Factsheet – Creating a positive birth space environment
Bruna Dias Alonso
Independent Midwife, Lecture and Researcher based in São Paulo city (Brazil). BSc, MSc, and PhD
This factsheet is about birth space environment, where settings should support physiological labour and birth universally for all childbearing women. Beyond giving birth at home (i.e. planned home birth), there are a variety of institutional maternity care settings that may offer care during labour in hospitals – such as: alongside midwifery units and obstetric units or freestanding birth units. In these institutional maternity care settings, there are many different types of spaces; bedroom-like rooms, ambient rooms and Snoezelen rooms (multi-sensory environments). In general, the idea is creating a positive birth environment, considering women’s needs and exploring multiple sensory stimulations that are shown to be helpful during labour and birth. This article provides you with information about the benefits of a positive birth space environment and how this relates to your birth experience.
What we know
All women are offered options to birth either at home or in a variety of institutional maternity care settings like; freestanding midwifery units, alongside midwifery units, or obstetric units.1
Freestanding midwifery units are on a separate site from a hospital, in an independent building or on the site of a community hospital – where transfers occur, where necessary by car or ambulance. In freestanding midwifery units, the care is led by midwives.
Alongside midwifery units are within a hospital – close to labour ward or delivery suite – or may be on the same site in a different building – in this case, transfers could occur by walking, wheelchair, or bed. In alongside midwifery units, the care is led by midwives.
Obstetric units are always situated in hospitals, where is available obstetric, neonatal, and anaesthetic care. Midwives provide care to all women, and obstetricians oversee the care of women with complex needs (i.e. women with health problems or less straightforward pregnancies) and those who develop complications during labour, birth or postpartum.
Regardless of the institutional maternity care setting, research indicates that the environment in which a woman gives birth has a positive influence on labour onset and physiological birth. It known that a calm, private and safe ambience assists in normal neuro-hormonal functioning, it supports the physiology of labour and birth.2 When we think of a physiological labour and birth, we refer to a labour that starts spontaneously and ends in a vaginal non-instrumental birth, where mother and baby are healthy.
In addition, women are more likely to have a positive experience.3,4 Studies agree that a familiar environment reflects fewer medical interventions during labour and birth, and greater maternal satisfaction with care.1,5,6,7
But how do maternity organisations deal with this kind of evidence? In other words, how do conventional hospitals – sometimes having an impersonal atmosphere – try to transform them into more welcoming environments?
Birth environment should be adaptable enough to meet the unique needs of women, including different social-cultural requirements.7 Different types of spaces, bedroom-like rooms, ambient rooms or Snoezelen rooms6may use multiple sensory stimulations, including vision, touch, sound, and aromas that also could be helpful during labor and birth. Creating a positive birthplace involves, in terms of the physical environment: comfortable furniture (especially the bed); shower and ensuite toilet; access to water immersion (birthing pool); space to move around; ability to control the lighting, heating, noise, clean rooms and privacy.7
A review that included nine studies and 10,684 women showed that alternative settings for birth (i.e. bedroom-like rooms and ambient rooms) represented an increased the likelihood of: no intrapartum analgesia or anaesthesia, spontaneous vaginal birth, breastfeeding at six to eight weeks and women’s positive view of care.6 It also found a decreased the likelihood of epidural analgesia, oxytocin augmentation of labour and episiotomy in these settings. There was no apparent effect on serious perinatal or maternal morbidity and mortality when alternative institutional settings for birth was compared to conventional hospital settings.6
We also know that alternative settings for birth, places a focus on midwifery-led continuity of care8 and continuous support9 which are all favoured and crucial factors that make-up the positive birth space environment according to women.3,4,7
What we don’t know
A recent study protocol for a randomised controlled trial will be investigating how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs.10 The participants will either receive care in a regular room or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes. This study will report on mother baby outcomes and women’s experience. Other authors have identified a lack of research about women’s experiences of choosing where to give birth in localities where alongside midwifery units and freestanding midwifery units are provided.11
Mothers and families: how to use the evidence
- A calm, private and safe ambience will support you during labour and birth, contributing with better outcomes for you and your baby,2,6 including positive birth experience3,4
- Birthplaces that allow you to be accompanied also contribute to better outcomes9
- If you are a healthy woman with a straightforward pregnancy, birth at an alongside midwifery unit or freestanding midwifery unit is as safe as obstetric units in hospitals1
- It may be helpful to ask other women about their experiences of birth in alternative settings
- Ask your midwife or obstetrician about the options available to you
- Research all the available options in terms of birthplace
Midwives and birth workers: how to use the evidence
- Ensure policies support women’s choice of birthplace
- Ensure policies support non-obstetric units (i.e. alongside midwifery units and freestanding midwifery units), as these settings result positive mother and neonatal outcomes,1,12 and the costs of care are also lower13
- Healthcare practitioners should routinely provide all women full information about birthplace at an opportune time, i.e. ensuring that women have the opportunity to discuss options, benefits, and concerns.14,11
- Healthcare providers should support women’s choice11
- Maternity care settings should provide physical environments that support hormonal physiology, creating a positive birth space environment through, comfortable furniture (especially the bed); shower and ensuite toilet; access to water immersion (birthing pool), space to move around, lighting control, heating control, noise, clean rooms and privacy7
Links to other resources
Ingleside Birth and Community Centre
NICE – Information for the public – Care of women and their babies during labour and birth
Queensland Mother and Babies -Birthspace: An evidence-based guide to birth environment design
NHS Birthplace decisions – Birthplace and you
Towards Salutogenetic Birth Space By Zalka Drglin
National Childbirth Trust – Creating a Better Birth Environment – Women’s views about the design and facilities in maternity units: a national survey
AIMS – Birth Space, Safe Place: environment, people and attitudes to pain during labour
- NICE. Intrapartum care: care of healthy women and their babies during childbirth. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg109. Published 2014. Accessed May 12, 2020.
- Buckley, Sarah J. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women & Families, January 2015.
- Pereda-Goikoetxea, B, Marín-Fernández B, Liceaga-Otazu NE et al. A qualitative study of hospital birth perceptions: The helix of priority needs. Midwifery. https://doi.org/10.1016/j.midw.2019.03.018
- Downe S, Finlayson K, Oladapo O, Bonet M, Gülmezoglu AM. What matters to women during childbirth: A systematic qualitative review. PLoS ONE. https://doi.org/10.1371/journal.pone.0194906
- Schneck CA, Riesco MLG, Bonadio IC, Diniz CSG, Oliveira, SMJV. Maternal and neonatal outcomes at an alongside birth center and at a hospital. Rev Saúde Pública. https://doi.org/10.1590/S0034-89102012000100010
- Hodnett_ED, Downe_S, Walsh_D, Weston_J. Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews. 2010. doi: 10.1002/14651858.CD000012.pub3.
- Newburn M, Singh D. Creating a Better Birth Environment Women’s views about the design and facilities in maternity units: a national survey. The National Childbirth Trust 2003.
- Sandall_J, Soltani_H, Gates_S, Shennan_A, Devane_D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews. 2016. doi: 10.1002/14651858.CD004667.pub5.
- Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 2017. doi: 10.1002/14651858.CD003766.pub6.
- Berg M, Goldkuhl L, Nilsson C et al. Room4Birth – the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden. BMC. https://doi.org/10.1186/s13063-019-3765-x
- Coxon K, Chisholm A, Malouf R et al. What influences birth place preferences, choices and decision making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a ‘best fit’ framework approach. BMC Pregnancy and Childbirth (2017) 17:103 doi 10.1186/s12884-017-1279-7
- Hollowell J, Rowe R, Townend J, et al. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. Health Serv Deliv Res doi 10.3310/hsdr03360
- Schroeder E, Petrou S, Patel N et al. Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ2012;344:e2292 doi:10.1136/bmj.e2292
- Hinton et al. Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups. BMC Pregnancy and Childbirth (2018) 18:12 doi10.1186/s12884-017-1601-4