Thursday, January 8, 2009

What women want in the place where they give birth

Before we go ahead and design our virtual birth unit, it is only right and proper that we take a breath and find out more about what women (and their families) want in the place where they give birth.

Twitter Poll
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
What women want
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
The experience of Guy's and St Thomas' Hospital
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
Image: 'LDR Stuff' Alice Chaos

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

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

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.


Francesca said...

Ed Webb put me on to you -- interestingly, I was just emailing my cousin about to give birth in NYC about these sorts of things. Her comment was this:

"The best thing for you and the baby is x, and the hospital does
y. So all this time spent doing yoga and thinking good thoughts and
trying to be zen about it all is pretty much wasted."

It makes me very very sad. I think much of labor is an internal process (to the point where I described later as Laborland, a place you move to inside your head). Feeling safe enough to surrender to Laborland and to trust that your team will do what you need/want them to without you having to communicate with them in linear speech -- that is the thing and the whole of the thing.

Environment seems most important to me in the early stages of labor (a place to walk, a ball to throw yourself over, something to look at out the window, whatever) and afterwards, when you're sitting with your baby for the very first time -- and the nest you're in at that moment holds you safely and tells you it's all right now, that there is love within and without.

I've given birth in the UK and in the US (once each place), both times through a midwifery practice (in the US, harder and more controversial). A brilliant midwife first time round did not "save" me from being transferred to hospital. A decidedly inferior midwife second time was made almost irrelevant by a brilliant doula.

Both times were lovely rooms with birth pools (one ensuite, one down the hall), a bedroom like feeling and an ensuite toilet/shower. There was a rocking chair in both rooms, I seem to remember. A large, welcoming looking bed. Daylight. Dimmable lighting. No one entering without knocking. A microwave was in one room (I think in the US) to reheat the ricepack which was being held to my back (ooh lovely). A staircase nearby is a boon, not that I was cheerful about them, but they moved labor on.

Mostly I remember the sense of privacy, the light, the bed, the bathroom, the lack of medical devices going ping! The hospital experience in the UK was helped by having spent most of my labor in the birthing room next door -- and they let me hide on the far side of the bed. Ooh, so the bed in relation to the door so that the bed blocks the door and makes a mini cave on the far side.

This is probably all things you have heard a hundred times but I appreciate the space to rant. I am just feeling worried about my cousin who would like not to have pitocin automatically when she has her Strep B antibiotics, or stirrups, or be strapped without being asked to a monitoring device, or to have the baby taken away without a by-your-leave, all of which seems very likely.

Hey ho. Perhaps time to resurrect my plans to become a doula.

Sarah Stewart said...

Thank you very much for your comment, Francesca. Yes, I have heard this before but it is vital that we (women and families) keep saying these things because they are so important, but sadly still keep getting ignored.

I am also keen to see your story documented here because it is evidence I can use to justify why I have chosen such and such feature in the virtual unit.

We have a very different system here in New Zealand so I hope we don't 'need' doulas in the same way they are needed in the USA. I send your cousin best wishes - she will need to be strong and have support who can be strong for her. May I suggest you contact @hbacmama and @savvydoula on Twitter - they are both doulas.

Anonymous said...

I've been avoiding commenting on this. Because IF it were me trying to get in to a birthing centre.
I'd be turned away before I even stepped foot in it.
vbacs not allowed.
Our frozen city is trying to build one. Some women who would need it the most, not comfortable going back to a hospital and not sure about home yet either, will not be 'allowed' to use it.
I stopped going to the planning meetings. It was too depressing.
Women in my city who are allowed a 'trial of labour',F*^#* hate that term... sorry for the profanity, take note! We Canadians are not supposed to show that side of our language skills! Anyway, vbac women are shoved in the 'high risk' unit. The rooms are about six feet width, maybe 14 feet long? The door has a window in it, AT THE END OF THE BED. The machines are along the bed. They basically hem you in to the bed with all the lines and such that are 'mandatory'. I DESPISED every single moment I've had to spend in one of those rooms with a client. They might as well handcuff her to the bed, like they do some inmates who are giving birth. It has the same feel about it.
I'm ranting!
I'm sorry.
I'll go get a cup of cider and try to be better later.
My one suggestion after reading your responses...
Add in a stuffed pony in the corner for the 'stirrups' requirement.

Francesca, I take it from the tone of your correspondence with your cousin, she does not have midwifery care for this birth.
pity, some AWESOME midwives there. The gal from Belly Tales I'd trust with my LIFE, even if she works in a hospital setting! LOVE HER.

Sarah Stewart said...

Thanks hbacmama. Again, you've brought up the issue about birth not just being about environment but also the way women are treated within that environment. Look forward to hearing your feedback as this project ensues.

Anonymous said...

Hi Sarah,

I passed along your post to my wife, Lisa, and encouraged her to post her thoughts as well, however she's still acclimating to the notion of blogs and public commenting - as opposed to relatively private groups. - and has asked me to pass it along myself.

Here are her thoughts:


"Ok well as you know we birthed here [at home for both children] :) As it was we didn't end up using much cause it was fast and to the point.

A birth pool - most important. nice and deep. I personally think sunken would be lovely as its easier for a woman in hard labour to get into - lifting your leg over the edge of a pool to get in or out is quite hard. And it should have enough room all around it so your midwife can get into position where ever instead of asking the birthing mother to be in a certain direction etc.

Just as important - relaxed cozy environment with nice lighting (I just had candles). A place to set up their birthing alter would be nice - ie blessing way candles and beads, etc. Be allowed to use aromatherapy if desired (can't do this at Nepean!). Nothing medical looking in center stage.

A very comfy area for the first nurse [breastfeed] bonding session after birth - lots of big pillows and bean bags on the floor all piled up is what we did. This could be used to lie on for massage in early labour, to lie back on with baby (and other family members) for the bonding session after, etc.

I personally think this should look as inviting and beautiful as possible - your not likely to be on it hard labour (well I wouldn't be :)) but early and after it would be used and should be inviting and nuturing.

Access do an outside area of nature - maybe a courtyard garden. I wanted to see nature as I birthed so our big windows overlooking all the trees was great. I wanted it private but I also wanted the option to go for a walk in nature if desired - so the courtyard with a door leading out to a larger garden path would be ideal.

The sound of running water (small water feature) and the ability to place music - that was important cause I had all my hypnobirthing tapes [A series of meditation and relaxation exercises - Hypnobabies was the company].

A bar fridge if it wasn't in your own home - so you could bring whatever you wanted for fluids and or ice, etc. Oh and a way to heat up wet towels (we used a rice cooker) - you can't beat those hot towels!

A space for the family members to be if they were bored of being in the immediate birthing space. - I'm thinking siblings here :)


Hope her response is of some use. Perhaps next time I'll help her gain enough confidence to post the comment herself!



Sarah Stewart said...

Can you thank your wife for me, Mike. She has described exactly what I would want my birth unit to look like. Tell her to look at my post: Concepts of birth unit design - she's practically described what Bianca has said, word for word.

Warn her now (so she has time to get used to the idea) that I'll get her to come and have a look at the unit when its built in SL :)

Thank you.

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