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Transforming birth rooms to advance normal birth

UTS Professor of Midwifery Maralyn Foureur
Photo: UTS Professor of Midwifery Maralyn Foureur
Birth rooms with projected images on surrounding walls, moving the bed out of the centre of the room, adding baths for water immersion, and including a mantel for the woman to lean on during birth.

These are just some of the ways birth rooms are gradually being redesigned in Australia and overseas in a bid to facilitate normal birth, and drive down medical interventions during labour in hospitals.

Other options for birth rooms range from concealing medical equipment, removing overt surveillance, to adding a private corridor that leads to the birth rooms to guarantee privacy.

Maralyn Foureur, a Professor of Midwifery at the University of Technology Sydney, is a midwifery researcher who has contributed to the design of birth rooms in Wellington, New Zealand, and at the Royal North Shore Hospital, in New South Wales.
Professor Foureur says more hospitals are now beginning to embrace innovative and evidence-based designs that promote a more comfortable, private and safe way for women to give birth.

“We know already from The Birthplace Study in the UK that women are much more likely to have a straightforward normal birth without intervention if they are birthing out of tertiary hospitals, we are repeating a similar study here in Australia, and I imagine we will find similar things,” she says.

“What I suggest from the perspective of my research is that tertiary hospital labour wards are not designed to facilitate straightforward labour and birth, and either we set up more alternative birth centres so that women can birth out of tertiary hospitals or we have to majorly modify what we are designing in terms of hospital ‘labour wards’. Even the language of ‘labour ward’ has to change.

“And it is possible - Royal North Shore Hospital has managed to design radically different birth spaces in a public hospital, so there is absolutely no reason why it can’t happen.”

Professor Foureur says hospital birth spaces, which often resemble modified operating theatres, have a major impact on the way in which women give birth.

“They are frightening spaces and from a neurophysiological level you can actually articulate what happens in terms of the neurohormones of labour,” she says.

“If a woman is particularly fearful in labour…and these environments are fairly frightening on every level…the woman’s brain starts to secrete adrenalin and this interferes with the production of oxytocin, which is the hormone that makes her labour progress towards birth.

“So, her labour slows down or may stop, which is one of the main reasons for intervention in childbirth, once labour has started.

“The other thing that happens if she’s particularly frightened is that blood can be diverted away from the abdomen in the automatic fight, flight or freeze response - and that means that blood is diverted away from the uterus and away from the placenta, and the baby’s oxygenation is interfered with,” she says.

“The second main reason for all intervention in childbirth once labour has started is foetal distress.

“So, there’s a nice plausible, theoretical pathway that suggests when putting women into spaces where they feel unsupported and frightened we may actually cause the very things that require us to intervene in childbirth.”

Professor Foureur says her research shows birth room design also affects the way midwives practice, preventing midwives from providing the kinds of support women need in order to have a normal labour and birth.

“There is hardly anywhere to move the bed out of its most prominent position, the place is so full of equipment there’s hardly room for the woman’s support person to sit down, let alone any space for the midwife to be able to spend time properly supporting the woman in labour, so the spaces we build inhibit good midwifery practice.”

Effective birth unit design should consider every sense modality, ranging from what the woman might perceive through her sense of smell, or what she can hear, and also the visual messages the room communicates - such as the central position of the bed which may suggest to the woman that this is where she should passively position herself.

“In thinking about designing spaces for birthing women, we have to start with the brain in mind - what is it that’s going to send messages of calmness, confidence, trust, and suggests this is a safe place?

“Of course for some women, having emergency equipment on display around the bed makes them feel safe but those women are actually in the minority. For most women, having equipment, such as the neonatal resuscitaire or IV stands and pumps on display actually sends quite frightening messages.”

Professor Foureur is now working with midwives in Denmark studying the stress reducing effect of projecting moving or still nature-based images of different environments, such as a beach or forest, on to the walls of birth rooms. A similar study will soon be conducted at Blacktown Hospital.

Once birth rooms have been redesigned, she says it’s important to up-skill midwives on the potential use of each of the design elements to ensure they are able to assist and educate women on how to maximise the benefits of the birth space.

“For example, in every one of the birth rooms at the Wellington Women’s Hospital in New Zealand and at Royal North Shore there is a mantel piece or a leaning place where women can stand and lean forward, which is the optimal position for helping the baby to rotate into the best position for birth,” she says.

“However, only some of the midwives were part of the design team and understood what they were intended for.”

Professor Foureur encouraged midwives interested in transforming hospital birth rooms into environments more conducive to normal labour and birth to speak up and be included in the design of new or the redevelopment of existing birth rooms.

“It’s not a simple process and it’s not merely decoration - it’s much more profound than that,” she says.

“There is plenty of material now that will provide midwives with information and insights that they can bring to the table, but fundamentally it’s about guaranteeing privacy and getting that bed out of central stage mode,” she says.

“It’s also about offering women, wherever possible, water immersion for labour and birth - it’s not simply for pain relief.

“Immersion in a deep tub of warm water helps a woman to feel safe and secure and private - perceptions that are integral to giving birth in a straightforward way.”


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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords