Best Birth Places.

Despite, research from  New Zealand, UK and other countries, which shows that for healthy pregnant women homebirth with an experienced midwife, is safer that labouring in an obstetric hospital, an increasing majority of New Zealand women are delivered in a secondary or tertiary hospital (over 85% in 2011).

The Royal College of Midwives Practice Guidelines state that “Hospital is an alienating environment for most women, in which institutionalised routines and lack of privacy can contribute to feelings of loss of control, and increased anxiety brought on through loss of control can interfere with the normal effective physiology of labour” and that “control, or lack of it, was important to the women’s experience of labour and their subsequent emotional well being.”  

New Zealand women and many midwives seem unaware that local [1,2, 3] and  international [4] evidence shows that the place of birth not only has an important effect on interventions but that women report higher satisfaction with their experiences in “home‐like” environments, with the following features;

  • Control over temperature
  • A pleasant place to walk
  • Sufficient pillows, floor mats and bean bags
  • A homely, non-clinical room
  • Not being overheard by others,
  • A place to get snacks
  • Control over the brightness of light.”

These factors are part of Bianca Lepori’s “Mind- Body-Spirit” architecture which creates birthing spaces to decrease sensory stimulations which interfere with a woman’s neuro- hormonal drivers of (natural) labour and birth, as explained in my last blog. Thus as per the diagram below Bianca’s designs aim to give each women privacy, the ability to be ‘hidden’ with beds out of the way of doors and the centre of rooms; access to water, room to walk and move in response to her baby and labour.  Other features of this supportive approach include space and supports to kneel, stretch, lean, squat or be still; surfaces which range from soft and yielding to firm and supportive as well as use of different textures, curved edges, images, colours and variations in light. Spaces which allow women to ‘hide’, control light, noise and temperature, reduce their need to think rationally which can interfere with the flow of helpful birth hormones. Similarly the availability of different surfaces and supports encourages a woman to find or adopt various, appropriate positions in response or to accommodate the baby’s efforts to be born.

 

From Chapter 8 of “Birth Territory and Midwifery Guardianship. Theory for practice, education and research.” by Fahy, K. Foureur, M. & Hastie, C. (2008) Elsevier’ Books for Midwives .

 

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Australian research into healthy birthing spaces supports all of the above and adds that: ” Labour and birth should happen as close to home as possible. Proximity to friends and support are essential for a healthy healing birthing experience and being a long way from home makes this difficult. Proximity to home can also be a spiritual thing. The familiarity of the birth space can reflect sufficient elements of home to reduce alienation and anxiety.” This statement is consistent with the vision of Waitakere women who sought a Whanua-ora inspired,  local community- managed, culturally-sensitive, birth-parenting centre which as well as the women-centred Mind-Body-Spirit birth spaces would also include:

  • Family friendly post-natal rooms, with a community dinning area.
  • A drop-in centre for childbearing women and their children, with breastfeeding supportive services.
  • Consultation rooms for midwives, lactation consultants, doctors and complementary therapy practitioners.
  • A maternity-parenting resource centre.
  • Safe play areas for children – inside and out.
  • Rooms for maternity and early parenting community groups to meet and host related activities.
  • Art works and decorations which honour women and parenting.
  • Accommodation of support services (eg catering and home help) for newly birthed women at home including those who homebirth locally.
  • Flower, herb and vegetable community gardens.
  • Ecologically sustainable and wheel chair accessible buildings and facilities.
  • External space and a design which will support future growth both internally (eg storage areas) and externally.

The National Childbirth Trust (NCT) has developed a service to encourage and assist UK health boards to create women-centred birthing spaces, and most recently was involved in the UK Birth Place study, which concludes ; The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

When and how will New Zealand maternity facilities adopt evidence based, women-centred birth space standards?

[1]Solomon, J. ‘New Zealand Research on Place of Birth’, Women’s Health Update, Vol 12, No 1, January,

pp. 1 ‐ 2.

[2] Earl, D. Hunter, M. 2006 ‘Keeping birth normal: midwives experiences in a tertiary obstetric setting’,
New Zealand College of Midwives Journal, Vol 34, April, pp. 21 – 23;

[3]  Skinner, J. Lennox, S. 2006 ‘Promoting normal birth: a case for birth centres’, New Zealand College of
Midwives Journal, Vol 34, April, pp. 15 – 18.

[4] Hodnett, ED. Downe, S. Edwards, N. Walsh, D. Home‐like versus conventional institutional settings for
birth. Cochrane Database of Systematic Reviews 2005, Issue 1, Art. No: CD000012. DOI
10.1002/14651858.CD000012.pub2.

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Trust children. Nothing could be more simple, or more difficult. Difficult because to trust children we must first learn to trust ourselves and most of us were taught as children we could not be trusted. — John Holt
The greatest joy is to become a mother; the second greatest is to be a midwife. — Norwegian proverb
I can promise you that women working together - linked, informed and educated - can bring peace and prosperity to this forsaken planet. — Isabel Allende
We need to have their hearts before we can open their minds. — Dr Gordon Neufeld
Nothing in life is to be feared it is only to be understood. Now is the time to understand more so we can fear less. — Marie Curie
A loving heart is the truest wisdom. — Charles Dickens
Birth is not only about making babies. Birth is about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength. — Barbara Katz-Rothman
No other natural bodily function is painful and childbirth should not be an exception. — Grantly Dick-Read
All change is not growth, as all movement is not forward. — Ellen Glasgow
Without deviation from the norm, progress is not possible. — Frank Zappa