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From here to maternity

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The surroundings during childbirth are of undeniable importance to the mother's comfort and overall experience.

Fiona McWilliam reports on the National Childbirth Trust's new 'audit toolkit', which aims to guide and influence architectural decisions, and improve the design of maternity units

While stables might not meet current health requirements for maternity units, the one visited just over 2,000 years ago by Mary and Joseph is widely believed to have been quiet and homely - features as important to new mothers today as they were 2,000 years ago.

Of the many factors likely to influence a woman's experience of childbirth, the surroundings in which she delivers her baby have, undeniably, huge significance. In a recent survey of some 2,000 new mothers in the UK, nine out of 10 felt that physical surroundings could affect how easy or difficult it is to give birth.Yet more than half the women interviewed said they were denied access to facilities they considered important - facilities ranging from 'a pleasant place to walk around in' to room temperature controls and an en-suite WC. The findings reveal a great deal about the state of the country's maternity wards - where more than 90 per cent of women give birth - as well as throwing up some interesting architectural challenges.

Most labour units comprise an antenatal ward, for women who are in the early stages of labour or who have come in for assessment, a post-natal ward, for those who have already given birth, and several labour beds, which are nearly always in single rooms.

Some hospitals have single rooms designed for delivery and post-natal care, while midwife-led maternity units, of which there is a growing number, tend to offer beds in single rooms for antenatal care, labour and post-natal care.

According to the independent Dr Foster Good Birth Guide (Dr Foster, £16.99), which provides facts and figures on every maternity unit in the United Kingdom, 'maternity units are increasingly keen to dispense with the intimidating environment of a traditional labour ward and offer a range of birthing options including home-from-home rooms with comfortable furniture and tea-making facilities'.Water birth is an established alternative to the labour bed, it states, with many hospitals and midwife-led maternity units now offering this service.

The aforementioned survey, conducted earlier this year by Europe's largest childbirth and parenting charity, the National Childbirth Trust (NCT), brings to light a number of commonly shared concerns about hospital birthing facilities. 'Most were very basic things such as the lack of a nearby toilet or the fear of being overheard, ' explains NCT research consultant Debbie Singh, 'but all can have a big impact on the type of birth a woman experiences.'

The physical and psychological effects of the birth environment may even influence the outcome of a birth, Singh suggests. A poor environment can induce stress, for example, which, in turn, could influence the type of birth and level of intervention. And the greater the level of intervention, the higher the cost of a birth, which goes some way to explaining the government's desire to cut this country's burgeoning elective Caesarean rates. (The UK's Caesarean rate of more than 22 per cent is among the highest in Europe; the World Health Organisation suggests that no more than 10-15 per cent of babies should be delivered by Caesarean in developed countries. ) The NCT goes as far as suggesting that 'poor facilities and inadequate design' in labour rooms may contribute to the rising number of Caesarean sections in the UK.

Action should be taken, it argues, to ensure that all women have 'every opportunity to experience a straightforward vaginal birth'.

With this in mind, it has put together what it calls an 'audit toolkit', to help architects improve the way that maternity units are designed - or refurbished - in future.

'Creating a Better Birth Environment: An Audit Toolkit' provides guidance about the kind of surroundings, facilities and privacy that women find helpful during labour, says the NCT, 'and those which will enable them to have the type of birth they want'.

It argues that building quality standards should be set for the design of rooms used for labour and birth, and that these standards should ensure that women are 'able to be as comfortable and relaxed as possible throughout labour, that their movement is not restricted, that they can control the heating and lighting, and that they do not feel exposed when someone enters the room'.

Sunand Prasad, of Penoyre & Prasad, praises the NCT's survey for being based on the actual experiences of women and their partners or companions.He believes, however, that architects can do even better than the NCT's conclusions indicate, through attention to design; working with natural light, for example, and creating beautiful spaces.

'This fits in with my belief that the environment and its design should be seen as an actual part of caring and healing, ' he said.

Heather Mellows, vice-president of the Royal College of Obstetricians and Gynaecologists, believes it is important to make labour rooms as 'women-friendly' as possible. She agrees that women in labour should have access to facilities such as en-suite bathrooms and moveable beds, but warns that, as much as many women would like a labour room to look like 'a normal bedroom', this is not always appropriate.

'Architects should design a room that looks 'normal' most of the time, but can be readily transformed to a high dependency area for assisted deliveries, ' she asserts. And this means easy access to medical equipment such as foetal monitors and drip stands.

Richard Mazuch is a director at Nightingale Associates, which specialises in designing healthcare buildings and counts a number of maternity units among its recent achievements, including Princess Diana Hospital in Grimsby, the Royal Berkshire Hospital and the Birmingham Children's Hospital. He believes that labour rooms should look 'almost like sitting rooms', with adjustable domestic beds and sofas, and bacteria-resistant carpets and cushions. Furniture should be soft and yielding, he says, and equipment should be hidden away, if possible in an adjacent equipment room. 'Privacy is extremely important, and natural light is essential, for both the mother's and the baby's subliminal cognition of the time of day.'

Mazuch has conducted a great deal of research on sensory environments and their impact on all aspects of healthcare. He mentions, for example, the importance of choosing the 'correct colours' for labour rooms, advising against red and 'dense' orange, both of which, he asserts, can raise anxiety levels. (Conversely, he adds, wearing orange can encourage the mother of a premature baby to lactate - while smelling vanilla is thought to encourage an appetite in pre-term babies. ) Mazuch believes too that women should have access to a therapy room - 'an internal or indoor garden designed to engage the senses', which would provide a calming environment for those in the earliest stages of labour.

While the NCT recommends building quality standards be implemented when new maternity units are built and existing units refurbished, it insists that significant improvements can be made to existing facilities, 'in terms of cleanliness, furnishing and décor', for relatively little money.

In practical terms, the requirements of mothers for childbirth seem straightforward enough to be readily addressed by architects and clients, even in this age of cost-conscious, value-engineered procurement.

'There is no reason that good design should not be produced under PFI if the client body is prepared to insist on it and budget for it, ' agrees Sunand Prasad. 'At the same time, ' he adds, 'I do think that not enough architects with passion and imagination, as well as skill, are involved in PFI.'

'Creating a Better Birth Environment: An Audit Toolkit' is available for £204 (including postage and packaging) from the National Childbirth Trust. Tel 0870 770 3236, email enquiries@national-childbirth-trust. co. uk

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