Australian hospitals aim to reduce the number of medical interventions by improving the environment in which women give birth.
Hospitals around the country are moving away from stark, clinical birth rooms.
Improving Birth Room Design – The Pros And Cons
They are redesigning their birth suites, adding baths, and home-like décor, and moving medical equipment into cupboards.
On the surface, this innovation would seem to deserve praise for aiming to reduce unnecessary interventions. But is it all as it should be?
How Does Environment Affect Birth?
The large majority of Australian women will give birth in a hospital, and very few will achieve a normal physiological birth without any intervention.
Many people would assume that’s because birth is a very dangerous event, and most women and babies need some type of assistance to get through it alive and healthy.
But that isn’t the case. Home births and birth centre births achieve very high rates of normal births, without any assistance.
One of the biggest impacts on birth is what occurs when a certain part of the brain is stimulated. Birth is governed by a complex hormonal system, which requires the mammal or primitive part of the brain to remain in control.
The neocortex is stimulated by a range of environmental factors, such as noise, bright lights, and unfamiliar people and places, which are perceived as hostile or frightening.
This sets off a ‘fight or flight’ response, where a woman’s body will begin to produce stress hormones. These hormones interfere with the normal production of oxytocin.
Oxytocin promotes efficient and regular contractions of the uterus. As labour progresses normally, more oxytocin is produced, increasing the speed and tempo of contractions.
In order to produce oxytocin in ever increasing amounts, a labouring mother needs to feel safe, supported, unobserved, and comfortable (dim lights, low noise).
Once the stress response has been triggered, adrenaline levels begin to rise. Adrenaline inhibits the release of oxytocin, and slows down contractions and labour. This is an important evolutionary protective mechanism, which allows birthing mothers to move away from danger before giving birth.
Human beings no longer give birth in the wild, where they are at risk of being attacked by predators, but the response is still very much in place. This is apparent in hospitals, where birthing women are stuck in an environment that is not conducive to normal labour, and end up having multiple interventions as a result.
You can read more about Undisturbed Labour – What Is It And Why Aim For One? here.
Can A Hospital Provoke Stress Response?
Historically, hospitals were designed to improve the use of interventions during labour and birth.
With the advent of maternity hospitals, medical assistance during birth was often necessary, thanks to practices such as Twilight Sleep, the routine use of episiotomies and forceps, and when babies were born in distress.
Women might no longer be subjected to some of the more barbaric practices of the past, but society’s attitude toward birth hasn’t changed a great deal. Birth is rarely viewed as woman-centred; rather it is seen as a medical emergency waiting to happen. Care providers are trained to think of safety first on a large scale, rather than to individualise the care they give to each woman.
The reasons women choose to give birth in hospital vary. It might be simply because ‘that’s where everyone goes’, or perhaps because women are conditioned to think hospital is the safest place to be.
Yet hospitals can often provoke the very responses that women want to avoid, which are fear, and stress. The environment is unfamiliar, and can be busy, bright, and noisy.
Birth suites are often quite sterile and clinical looking, giving women the feeling they lack control over what they can choose to do.
Hospital policies might mean women are unable to use comfort techniques, such as labouring in water, or in upright positions, or they must have certain routine procedures that interfere with labour progress.
Hospital staff might be unable to meet a woman’s personal needs, also because of hospital policies; this can lead women to feel unsupported and isolated.
The Pros And Cons
Evidence from The Birthplace Study, in the UK, clearly demonstrates what many women and midwives already know: environment has a strong influence on birth outcomes.
The study highlights that women are more likely to have a normal birth, without intervention, if they are birthing in midwifery-led models of care instead of obstetric hospitals.
Another study in the UK looked at the effect of colour and design in birth suites, and found that hiding medical equipment from view shortened the length of labour by two hours, and reduced requests for epidural pain relief by 7%.
Midwifery-led models of care are generally provided in settings such as birth centres, which traditionally emulate a more homelike environment, including less visible medical equipment, and baths for water immersion. They utilise colour and sound in ways that make the environment less threatening.
Women who choose to have home births often do so because they are keen to be in their own space, with familiar rooms and objects to help them cope during labour.
Because so many women choose to give birth in hospitals, improving the environment they are labouring in would seem to have many benefits, including:
- Reducing interventions and c-section births
- Lowering risk of trauma
- Normalising birth as a physiological process, not a medical event
- Reducing maternal requests for pain relief
- Improving outcomes
- Reducing costs for hospital.
However, there are certain factors that need to be in place for these benefits to be achieved. Care is still being provided within a hospital framework, and simply improving the visual aspects of a birth suite might not be enough.
Women might still be subjected to procedures that interfere with normal labour progress, such as routine vaginal examinations or continual fetal monitoring. They might not know any of the staff present, and could feel unsupported in their birth preferences.
These factors have just as much impact on a woman’s labour progression as the design of her birth room. A woman who gives birth at home, or in midwifery-led models of care, will choose the care provider she feels most comfortable with – someone who provides one to one support during pregnancy and labour.
This encourages a rapport and relationship which allow her to trust in birth as a normal process, and know her midwife is able to provide individualised care, depending on her needs.
What Does This Mean For Women?
When hospitals work towards lowering unnecessary interventions, by redesigning birth suites, they are heading in the right direction. However, there is still a lack of acknowledgement that the care provided in maternity hospitals is not equal to that provided in midwifery-led models of care.
With increasing restrictions on home birth in Australia, and increasing numbers of state-led public home birth programs, women’s choices for birth are being directed towards the hospital model of care.
If hospitals seek to emulate the environmental features of a midwifery-led model of care, without addressing the philosophical aspect, this could be to the detriment of birthing women everywhere – particularly if there are few choices for midwifery-led models of care available.