Impact of the built environment on labour and birth outcomes: the Swedish Room4Birth randomised trial

• Background: Attempts have been made to improve hospital birth environments to preserve birth physiology and, thereby, reduce unnecessary interventions in labour. However, research about the effect of these improvements on birth outcomes shows contradictory results. Objective: To evaluate whether a birthing room redesigned with person-centred considerations improves birth outcomes and experiences of nulliparous women, compared with regular birthing rooms. Methods: We conducted a randomised controlled trial in nulliparous women admitted to a Swedish labour ward. Women were randomised to either the redesigned room (New room) or a Regular room. An estimated number of 1274 participants were needed to detect a difference of 8% between the groups in the primary composite outcome: spontaneous vaginal birth, no oxytocin augmentation, post-partum blood loss <1000ml, and positive childbirth experience. Secondary outcomes included birth outcomes and questionnaire-based data regarding childbirth experience 3 and 12 months after birth. Results: Due to the Covid-19 pandemic, the trial was terminated early, and 406 women were included (n=204 in the New room, n=202 in the Regular room). No statistically significant difference was found in the primary outcome (42.2% versus 35.1%; odds ratio: 1.35, 95% CI 0.90–2.01). Women in the New room required epidural analgesia to a lower extent and had a more positive childbirth experience 3 and 12 months after birth compared with women in the Regular room. Conclusion: This prematurely terminated trial could not verify that the New room would improve the primary outcome. Nonetheless, the findings demonstrate that a birth environment with conscientious design positively affects women’s childbirth experience up to one year after birth. Key message: These findings provide knowledge about the value of the built environment in improving women’s childbirth experiences and perceptions of pain. Ethical approval No 478-18 (Gothenburg regional ethics board). ClinicalTrials.gov Identifier: NCT03948815. The authors declare no conflicts of interest.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

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