUND Although it is known that the birth environment can support or hinder birth processes, the impact of the birthing room design on maternal childbirth experience over time is insufficiently studied. METHODS The Room4Birth randomized controlled trial was conducted at a labor ward in Sweden. Nulliparous women in active stage of spontaneous labor were randomized (n = 406) to either a regular birthing room (n = 202) or a new birthing room designed with more person-centered considerations (n = 204). Childbirth experiences were measured 2 hr, 3 months, and 12 months after birth by using a Visual Analogue Scale of Overall Childbirth Experience (VAS-OCE), the Fear of Birth Scale (FOBS), and the Childbirth Experience Questionnaire (CEQ2). RESULTS Women randomized to the new room had a more positive childbirth experience reported on the VAS-OCE 3 months (p = .002) and 12 months (p = .021) after birth compared to women randomized to a regular room. Women in the new room also scored higher in the total CEQ2 score (p = .039) and within the CEQ2 subdomain own capacity after 3 months (p = .028). The remaining CEQ2 domains and the FOBS scores did not differ between the groups. CONCLUSIONS These findings show that a birthing room offering more possibilities to change features and functions in the room according to personal needs and requirements, positively affects the childbirth experience of nulliparous women 3 and 12 months after they have given birth.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden,Lisa Goldkuhl, MSc, RN, RM, Arvid Wallgrens backe, Box 457, 405 30 Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden,Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, D. R. Congo
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Murray-Davis B, Grenier LN, Plett RA, Mattison CA, Ahmed M, Malott AM, Cameron C, Hutton EK, Darling EK. Making Space for Midwifery in a Hospital: Exploring the Built Birth Environment of Canada’s First Alongside Midwifery Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:189-207. [PMID: 36384318 PMCID: PMC10133785 DOI: 10.1177/19375867221137099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Canada’s first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people’s experiences. Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where “making space” for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.
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Affiliation(s)
- Beth Murray-Davis
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay N. Grenier
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca A. Plett
- Department of Anthropology, McMaster University, McMaster University, Hamilton, Ontario, Canada
| | - Cristina A. Mattison
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Maisha Ahmed
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Anne M. Malott
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Carol Cameron
- Markham Stouffville Alongside Midwifery Unit, McMaster Midwifery Research Center
| | - Eileen K. Hutton
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K. Darling
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Nicoletta S, Eletta N, Cardinali P, Migliorini L. A Broad Study to Develop Maternity Units Design Knowledge Combining Spatial Analysis and Mothers' and Midwives' Perception of the Birth Environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:204-232. [PMID: 36165447 PMCID: PMC9520132 DOI: 10.1177/19375867221098987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This article investigates how the physical birth environment is perceived by the users (women and midwives) in different settings, a midwife-led unit and an obstetric-led unit, placed in Italy. BACKGROUND In the field of birth architecture research, there is a gap in the description of the spatial and physical characteristics of birth environments that impact users' health, specifically for what concerns the perception by women. METHODS The study focuses on multi-centered mixed methods design, employing both quantitative and qualitative research methods (questionnaire, spatial analysis) and covering different disciplines (architecture, environmental psychology, and midwifery). RESULTS The results revealed significant differences between the two settings and some associations between perceived and spatial data concerning: calm atmosphere, greater intimacy, spacious birth room, clarity of service points, clarity in finding midwives, sufficient space for labor, noise, privacy, and the birth room adaptability. CONCLUSIONS The findings confirm the importance of the spatial layout and indicate documented knowledge as an input to consider when designing birth spaces in order to promote user well-being.
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Affiliation(s)
- Setola Nicoletta
- Department of Architecture, TESIS Centre, University of Florence, Italy
| | - Naldi Eletta
- Department of Architecture, TESIS Centre, University of Florence, Italy
| | - Paola Cardinali
- Department of Education Sciences, University of Genoa, Liguria, Italy
| | - Laura Migliorini
- Department of Education Sciences, University of Genoa, Liguria, Italy
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13
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Martens C, Delcourt C, Petermans A. Maternity Healthscapes: Conceptualization and Index Development. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:183-203. [PMID: 35996350 DOI: 10.1177/19375867221117248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This article provides a conceptualization and an index of the multidimensional concept of maternity healthscapes (MHS). BACKGROUND Healthscape has emerged as a potential key aspect to improve patient experience. Surprisingly, there has been little effort to delineate the concept of MHS from a design perspective, while maternity wards have unique characteristics and particular challenges. Indeed, patients in maternity wards are usually not acutely ill but can feel highly vulnerable due to the pain, stress, and the many uncertainties surrounding labor and delivery-which can heighten patients' need for intimacy, supporter comfort, and additional supporting services. Thus, healthscapes need to be designed to account for the specificities of childbearing and needs of those patients and their family. METHODS A multidisciplinary literature review and 39 in-depth interviews were conducted with various stakeholders-mothers, midwives, heads of midwives, and chief executives. RESULTS The authors develop a conceptualization to establish a comprehensive understanding of the dimensionality of MHSs. Based on that comprehensive conceptualization, the authors develop an index providing a census of the aspects in the MHS that various stakeholders-such as healthcare providers, designers, and architects-should take into account when conceiving MHS. CONCLUSIONS Healthcare providers, designers, and architects can use this conceptualization and index to closely monitor and measure for evaluations and further improvements of the MHS, thereby enhancing patient experience in maternity wards.
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Affiliation(s)
- Carmen Martens
- Faculty of Architecture and Arts, Hasselt University, Belgium.,Department of Marketing, HEC Liège, Management School of the University of Liège, Belgium
| | - Cécile Delcourt
- Department of Marketing, HEC Liège, Management School of the University of Liège, Belgium
| | - Ann Petermans
- Faculty of Architecture and Arts, Hasselt University, Belgium
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14
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100731. [PMID: 35500476 DOI: 10.1016/j.srhc.2022.100731] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. METHODS A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. RESULTS A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90-2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71-0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). CONCLUSIONS The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of the Congo, The
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15
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Skogström LB, Vithal E, Wijk H, Lindahl G, Berg M. Women's Experiences of Physical Features in a Specially Designed Birthing Room: A Mixed-Methods Study in Sweden. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:193-205. [PMID: 35293256 PMCID: PMC9254390 DOI: 10.1177/19375867221077097] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aim: To explore women’s experiences of physical features in a birthing room
designed to be adaptable to personal wishes and needs during labor and
birth. Background: Childbirth is a central life event influenced by numerous factors, including
the healthcare environment; however, there is insufficient knowledge on how
the physical design affects women during birth. Methods: This study was part of a randomized controlled trial in the Room4Birth
research project, including women randomized to receive care in a new
birthing room designed with physical features changeable according to
personal wishes. Data consisted of responses to two questions analyzed with
descriptive statistics (n = 202) and semi-structured
interviews analyzed for content (n = 19). Results: A total of 93.6% (n = 189) assessed the physical features in
the birthing room as meaningful to a very high or high extent. The overall
impression of the room was positive and exceeded women’s expectations. They
felt welcomed and strengthened by the room, which shifted the focus to a
more positive emotional state. The room differed from traditional hospital
birthing rooms, contained familiar features that maintained integrity, and
had space for companions. The variety of physical features was appreciated.
Of nine listed physical features, the bathtub was ranked most important,
followed by the projection of nature scenery, and dimmable lighting, but the
room as a whole appeared most important. Conclusions: When planning and designing hospital-based birthing rooms, it is crucial to
offer possibilities to adapt the room and physical features according to
personal wishes.
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Affiliation(s)
- Lisa Björnson Skogström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Vithal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Opiyo N, Bellizzi S, Torloni MR, Souza JP, Betran AP. Association between prelabour caesarean section and perinatal outcomes: analysis of demographic and health surveys from 26 low-income and middle-income countries. BMJ Open 2022; 12:e053049. [PMID: 35039290 PMCID: PMC8765036 DOI: 10.1136/bmjopen-2021-053049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Caesarean section (CS) conducted before labour (prelabour CS (PLCS)), compared with vaginal birth, may pose additional maternal and perinatal risks. No multicountry analysis has examined PLCS in low-income and middle-income countries (LMICs). This study assessed rates, risk factors and associations of PLCS with perinatal outcomes in LMICs. DESIGN Population-based cross-sectional surveys. SETTING Demographic and Health Surveys conducted between 2015 and 2018 in 26 LMICs (13 countries in Africa, 11 in Asia and 2 in the Americas). PARTICIPANTS Women aged 15-49 years with singleton term births. OUTCOME MEASURES Main outcomes were early neonatal mortality, neonatal mortality, early breastfeeding (within 1 hour of birth), skin-to-skin contact and duration of hospital stay. RESULTS 255 227 women were included in the main analysis. Average rates of primary PLCS ranged from 1.3% in Zambia to 19.5% in Maldives. Median PLCS rate was 1.8% in the poorest versus 5.8% in the richest subgroups.Higher maternal age, education, economic status and BMI, lower parity, urban residence, delivery in private hospitals, larger baby size, having health insurance, more antenatal care (ANC) visits, ANC by a doctor and ANC in private hospitals were associated with increased primary PLCS.Across the 26 countries, primary PLCS, compared with vaginal delivery, was associated with increased neonatal mortality (adjusted odds ratio, aOR 1.2, 95% CI 1.0 to 1.5), decreased early breastfeeding (aOR 0.4, 95% CI 0.3 to 0.5) and skin-to-skin contact (aOR 0.4, 95% CI 0.3 to 0.5) and longer hospital stay (aOR 6.6, 95% CI 5.9 to 7.4). No significant association was found for early neonatal mortality (aOR 1.2, 95% CI 0.9 to 1.5). CONCLUSION Primary PLCS, compared with vaginal birth, is associated with adverse perinatal outcomes in singleton term pregnancies in LMICs. Caesarean births should be audited regularly to monitor trends, appropriateness and context-specific drivers of CS.
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Affiliation(s)
- Newton Opiyo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Maria Regina Torloni
- Evidence-Based Healthcare Post-Graduate Program, Department of Medicine, São Paulo Federal University, Sao Paulo, Brazil
| | - Joao Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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17
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Pereda-Goikoetxea B, Huitzi-Egilegor JX, Zubeldia-Etxeberria J, Uranga-Iturrioz MJ, Elorza-Puyadena MI. Hospital Childbirth: Perspectives of Women and Professionals for a Positive Experience-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910238. [PMID: 34639543 PMCID: PMC8507606 DOI: 10.3390/ijerph181910238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
The perception and interpretation of childbirth are changing as values change. This requires women and professionals to adapt to new circumstances. The objective of this study was to analyze the perspectives of women and professionals on hospital birth and to identify improvement areas in order to achieve a positive perinatal experience. A qualitative prospective study with a phenomenological approach was conducted using semi-structured interviews with women, two and eight months after childbirth, participant observation, and professional focus groups. The analysis of the transcribed texts involved a thematic inductive approach. Four improvement areas emerged from the analysis: (a) strengthening communication and the therapeutic relationship; (b) unifying criteria between hospitals and primary care centers to provide coordinated and coherent information; (c) involvement of the partner in the whole process of pregnancy-childbirth-puerperium; (d) improvement of the spaces used in prenatal care and births. The need for a continuity of care from the beginning of pregnancy to the postpartum period is emphasized, which requires an improvement in information, participation, and the promotion of shared decision-making. To this end, coordinated interdisciplinary work, involvement of the partner and the improvement of the spaces used in prenatal care and births are essential.
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18
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Goldkuhl L, Dellenborg L, Berg M, Wijk H, Nilsson C. The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study. Women Birth 2021; 35:e337-e347. [PMID: 34321183 DOI: 10.1016/j.wombi.2021.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/18/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors. AIM To explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward. METHODS Five months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a 'Regular' birthing room (n = 8) or a specially designed, 'New room' (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process. FINDINGS The analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women's agency was facilitated. CONCLUSION Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women's needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women's sense of agency.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lisen Dellenborg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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19
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Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One 2020; 15:e0230992. [PMID: 32722725 PMCID: PMC7386571 DOI: 10.1371/journal.pone.0230992] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
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Affiliation(s)
- Ibone Olza
- Faculty of Medicine, University of Alcalá, Henares, Spain
| | | | | | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, Heerlen, The Netherlands
| | - Stella Villarmea
- Faculty of Philosophy, University of Alcalá, Henares, Spain
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Andria Spyridou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sarah Buckley
- School of Public Health, The University of Queensland, Herston, Qld, Australia
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20
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Nilsson C, Wijk H, Höglund L, Sjöblom H, Hessman E, Berg M. Effects of Birthing Room Design on Maternal and Neonate Outcomes: A Systematic Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:198-214. [PMID: 32077759 PMCID: PMC7364772 DOI: 10.1177/1937586720903689] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Quality Assurance and Patient Safety Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Lina Höglund
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helen Sjöblom
- Biomedical Library, University of Gothenburg, Sweden
| | - Eva Hessman
- Biomedical Library, University of Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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