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Your  Birth  Space:    How  to  plan,  negotiate  and  create  an  optimal  birth  environment  

This   information  sheet  explains  how  the  physical  environment  can  affect  your  birth  experience.  Many  women  get  to  see  the  type  of  room  they  will  have  their  baby  in  before  labour.  You  may  wish  to  pay  special  attention  to  some  of  the  features  in  the  room  and  ask  your  care  providers  questions  about  these  features.  You  can  also  plan  ways  to  adjust  the  physical  environment  to  meet  your  needs  during  your  labour  and  birth.      

Not   everyone   wants   or   can   achieve   a   birth  without   any   medical   intervention,   but  whatever   kind   of   birth   you   are   planning   or  hoping   for,   you  probably   hope   that   it  will   be  safe  and  satisfying.  Feeling  safe  is  a  major  part  of   achieving   a   safe,   satisfying   birth.   This   is  because   the   hormones   that   help   you   labour  and  birth  your  baby  work  best  when  you  feel  safe  and  relaxed.  There  are  lots  of  things  that  might   contribute   to   you   feeling   safe   and  relaxed.   This   information   sheet   focusses   on  the   physical   environment   that   can   help   you  achieve  this.      

Most   Australian   women   give   birth   in  hospitals,   where   the   birth   rooms   are   much  like  the  other  parts  of  the  hospital  designed  to  provide  care  during  times  of  sickness.  Women  who  gave  birth  in  more  home-­‐like  birth  rooms  (such  as  birth  centres)  are:7  

• Less   likely   to   use   pain   relief   medications  during  their  labour.  

• Less   likely   to   have   a   hormone   drip   to  speed  up  their  labour.  

• Less  likely  to  have  an  instrumental  vaginal  birth.  

• Less  likely  to  have  an  episiotomy.  

 

• More  likely  to  have  a  spontaneous  vaginal  birth.  

• More  likely  to  be  breastfeeding  their  baby  at  six-­‐to-­‐eight  weeks  after  birth.    

• More   likely   to   have   very   positive   views  about  the  care  they  received.    

Regardless   of   where   you   give   birth   to   your  baby,  the  physical  space  will  have  aspects  that  you  can  use  to  help  you  feel  safe  and  relaxed  during  your  labour  and  birth.  You  may  also  be  able   to   change   aspects   of   the   room   or   bring  some   items   from   home   in   order   to   help   you  feel  safe  and  relaxed.    

It   is   normal   to   feel   a   little   anxious   during  labour,  especially  when  you  arrive  in  the  new  and   unfamiliar   environment   of   the   hospital,  so   much   so   that   many   women   experience   a  slowing   or   even   stopping   of   their   labour   at  this   time.8   This   is   due   to   the   release   of  adrenaline,   a   stress   hormone   that   works  against   oxytocin,   the   naturally   occurring  hormone   which   makes   labour   and   birth  happen.   As   frustrating   as   this   might   be,  feeling   safe   and   relaxed   in   the   birth  environment   will   reduce   the   release   of  adrenaline,  which  in  turn  increase  the  release  of  oxytocin,  and  allows  the  labour  to  resume.  

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This  information  sheet  explains  the  evidence  about  how  the  physical  environment  can  help  women  to  feel  safe  and  relaxed  during  labour  and  birth,  particularly  in  terms  of:  

• Privacy  • Space  and  furniture  • Use  of  water    • Light  

 

• Noise  • Nature  • Personal  items  • Provisions  for  support  people  • Cultural  considerations.  

A  more  comprehensive  guide,  entitled  BirthSpace:  An  evidence-­‐based  guide  to  birth  environment  design   is  also  available  from  www.qcmb.org.au/birthspace    

 Privacy  Feeling   observed   during   labour   can   interfere  with   the   hormonal  mix  which   powers   labour  and   birth,   making   labour   last   longer   and  increasing   women’s   experience   of   pain.   A  sense  of  privacy  is  therefore  important.9    

Birthing  women   report   the   greatest   sense   of  privacy  when:10-­‐13    

• Doors  do  not  open  directly  into  the  room,  but  onto  a  screened  entry  or  curtain.  

 • There   are   no   interior   windows   (windows  

between  the  birth  room  and  neighbouring  spaces).  

• External   windows   allow   natural   light   to  come  in,  but  which  you  can’t  see  through  from  the  outside.    

• The  birth  room  is  spacious.  • The   birth   room   has   a   private   ensuite  

toilet.  

 

In  a  birth  room,  you  might  consider:  • When  the  door  is  open,  is  there  a  curtain  or  screen  that  protects  privacy  within?    • Are  there  internal  windows  between  the  birth  room  and  neighbouring  areas?    • Do  all  windows  have  curtains  or  blinds  for  privacy?  • Are  the  birth  rooms  spacious  enough  to  create  a  sense  of  privacy?  • Do  all  birth  rooms  have  private  access  to  an  ensuite  toilet?  • Are  there  secluded  spaces  within  the  birth  room  that  might  be  useful   if  you  feel   like  you  need  

more  privacy?  

You  might  ask  your  maternity  care  provider:  • Is  it  usual  for  hospital  employees  to  knock  before  entering  a  birth  room?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • You  might  take  a  ‘please  knock’  sign  with  you  to  attach  to  the  outside  of  the  door  to  your  birth  

room.    

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Space  and  furniture  Being   able   to   move   around   and   change  positions   freely   is   very   important   to   women  during  labour.11  Women  who  are  able  to  move  around   during   labour   are   less   likely   to   need  medical   intervention,14   including   emergency  caesarean  section.15    

It   is   easiest   for   a   woman   to   move   around  during  labour  if  her  birth  room  is  spacious  and  has   a   range   of   furniture   options.   Changing  positions   regularly   makes   labour   progress  more   quickly   and   may   help   women   manage  pain.16   Having   a   range   of   furniture   available  (e.g.  birth  ball  or  stool,  rope  or  swing)  enables  women   to   choose   the   props   which   are   most  useful  to  them,  and  change  positions  easily.17,  18    

Women  who  labour  on  the  bed,  are  also  more  likely   to   birth   on   the   bed,   and  more   likely,   in  turn,   to   birth   lying   down.19   Upright   positions  (squatting,   kneeling,   standing)   may   be   easier  and   more   comfortable.9,   16,   20   Women   who  birth   in  upright  positions  are  also   less   likely  to  have   instrumental   birth   or   an   episiotomy.21  This  may  be  because   the  bony  opening  of   the  pelvis   (through   which   the   baby   travels)   is  largest   when   a   woman   is   upright.22   When  upright,  the  woman  is  also  more  able  to  move  around   and   find   the   most   comfortable   and  effective   position.18,   23   She   can   also   rock   and  sway   in   an   instinctive   ‘birth   dance’.24   It   may  also  help  women  feel  more  in  control.21,  25    

 

To  reduce  the  focus  on  the  bed,  and  encourage  women   to   labour   and   birth   in   upright  positions,   some   birth   rooms   have   other  furniture   such   as   floor   mattresses,   beanbags,  birth   balls,   rope   swings   and   stools.   Most  women   find   using   props   such   as   a   birth   ball  during   labour   helps   to   relieve   pain.26   Birthing  stools  are  useful  as  they  help  women  adopt  of  posture  that   is  effective  for  bearing  down  and  pushing.  Women  who  birth  on  a  birth  stool  are  less   likely   to   have   an   episiotomy   and   their  babies   are   less   likely   to   show   abnormal   fetal  heart  rate  patterns  during  labour.21    

Queensland  Centre  for  Mothers  and  Babies  has  published   a   ‘decision   aid’   to   support   women  planning   a   vaginal   birth   to   make   decisions  about   positions   in   labour   and   birth.   You   can  find  it  at  www.qcmb.org.au/decision-­‐aids.    

In  a  birth  room,  you  might  consider:  • Is  the  bed  the  focus  of  the  room?  Can  the  bed  be  moved?  • Are  there  other  furnishings  and  equipment  that  would  be  useful  support  for  you  if  you  chose  an  

upright  position  for  labour  and  birth?  • Are  the  rooms  large  enough  for:    

- The  woman  and  her  support  people  to  move  around  easily?  - A  range  of  equipment/furniture  options?  - The  woman  to  walk  around  and  adopt  different  positions?  

 

 

Figure  1:  Birth  room  at  Western  Middlesex  University  Hospital.3 A   variety   of   equipment   and   furniture   is  provided  in  a  spacious  birth  room.    

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You  might  ask  your  maternity  care  provider:  • What  does  s/he  do  to  encourage  women  to  move  about  during  labour?    • Are  they  comfortable  supporting  women  to  labour  in  upright  positions?  • If  you  choose  to  have  continuous  monitoring  of  your  baby’s  heartbeat  during   labour,  can   it  be  

done  wirelessly  so  that  you  can  still  move  around  easily?  • How  will  different  pain  relief  options  affect  your  ability  to  move  around  easily?  • What  is  the  policy  on  partners  staying  overnight?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Is  there  equipment  (such  as  a  birth  ball  or  beanbag)  that  you  would  like  to  take  with  you  if  it  is  

not   already   available   in   your   birth   room?   You   might   practice   relaxation   while   using   this  equipment  later  in  your  pregnancy.  

 

Use  of  Water    Being  in  water,  either  by  having  a  shower  and  by  being   in  a  warm  bath,  helps   the  release  of  oxytocin   and   may   therefore   make   labour  progress  more  quickly.27    

Most  women   like  having  access   to  an  ensuite  shower  during   labour11,   15   and   find   it   is  useful  for  managing  pain.26,  28  Taking  a  shower  during  labour   can   also   promote   privacy   within   the  birth   room.12   Showers   that   are   large   enough  for  two  or  more  people  allow  a  support  person  and/or  a  care  provider  to  be  with  the  woman.  Having   two   showerheads   with   hoses   allows  the   woman   to   direct   the   water   onto   specific  areas  to  ease  discomfort.29    

Some   birth   rooms   have   a   deep   bath   for  women   to   use   during   labour,   and   sometimes  also   for   waterbirth.   Many   women   find   that  being   in   a   deep   warm   bath   is   soothing,  relaxing   and  provides   buoyancy   that  makes   it  easier   to   change   positions.   Being   in   the   bath  may   also   provide   privacy   within   the   birth  room.27   A   suitable   bath   is   deep   enough   for   a  woman  to  adopt  a  range  of  positions  and  still  have  her  belly  and  buttocks  under  water.    

 

When  baths  are  wider  than  normal  household  baths,   women   can   adopt   a   wider   range   of  positions  and  change  positions  more  easily.    

Women   who   use   a   warm   water   bath   during  the   first   stage   of   labour   (where   the  contractions   cause   the   cervix   to   dilate   or  open)   are   less   likely   to   have   an   epidural   or  spinal   analgesia,   and   more   likely   to   have   a  shorter   first   stage   of   labour.   There   is   no  difference  in  the  chance  that  they  will  have  an  instrumental  birth,  or  that  their  baby  will  have  an  adverse  outcome.30,  31    

 

Figure   2:   Bath   for   water   immersion.2 The   bath   is  located  in  a  protected  corner  of  the  room,  and  the  colour   scheme   and   use   of   natural   decor   of   the  room  create  a  less  clinical  feel.  

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In   some   hospitals,   women   are   supported   to  stay   in   the   bath   during   the   second   stage   of  labour   (pushing)   and   birth   their   baby   under  water   (waterbirth).   These   women   report  higher   levels   of   satisfaction   with   their   birth  experience.30   Waterbirth   is   popular   and   safe  for  the  woman  and  her  baby.32-­‐34    

Queensland   Centre   for   Mothers   and   Babies  has   published   a   ‘decision   aid’   to   support  women   in   making   informed   decisions   about  using   a   bath   or   pool   during   labour.   You   can  find   it   at   www.qcmb.org.au/decision-­‐aids.

 

Light  Lighting,   and  particularly   the  ability   to   control  light   levels,   is   important   to   many   labouring  women.6,  11,   12  An  interactive  demonstration  of  the   impact   of   lighting   on   the   ambience   of   a  birth  room  is  available  at    www.westmidmaternity.org.uk/wm3_c03b.php    

Exterior   windows   may   allow   natural   light   in  and   provide   a   view   of   nature.35,   36   When  patients   have   a   view  of,   and   access   to   nature  they   report   less   stress37   and   use   less   pain  medication.35,   38   Curtains   and   blinds   can   be  used  to  control  light  levels  and  protect  privacy.  Having   windows   that   open   may   allow   the  woman  to  control  the  temperature  of  her  birth  room,   promote   privacy   and   enable   contact  with  the  outdoors.10    

In  a  birth  room,  you  might  consider:  • Does  each  birth  room  have  a  private  shower?  • Is   the   shower   large   enough   to   accommodate   you,   your   support   person   and   care   provider,  

together  with  a  chair,  birthing  ball  or  stool?  • Does  the  shower  have  two  showerheads  on  flexible  hoses  to  allow  you  to  direct  the  water  flow?  • Does  the  shower  have  rails  on  the  walls  for  you  to  use  as  supports?  • Is  there  a  bath  in  each  birth  room?  Is  it  deep  enough  and  wide  enough?  • Is  the  bath  in  a  protected  corner  of  the  room  to  help  you  achieve  a  sense  of  privacy?    

You  might  ask  your  maternity  care  provider:  • What  is  their/the  hospital’s  policy  on  water  immersion  during  labour?  • What  is  their/the  hospital’s  policy  on  waterbirth?  • Can  you  to  bring  your  own  inflatable  pool?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Do  you  have  a  suitable  bath  or  inflatable  pool  at  home  that  you  could  use  in  early  labour,  even  

before  going  to  your  planned  place  for  birth?  

 

Figure   3:   Snoezelen   room   at   Osborne   Park  Hospital   in  Western   Australia  where   projected  light  murals  and  fibre  optic  lights  are  used.6

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Bright   ceiling   lights   are   important   in  emergencies,   but   other   lighting   is   also  important   during   labour.   Bright,   artificial   light  may  trigger  the  release  of  adrenalin,  slowing  or  even   stopping   labour.9   Low   light   levels   may  create   a   sense   of   privacy12   and   make   the  

environment   feel   less   clinical.6,   11,   39   Coloured  lights   and   light   projection   systems   have   also  been  used  creatively  in  birth  rooms  to  create  a  calming   and   relaxing   ambience   and   provide   a  positive  distraction.6  

 

In  a  birth  room,  you  might  consider:  • Do  all  rooms  have  windows?  • Are  the  windows  large  enough  to  allow  natural  light  to  fill  the  room?  • Are  there  curtains  or  blinds  to  protect  privacy  and  control  light  levels?  • Do  the  windows  open?  • Do  windows  look  out  on  a  natural  scene?  • Can  you  see  the  view  through  the  window  from  all  parts  of  the  room,  or  only  when  up  close  to  

the  window?  • Are  bright  ceiling  lights  the  only  lighting  available?  • Are  the  lights  dimmable?    • Does  the  lighting  create  a  calming  feel?  • Are  there  any  coloured  lights,  night  sky  simulations  or  light  projection  options?  

You  might  ask  your  maternity  care  provider:  • During  my  labour  and  birth,  will  I  be  able  to  determine  the  light  level  that  makes  me  feel  most  

comfortable?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Would  it  be  useful  to  take  a  scarf  or  sarong  to  throw  over  bright  lights  or  your  head?  • If   bright   celling   lights   are   the   only   lights   available,   would   you   like   to   turn   those   lights  

completely  off  and  use  small  battery-­‐powered  lamps  instead?  

Noise  Hospitals   are   noisy   places,40  which   can   cause  stress   and   anxiety   for   patients,   staff   and  families.13   In   noisy   environments,   people  show   less   pain   tolerance   and   perseverance  and   use   more   pain   relief   medications.40-­‐43  Some   birth   rooms  may   have   noise-­‐absorbing  materials  to  reduce  hospital  noise  and  protect  privacy   by   making   sure   that   sounds   are   not  overheard  between  birth  rooms.39,  44    

Music   may   be   useful   to   mask   background  noise  and  provide  a  positive  distraction.    

 

Women   who   listen   to   music   during   labour  report   lower   levels   of   anxiety   and   pain  possibly   because   the   music   provided  something   else   to   focus   on.45-­‐47   Women  benefit   most   from   music   during   labour   and  birth   if   they  have  used  music  as  part  of   their  relaxation   practice   in   preparation   for   birth.46  Listening   to   music   via   earphones   may   be  especially   useful   in   blocking   out   unwanted  noise.

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In  a  birth  room,  you  might  consider:  • When   inside   the  birth   room,   can  you  hear  noise   from   the  hospital  or   from  neighbouring  birth  

rooms?  • Is  there  a  CD  player  or  iPod/MP3  dock  for  you  to  play  music  during  your  labour  and  birth?  Is  that  

system  portable  so  that  it  can  move  with  you  around  the  room  and  into  the  bathroom?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Would  you  like  to  create  your  own  playlist  or  CD  of  music  you  find  relaxing?  • Would  you  like  to  use  music  as  part  of  relaxation  practice?  • Would   earphones   be   a   useful   way   for   you   to   listen   to  music   and/or   block   out   hospital   noise  

during  your  birth?  

Nature    When  patients  have  a  view  of,  and  access  to,  nature   they   report   less   stress37   and   use   less  pain  medication.35,   38  Windows   that   look   out  on  natural  scenes,  as  well  as  including  natural  objects   within   the   birth   room   (such   as  fountains,   green   indoor   plants,   shells,   and  aquariums)   or   artworks   depicting   nature   can  serve  this  purpose.44  The  sounds  of  nature  can  also  be  included  in  musical  selections.    

Courtyards   and   outdoors   areas   are   also  useful.   Access   to   a   courtyard   may   be  particularly   useful   if   a  woman’s   labour   slows  down  as  a  result  of  the  stress  of  moving  from  the  home  to  hospital  environment.8  Providing  a   peaceful,   outdoor   space   can   help   women  relax  which  will,  in  turn,  help  restore  oxytocin  levels   and   encourage   labour   to   resume   or  intensify.44  

 

 

Birth   rooms   that   are   on   the   ground   floor   of  the   hospital   make   it   easier   for   women   to  access   them   during   labour,   and   also   permit  access  to  courtyards  and  outdoor  areas.48  

 

In  a  birth  room,  you  might  consider:  • Are   birth   rooms   decorated  with   images   of   nature,   indoor   plants,   aquariums   or  windows   that  

look  out  onto  a  natural  scene?    • Do  birth  rooms  have  easy  access  to  outdoor  spaces,  gardens  and  courtyards?  • Are  the  birth  rooms  located  on  the  ground  floor  and  easy  to  find?    

 

Figure   4:   Birth   room   in   the   award   winning  Birmingham   Birth   Centre,   UK,   incorporating   a  nature  mural.4

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You  might  ask  your  maternity  care  provider:  • How  does  s/he  support  women  whose  labours  slow  or  stop  on  arrival  at  the  hospital?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Are  there  natural  objects  or  images  or  sounds  of  nature  that  you  would  like  to  take  with  you  to  

your  birth?  

Personal  items  Hospitals  often  seem  impersonal,10  so  women  may   value   the   option   of   personalising   their  birth   space.49   Personalising   the   birth   room  encourages   women   to   create   a   ‘territory’   in  which  they  are  safe  to  pursue  a  broader  range  of  behaviours  during   labour  and  birth.10  Also,  for   many   people   ‘that   hospital   smell’   is  unpleasant   and   worrying.42,   50   Pleasant  aromas,  on  the  other  hand,  can  lower  anxiety  and  pain  perception.42  Taking  a  doona  or  quilt  from  home   is  one  way   to  make  a  birth   room  look  and  smell  more  home-­‐like  and  familiar.12  Scented  massage  oils  may  also  be  valuable.    

 

In  a  birth  room,  you  might  consider:  • Are  there  places  to  display  personal  items  if  you  chose  to  bring  them  with  you?    

Other  ways  you  might  create  your  optimal  birth  space:  • Would  you  like  to  take  items  of  personal  significance  with  you  to  personalise  your  birth  room?  • Would   you   like   to   take   personal   items,   such   as   a   quilt   or   doona,  with   you   to   create   a  more  

home-­‐like  feel  in  your  birth  room?  • Are  there  any  scented  massage  oils  that  you  would  like  to  use  during  labour?  

Provisions  for  support  people  The  presence  of  support  people  during  labour  is   very   important   to   many   women.   Women  who   have   continuous   support   during   labour  and   birth   are   less   likely   to   have   a   caesarean  section  or  instrumental  birth,  less  likely  to  use  pain   relief  medication   and   are  more   likely   to  be  satisfied  with  their  birth  experience.    

 

They   are   also   more   likely   to   have   a   slightly  shorter  labour,  and  their  babies  are  less  likely  to  have  a  low  Apgar  scorea   five  minutes  after  birth.51    

                                                                                                                         a   Apgar   scores   are  used   to  describe   the  health  of  newborn  babies  at  and  soon  after  birth.  The  baby’s  colouring,   pulse,   reflexes,   activity   and   breathing  each  contribute  up  to  two  points  to  the  score,  for  a  maximum  of  Apgar  score  of  ten.    

 

Figure   5:   Inside   the   "Gardenia   Room"   at   Toowoomba  Birth  Centre,  with  shelving  to  display  personal  items.5

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Although   often   overlooked,   it   may   be  important   to   consider   how   hospitable   and  comfortable  a  birth   space  will  be   for   support  people.52  Birth  rooms  may  provide  for  support  people  by   including   seating  or  a   sofa  bed   for  them  to  rest.  Support  people  may  be  included  in  food  and  drink  provisions,  or  there  may  be  facilities   where   they   can   prepare  refreshments.   Support   people   may   have  access  to  separate  but  nearby  toilet   facilities.  Some  hospitals  also  have  double  beds  in  birth  rooms,   and   welcome   women’s   partners  overnight  after  birth.  

 

In  a  birth  room,  you  might  consider:  • Are  the  birth  spaces  spacious  and  well-­‐furnished  enough  to  comfortably  accommodate  support  

people?  • Is  there  a  chair  or  a  sofa-­‐bed  for  your  support  person/people  to  rest?    • Is  food  and  drink  provided  for  support  people,  or  are  there  facilities  to  prepare  refreshments?  • Where  is  the  toilet  for  support  people  to  use?  • Is  there  a  double  bed?    

You  might  ask  your  maternity  care  provider:  • What  is  the  hospital  policy  on  partners  staying  overnight?  

Other  ways  you  might  create  your  optimal  birth  space:  • Would   your   support   person/people   like   to   take   anything  with   them   into   your   birth   space   for  

their  own  comfort?  

Cultural  Considerations  During  labour  and  birth,  and  soon  after  birth,  some   women   want   to   observe   particular  cultural  practices  and  traditions.  In  addition  to  each   of   the   topics   already   covered,   women  with   specific   cultural   needs   might   place  particular  emphasis  on:  

• The   availability   of   culturally-­‐specific  maternity  care  programs.53  

• Types  of  food  available.54      

 

   • The   presence   of   men   during   labour   and  

birth.54,  55  • The   role   of   the   father   during   labour   and  

birth,  as  well  as  soon  after  the  birth.54,  55  • What   happens   to   the   placenta   after   the  

birth.54  • Artwork  in  the  birth  room.53,  56  • The   ability   to   perform   traditional  

ceremonies.54

 

Figure  6:  A  birth  room  at  the  Origine  Birth  Centre  in  the  Netherlands,  which  includes  bed,  seating  and  tea  and  coffee  facilities  for  support  people.1

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In  a  birth  room,  you  might  consider:  • Does  the  birth  room  meet  your  own,  unique  cultural  needs  and  preferences?  

Other  ways  you  might  create  an  optimal  environment  for  your  birth:  • Would  you  like  to  take  items  with  you  to  your  birth  to  reflect  your  cultural  needs?    • What   specific   cultural   needs   would   you   like   to   discuss   with   your   care   provider   before   your  

labour  begins?  

 

References  are  available  from  www.qcmb.org.au/birthspace