‘Child birth… oh no…what??.. .She’s about to tell us her personal birthing story?’ Before you close your eyes, put your fingers in yours ears and go “la, la, la,”, I’m not going to start the commentary with a personal birthing story, but with statistics (much more exciting). In 2016, 306,000 babies were born in Australia, if you double that to include support partners, approximately 600,000 people experienced being in a birthing room of some form, do a few more calculations taking into consideration past and future generations, this is a lot of people. The environment in which this significant life changing event takes place should be well designed to promote a positive experience of all involved.
The objective is the delivery of a healthy baby, but as in recent guidelines published by the World Health Organisation,(2018) they also recognise that an optimal outcome for women is to have a ‘positive birth experience’. This is a positive experience which is both clinically and psychological safe whereby the woman is in control of the decision making, ‘even when medical interventions are needed or wanted’. (1).
The birth experience and birthing outcomes (birthing outcomes being the scale of medical intervention from natural through to cesarean) has been linked to the degree of stress a woman experiences during labour and the effectiveness of the communication between the labouring woman and health providers. A stress response whereby hormones are released during labour and birth is a natural and essential process, however a stress response increased beyond what is needed can cause adverse effects. Buckley (2015) outlines how excessive stress, for example due to fear, can cause alterations to the hormonal response and thereby cause implications to mother and unborn child. Adverse levels of stress can slow or stall labour, which may lead to low oxygen levels in the unborn baby, both of which lead to medical intervention. (2) Apart from the clinical outcomes, negative experiences can affect a new mother’s postpartum mood, and expectations in subsequent pregnancies.
There are many external mediating factors at play during labour all of which play a role, each potentially affecting the birthing outcome. Foureur and others (2010) developed the safe, satisfying birth conceptual model, in attempt to visualise the complex interconnected components affecting birth (Fig 1)(3)
Fig. 1. A conceptual model describing the relationship between safe, satisfying birth (SSB) women’s stress and communication with women, staff stress, and communication with staff, mediated by birth unit design and model of care. (2)
Figure 1 above shows a safe satisfying birth can be influenced by the birth unit design and the model of care. This is where architects can be involved in designing out stress in environments and be advocates for birthing women. It can be achieved through understanding, what and why different elements are considered stress triggers and potential consequences increased stress causes. If architects are involved in the design of a health care facility which includes a birthing unit, the minimum requirement to keep in mind, birth is a natural process, is about mother and child and not an illness therefore the environment should reflect this.
Stenglins (2013) research explores the phycho-emotional needs of women during birth, suggesting the natural instinct of birthing women and animals is to seek a safe, secure, private and quiet environment. The design of a space can support these needs.
Access: Uncertainty is experienced by all pregnant woman to some degree. Increased uncertainty can trigger an anxiety stress response, affecting the perceived level of control and decision making, reducing uncertainty related stress can start at the entrance to a birthing unit / hospital through providing easily accessible entrances and direct wayfinding to the unit.
Safe: Design elements which have been associated with positive birthing experiences are non-institutionalised homely spaces, free of medical equipment, i.e. gas outlets, emergency trolleys, monitors, and even beds, all can be concealed behind walls or in cupboards. Similar to when you are on a plane, the oxygen masks and life jackets are concealed, you know they are there in an emergency, but you don’t need them in your view during the flight as a constant reminder of what could go wrong.
Privacy: The creation of a sense of privacy includes creating a space which cannot be opened onto from a corridor or an outside communal space and access to a private ensuite and bath.
Quiet: Sound proofed rooms are important for a variety of reasons as women do not want to hear other women give birth, nor do they want to be inhibited in fear of them being heard. A quiet environment is also preferred at different stages of labour to be able to focus inward and it promotes effective communication between the mother and staff and between staff.
Canada.
To many these design considerations may seem obvious, however even after all the guidelines, and policies promoting a positive birth experience and numerous research papers into the impact the environment has on women physically and emotionally some new birthing rooms, particularly in hospitals, continue to be built and fitted out in an medical and institutionalised manner, where the only differentiator between a birthing room and a ward for sick people is the different hue of beige on the walls. I am hoping its budgets and a functional brief that dominates these design outcomes.
Spaces can be manipulated to make us feel safe, and secure and can play a role in a woman having a safe and satisfying birth. Fortunately it appears that most birthing units are now focusing on providing an environment which recognises and respond to the needs of the birthing woman and child and not to the machines that go pinggg!
References
1 WHO, WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World
Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. (p7)
2 Dr Sarah Buckley (2015) Fact Sheet: Low-Stress Birthing Environments.
3 Maralyn Foureur, Deborah Davis, Jennifer Fenwick, Nicky Leap, Rick Iedema, Ian Forbes, Caroline S.E. Homer. (2010). “The relationship between birth unit design and safe, satisfying birth:Developing a hypothetical model’.Midwifery 26, 520–525. https://doi.org/10.1016/j.midw.2010.05.015
4. Maree Stenglin & Maralyn Foureur, (2013). “Designing out the Fear Cascade to increase the likelihood of normal birth.” Midwifery 29 (2013) 819–825. DOI: https://doi.org/10.1016/j.midw.2013.04.005 Accsessed 25/4/18
Images
1. Fig 1.Maralyn Foureur, Deborah Davis, Jennifer Fenwick, Nicky Leap, Rick Iedema, Ian Forbes, Caroline S.E. Homer. (2010). “The relationship between birth unit design and safe, satisfying birth:Developing a hypothetical model’.Midwifery 26, 520–525. https://doi.org/10.1016/j.midw.2010.05.015
2. Friend of birth centres, Canberra http://fbccanberra.org.au/
3. Queen Mary Hospital, Hong Kong.
4. Governemnt hospital HOng Kong
5. Toronto Borth Centre http://www.torontobirthcentre.ca/planning-to-give-birth-at-the-tbc-considerations/
6. Birth suite, Newcastle Hopsitals Trust, UK. Bowker Sadler Architecture. http://www.bowker-sadler.co.uk/projects.aspx?category=15&project=43
4. Fiona Stanely Hospital.
5. Monty Python, “Meaning of life” YouTube video screen shot, 3:31min, June 21.2006, https://www.youtube.com/watch?v=arCITMfxvEc
6. Townsville Birth Centre, https://www.health.qld.gov.au/townsville/tour_baby/birth-centre