Beds and birth rooms

Henci Goer recently wrote about a pilot study examining the effect of birth room design & furniture on the progress of labor. In her Science & Sensibility post, The Labor Environment: “Many things that count cannot be counted”, Goer discussed the study's design:

The June 2009 issue of Birth contains the results of a pilot study gauging the effects of modifying the labor room to encourage mobility, reduce stress and anxiety, and discourage routine medical intervention. Investigators randomly allocated 62 healthy women in spontaneous labor to either a modified room or the standard labor room. Women attended by midwives or doulas were excluded from participating, effectively creating a study population not predisposed to be mobile in labor.

Changes to the labor environment were relatively modest. The most radical innovation was to remove the labor bed, replacing it with a portable double-sized mattress and pillows in the corner of the room on the floor....Rooms were also equipped with a birth ball, a chair that promoted sitting upright or leaning forward, an LCD projector with a selection of movies of calming nature images, an mp3 player with a selection of music, and a chart illustrating upright labor and birth positions. All labor rooms had a private bathroom and lacked windows. No nursing alterations were made other than mandating intermittent auscultation, leaving the overhead light off, keeping the door closed, and putting a sign on it asking people to knock before entering.

As Goer noted, the results were promising, although the sample size was quite small (it was just a pilot study):

The trial was too small to draw firm conclusions, but the results certainly support conducting a larger one. Sixty-six percent of the women in the modified room reported spending less than half of their time in labor in bed versus 13% of women in the standard room, and only 35% spent three-quarters or more of their time in bed versus 87% of women in the standard room. (The bed was brought back at the woman’s - mostly for epidural analgesia - or caregiver’s request.) Women in the modified room were significantly less likely to have oxytocin augmentation (40% vs. 68%), and those who had it got it later in labor. Women also had somewhat shorter labors on average and longer times to initiation of analgesia/anesthesia.

I found another article discussing this research at VOA News: Re-Thinking Delivery Room Design Eases Labor. The lead researcher, University of Toronto nursing professor Ellen Hodnett, conceived of the study after noting women's behavior when they were giving birth at home. They moved around a lot and used household furniture to aid their labors. She commented:

They used a dining room table to lean over. They used the bathtub. They walked around the garden. They were moving, or on all fours, or side-lying on a mat on the floor… a variety of things…And that struck me, even then, that there were more opportunities, more ways for a woman to help herself to be more comfortable and perhaps her labor to be more effective if she were not confined to a bed.

Particularly interesting were Hodnett's comments on how the presence of a bed in a central location predisposes women to staying in bed, rather than moving around:

Doctors and midwives agree it's better for a woman to move around while she's in labor. Walking and changing position makes her more comfortable and helps the labor progress. But in many countries, women giving birth in hospitals are often instructed to lie in bed while their labor progresses.

University of Toronto nursing professor Ellen Hodnett observed that in many modern - and even some not-so-modern hospitals - a bed was at the center of the labor room.

"That bed is a problem," Hodnett says. "Because it's a central focus of the room, and it sends messages that that's where you're supposed to be in labor. And yet, we have pretty good evidence that spending long periods of time in bed, particularly confined in the way that a hospital labor bed confines you, is not conducive to normal, healthy labor progress."

Goer also noted how the presence of a delivery bed influences women's mobility in labor:

The investigators noted that the bed is a major reason for lack of mobility. Its prominence conveys that it is the appropriate place for laboring women, and a woman in bed offers ready access for interventions, an observation backed up by research. (Both Listening to Mothers surveys reported that few women were mobile after hospital admittance. In the first survey, two-thirds of the women gave as a reason that they were “connected to things” and more than one-quarter said they were “told not to walk around.”)

Switching from a delivery bed in the center of the room to a large, low mattress with several pillows in the corner of the room was something that French obstetrician Michel Odent did when he became the head of the maternity department at Pithiviers, France in the 1970s:

Before: Typical French delivery room

After: birth room & pool room

In hospital birthing rooms I have visited personally, the bed is the central focus of the room. Even the flooring and ceiling materials emphasize the bed's central role in the drama to unfold: inlaid patterns around the bed circumscribe the area where birth is allowed to occur, and the spotlights on the ceiling further dictate the location of birth. These photos are from the new UIHC maternity wing in Iowa City, where I did my PhD. Notice the inlaid pattern in the flooring around the bed and the spotlights in the ceiling:

And these photos of my local hospital's LDRP rooms. Again, notice the inlaid pattern in the flooring that outlines and emphasizes the centrality of the bed. The room revolves around the bed: the couch and rocking chair face it, the monitoring equipment surrounds it, and the lights focus on it:

I would love to see pictures of the modified birth rooms from Hodnett's study. Sometimes simple and inexpensive changes are better than the newest high-tech bed.