Despite its joyful purpose, a hospital delivery room can be a scary place, with its fluorescent lights, beeping machines and massive recumbent bed.
Imagine instead, a dimly lit room filled with the sound of crashing waves, a soothing beach scene projected on the wall and a low foam mattress big enough for your partner to hold you as you push new life into the world.
Could this be the delivery room of the future?
Perhaps, if a new study of ambient labour rooms gains traction in hospitals across the country.
Researchers at the University of Toronto's Bloomberg Faculty of Nursing found that women who give birth in a relaxing clinical environment without a standard labour bed use fewer birth-assisting drugs and are more likely to try different birthing positions.
The pilot study, called PLACE (Pregnant and Labouring in an Ambient Clinical Environment) was published in the current issue of the journal Birth, and found that women who delivered babies in a relaxing environment had a 28 per cent drop in oxytocin infusions, a drug that helps accelerate slow birth. Sixty-five per cent of women labouring in the ambient room reported spending less than half their hospital labour in the traditional bed compared to 13 per cent of those in the standard labour room.
Making a woman feel calm and in control can significantly reduce her physical and emotional stress, says the study's lead author, Ellen Hodnett, a professor and Heather M. Reisman Chair in Perinatal Nursing Research at the University of Toronto and Mount Sinai Hospital. This can lead to a smoother natural birth and can help lower the number of interventions such as cesarean sections, which have climbed to a rate of 26 per cent, she says – a 45 per cent jump since 1998.
“If we fix [the environment] we really have the potential to reduce unnecessary intervention during normal labour and birth,” she says.
Plus, she adds, more and more women are thinking creatively about how they want to give birth, but find they can't try these techniques when they get to the hospital.
In Prof. Hodnett's study, 62 labouring women in two Toronto teaching hospitals, Sunnybrook Health Centre and Mount Sinai Hospital, were randomly assigned to a standard or an ambient room. For women in the ambient room, it was all about choice: They could choose to listen to tunes on three playlists which offered everything from Bon Jovi's Livin' on a Prayer to the soothing sounds of Bach. They could also choose between watching scenes of a beach in Santa Monica or a Caribbean shoreline, among others. A poster of various birthing postures was tacked on the wall, showing them how to push while leaning on a shelf or sitting in the straight-backed lounge chairs. A standard labour bed and other medical equipment was available to the women, but wasn't present in the room.
Aside from the medical benefits, the women liked it. In a follow up survey, 15 of the 31 women said the room was calm all or most of the time as opposed to 10 in the standard room. Nineteen said the room never or rarely made them feel anxious. “I was able to relax and almost forget I was in a hospital,” one woman wrote.
Care providers liked it too. Nineteen nurses and six doctors in the ambient room said they felt the space helped women relax. They also spent more time in the room, but complained that the low level of the mattress made care difficult.
Though the project was considered an overall success, Prof. Hodnett said it was a tough sell to hospital administrators.
“The first three hospitals we asked to participate in this pilot turned us down flat,” she says. “They're used to women being in a bed, the bed to them constitutes safety, it's where safe things happen. They don't have kind of a reference or experience thinking about women labouring in a different way.”
Some physicians worried about safety. What if there was a complication and a physician can't provide the right level of care on a low foam mattress?
Prof. Hodnett isn't aware of any other hospitals with ambient labour rooms, though some hospitals have been trying to introduce more relaxing and holistic environments. Some hospitals in Britain use aromatherapy (a technique she doubts would take hold here due to strict anti-scent policies) and have double beds to encourage partners, family and caregivers to physically support the women as they give birth, she says. Other hospitals offer birthing tubs, in response to a growing body of research that suggests water and the rhythm of waves coaches a woman through her contractions.
The fewer interventions the better, agrees Katrina Kilroy, president of the Ontario Association of Midwives. She hopes the maternity ward renovations at her hospital, Mount Sinai, slated for completion in 2010, will include an ambient space for women to give birth.
“This is how midwives have been practising forever,” she says. “I think anything that hospitals can do to support things that we know are helpful for labour – mobility, comfort, one to one support – any systems approaches that help provide those things to labouring women are good.”
