I put out a call on Twitter today asking what people thought was important about the physical space for birthing. Here are the replies from chaps as well as women:
- birthing pool (this was the most requested thing)
- large cushions
- birthing pool outside (in garden-type environment [my words])
- pleasant light - day light or light that could be dimmed
- sturdy handles to pull on
- floor space that's padded and clean
- low bed
- flexible lighting
- privacy-ability to lock door
- moderate size - space to roam a little, but possibility of snug, cave feeling
Whilst this poll was very far from a credible study, the results echo the findings of more robust research. The National Childbirth Trust (UK) 2003 national survey of nearly 2000 women also found that they wanted:
- comfortable facilities for birth companions
- en suite toilet facilities
- control over temperature
- somewhere nice to walk
- not being overheard
- a room that was non-clinical, that replicated home
- somewhere they could get food and drinks
Before Guy's and St Thomas made changes to their maternity unit in 2003 they consulted with women users. The crux of what the women wanted was:
- that they didn't feel as if they were in hospital
- a comfortable environment
- a colorful environment
- a room with a view
- for all the medical equipment to be out of view
- paintings on the wall
- soft lighting
Effect of what women have got
In the research recently published by Andrew Symon et al (2008a; 2008b) 559 women who had recently had babies were surveyed about their experiences of maternity units in the UK. The women were more satisfied with their birthing experiences if the maternity unit was spacious and tidy. There were mixed responses about the desirability of a communal area, but women definitely wanted their own space in labour. Noise was a problem for many women, and a number of women were dissatisfied because they could not control lighting or ventilation.
Environment and quality of midwifery care
Two issues cropped up that particularly interested me in this research. The first element is the perception of the environment was tied up with the midwifery care the women received. In other words, it's no good having a nice, large room if the midwife insists on making the woman stay on the bed throughout her labour. The woman receives no benefit from the spaciousness of the birthing room in that situation. Conversely, the room can be small and cramped but if the woman receives excellent care, she is less likely to be dissatisfied with the environment.
Who controls the environment?
The other interesting issue was control over the environment. 227 midwives were asked about the environment of the maternity unit (Symon et al, 2008b). Over one quarter of these midwives felt that women should NOT have control over their environmental comfort ie they should not be able to control room temperature or air flow. The justification for this was their concern that the mothers would not be able to control the environment to meet the needs of the new born baby. Yet I bet you these midwives would say that they would want the women to feel 'at home' because of the implication that this helps women to labour well (Lepori, Foureur & Hastie, 2008). But do you not have control over your environment at home?
Midwives and the birthing environment
I would suggest that when designing our virtual birth unit it is just as important to consider attitudes of midwives and the impact midwifery practice has on the environment, as it is to think about what women's needs. How will the virtual birthing unit educate midwives about the birthing environment? How can it be used to encourage midwives to reflect on their own practice?
What is your story?
I would love to hear your story. How did the environment affect your birth or that of your wife/sister/friend? What would be the features of your perfect birthing unit - would environmental things would you want to see included in our Second Life birthing unit? How important is lighting, temperature control, or a nice garden to walk in? What is more important? A nice garden or a nice midwife? If you are or have been a support person, what was important to you with regards to the environment?
Design Council. (2008). Guy’s and St Thomas’ hospital. Designing a welcome sanctuary for mothers to be. Retrieved 8 January, 2009, from http://www.designcouncil.org.uk/en/Case-Studies/All-Case-Studies/Guys--St-Thomas-hospital
Lepori, B., Foureur, M., & Hastie, C. (2008). Mindbodyspirit architecture: creating birth space. In K. Fahy, M. Foureur & C. Hastie (Eds.), Birth territory and midwifery guardianship (pp 95-112). Edinburgh: Elsevier.
Newburn, M. & Singh, D. (2003). Creating a Better Birth Environment: Women’s views about the design and facilities in maternity units: a national survey. London: NCT. Retrieved 8 January, 2009, from http://www.nct.org.uk/about-us/what-we-do/campaigning/better-birth-environment
Symon, A., Paul, J., Butchart, M., Carr, V., & Dugard, P. (2008a). Maternity unit design study part 2: perceptions of space and layout. British Journal of Midwifery, 16, 2, 110-114.
Symon, A., Paul, J., Butchart, M., Carr, V., & Dugard, P. (2008b). Maternity unit design study part 3:environmental comfort and control. British Journal of Midwifery,16, 3, 167-171.