Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial

Healing Architecture in Birthing Rooms: A Scoping Review

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.

Influence of the Physical Environment on Maternal Care for Culturally Diverse Women: A Narrative Review

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.

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives' experiences

INTRODUCTION

Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives' provision of waterbirth at a university birthing clinic in Sweden.

METHODS

A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis.

RESULTS

The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines.

CONCLUSIONS

The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women's choices to facilitate an empowering birth experience.

Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review

PROBLEM

Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally.

BACKGROUND

There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously.

AIM

To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy.

METHODS

Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded.

FINDINGS

Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal.

DISCUSSION

Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research.

CONCLUSION

Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.

Implementing a new birthing room design: a qualitative study with a care provider perspective

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.

Influence of the birthing room design on midwives' job satisfaction - A cross-sectional online survey embedded in the 'Be-Up' study

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.

Effect of alternatively designed hospital birthing rooms on the rate of vaginal births: Multicentre randomised controlled trial Be-Up

BACKGROUND

There is limited research into the effects of the birth environment on birth outcomes.

AIM

To investigate the effect of a hospital birthing room designed to encourage mobility, self-determination and uptake of upright maternal positions in labour on the rate of vaginal births.

METHODS

The multicentre randomised controlled trial Be-Up, conducted from April 2018 to May 2021 in 22 hospitals in Germany, included 3719 pregnant women with a singleton pregnancy in cephalic position at term. In the intervention birthing room, the bed was removed or covered in a corner of the room and materials were provided to promote upright maternal positions, physical mobility and self-determination. No changes were made in the control birthing room. The primary outcome was probability of vaginal births; secondary outcomes were episiotomy, perineal tears degree 3 and 4, epidural anaesthesia, "critical outcome of newborns at term", and maternal self-determination (LAS).

ANALYSIS

intention-to-treat.

FINDINGS

The rate of vaginal births was 89.1 % (95 % CI 87.5-90.4%; n = 1836) in the intervention group and 88.5 % (95 % CI 87.0-89.9 %; n = 1863) in the control group. The risk difference in the probability of vaginal birth was + 0.54 % (95 % CI - 1.49 % to 2.57 %), the odds ratio was 1.06 (95 % CI 0.86-1.30). Neither the secondary endpoints nor serious adverse events showed significant differences. Regardless of group assignment, there was a significant association between upright maternal body position and maternal self-determination.

CONCLUSION

The increased vaginal birth rates in both comparison groups can be explained by the high motivation of the women and the staff.

The Birth Companions' Experience of the Birthing Room and How It Influences the Supportive Role: A Qualitative Study

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.

Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial

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.