Relax, you're about to give birth
Giving birth is life-changing, intimate, exhilarating. It can also be frightening and stressful. New research reveals this can have an adverse effect on mother and baby.
As interventions such as the use of drugs and caesarean section – and their associated risks – continue to rise in the developed world, UTS is embarking on world-first research to explore the relationship between birth unit design, the quality of communication, and staff and patient stress.
Led by Professor Maralyn Foureur, the multi- disciplinary project spans the faculties of Midwifery, Nursing and Health; Arts and Social Sciences; and Design, Architecture and Building. It is funded by a $227,000 Australian Research Council grant, which will cover the cost of two PhD scholarships.
Foureur, Communication Professor Rick Iedema, Industrial Design Course Director Berto Pandolfo and their teams will use their own specialised techniques and perspectives to analyse relevant elements of the same research data.
Data, in this case, is video footage recorded by a research midwife in the lead-up to labour. Many factors are at play in minimising stress, including the environment – facilities, design, equipment – and the communication techniques used by hospital staff.
"We are looking at how staff use the space and how they communicate about the space to the woman."
For example, says Foureur, a woman ushered into a room, with a bed being the main piece of furniture, would instinctively approach the bed and lie down.
"That's counterproductive to normal physiology in labour. Lying down on a bed is not the best thing to do. We are trying to look at other options that explain or make sense to the woman.
"We are looking at how the staff member communicates non-verbally to the woman and what the other objects and artefacts [in the room] do to communicate to her. This can be much more powerful than words – which is why we need to videotape what goes on."
Consenting patients will then be interviewed about their experience, comfort and anxiety levels.
The project also looks at the impact of the environment on hospital staff. Foureur says discoveries in neuroscience show that stress can interfere with the way people communicate and their ability to attend to their surroundings. "In a health setting, that's problematic. People are much more likely to make errors in judgement."
It is hoped that reduced stress leading up to and during labour will steady the increasing number of interventions during birth such as the use of drugs and caesarean section, which is now at an average of 25–30% in Australia, according to Foureur.
"Giving birth requires complex chemical processes to unfold in the mother's brain and body. The process can be interrupted or stopped altogether if the woman becomes frightened or stressed." She estimates that less than 25% of Australian women experience a natural birth. "All interventions have consequences," she says. "In some cases they are absolutely essential and life-saving for the mother or the baby. Those cases are fortunately quite rare.
"Health departments around the world have said enough is enough: we have to stop the rise in caesarean section. Twenty years ago, about 5% of women had caesareans. Twenty years ago, labour wards were fairly unsophisticated, non-technological rooms. These days we have highly sophisticated, highly technological environments that we usher women into." However, these modern rooms may not be stress-free.
Currently in Australia, fewer than 5% of women are able to access "domestic- like" primary birthing units in public hospitals, which contain reassuring design elements such as a comfortable bed and access to water such as a bath.
Instead, they may be admitted to standard labour wards or tertiary referral centres, which may seem too clean, scary or even threatening. "You can walk into a tertiary referral hospital or a labour room and they look like operating theatres," says Foureur. "There is all sorts of equipment on display.
"If you're trying to create a non-stressful environment... you don't want to be sitting in a room where you're staring at this huge prenatal resuscitation trolley with a hidden message that something might go wrong and your baby might be put on this machine.
"We have a challenge ahead of us to modify the environment and make it stress-reducing."
The three-year project, which began in May is being conducted on an exploratory level, and may lead to more in-depth research into the levels of stress. In the meantime, it is hoped a new understanding of health facility design will reduce the number of interventions and other long-term health effects.
Read more at the UTS Newsroom.
Words: Caroline Jenkins
Images: © Queensland Government