Altering the birthing room - The influence on birth outcomes and provision of care

Sammanfattning: Giving birth is a complex physiological process deeply influenced by psychological and social elements. A prerequisite for optimising this physiological process is to be in an environment that feels safe and protective. The studies in this thesis are based on an intervention involving the redesign of a birthing room at a Swedish labour ward with features aimed at supporting women’s emotional responses to labour. The overall aim of the thesis was to explore and evaluate how this birthing room alteration influenced birth outcomes and the provision of care. Study I employed an ethnographic study design in which data was collected through participant observations (n=17) and in-depth interviews (n=8) with nulliparous women giving birth in either the newly designed room or a regular birthing room. Study II and III were based on a Randomised Controlled Trial (RCT) evaluating whether the new room improved birth outcomes for nulliparous women (n=406) compared to regular rooms. Study IV was a qualitative interview study exploring care providers’ (n=21) experiences of the implementation of the new room. The RCT (study II and III) was terminated prematurely due to the Covid-19 pandemic, resulting in insufficient statistical power to detect a significant difference between the randomised groups in the primary outcome (a composite of spontaneous vaginal birth, no use of oxytocin infusion, postpartum blood loss <1000ml, and a positive childbirth experience). The secondary analyses showed that women in the new room used epidural analgesia to a lower extent and reported a more positive childbirth experience at 3 and 12 months after birth than women in regular rooms. However, the findings of study I and IV revealed that the room design is not the sole determinant of birth outcomes and women’s experiences. The birth environment is evidently a co-creation involving physical design, human interaction, and the institutional context. It was found that the new room was implemented in a context dominated by biomedical norms, where the approach to childbirth primarily leaned towards a pathological perspective. The new room had the potential to challenge these dominating norms, especially as it reflected a more salutogenic perspective of childbirth. To address the increasing trend of medical interventions observed in Sweden and many other countries, there is a need to acknowledge that merely altering the physical design of a birthing room is insufficient. Hospital organisations and care providers must recognise their role as co-creators of the birthing room atmosphere — a factor that profoundly influences women’s birth outcomes and experiences. Hence, the provision of maternity care should be rooted in the fundamental understanding of how the sensitive physiological process of birth is supported and not disturbed.