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| 2. |
- Berg, Marie, 1955, et al.
(författare)
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Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
- 2019
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215 .- 1745-6215. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. METHODS/DESIGN: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. DISCUSSION: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
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| 3. |
- Goldkuhl, Lisa, 1983
(författare)
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Altering the birthing room - The influence on birth outcomes and provision of care
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 4. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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An ethnography of the influence and meaning of the hospital birthing room for labouring nulliparous women
- 2022
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Ingår i: Nordic Midwifery Congress, Helsinki 2022.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Since giving birth is a profound life experience, it is important to understand the impact of the physical and psychosocial environment on women´s birth processes. As part of the Room4Birth research project, a birthing room at a labour ward in Sweden was redesigned to increase its potential to be adapted to personal needs, reduce stress, enable the endogenous oxytocin release and thereby facilitate a healthy labour and birth process. Aim: To explore the influence and meaning of the birthing room for nulliparous women. Methods: Ethnographic fieldwork was conducted, including five months of participant observations of nulliparous women (n = 16) labouring in either a regular birthing room (n = 8) or the redesigned birthing room (n = 8). Reflective memos and informal interviews with women, companions, and care providers were transcribed and in-depth interviews with eight of the women were conducted two to seven months after birth. An ethnographic iterative process was used to analyse the data. Results: We identified the birthing room as consisting of the physical space, the human interaction, and cultural practices within it. The Birth Manual was an identified analytic concept for managing birth according to the organisational authority that was incorporated into the birthplace. The conforming of this manual affected the atmosphere, birth practices, and role disposition in the room. The results describe how authoritative guidance of birth processes can disposition women as passive participants, but also how midwives can enable a birth environment where women experience safety and a sense of agency. Conclusions: Regardless of the design of the room, a power imbalance between birthing women’s needs and organisational demands was identified. This emphasises the need to modify the physical design of birth units, but more importantly, to incorporate a care philosophy that promotes childbirth physiology and agency of birthing women.
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| 6. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Effekten av att föda barn i ett speciellt utformat födslorum: En randomiserad kontrollerad studie
- 2023
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Ingår i: Konferensbidrag Reproduktiv Hälsa, Karlstad.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Den upplevda miljön har betydelse för födselns fysiologiska processer hos kvinnor. Då majoriteten barn föds på sjukhus är det därav betydelsefullt att utforma sjukhusmiljön utifrån aspekter som främjar trygghet och förtrogenhet. Syfte: Att utvärdera om ett speciellt utformat rum ger bättre utfall i samband med födsel, i jämförelse med standardrum. Metod: En randomiserad kontrollerad studie genomfördes under åren 2019–2020 vid ett sjukhus i västra Sverige. Förstföderskor med en singelgraviditet i fullgången tid lottades till att vårdas antingen i ett rum speciellt utformat för att stödja födselns fysiologiska processer (testrummet) eller i ett standardrum. Hypotesen var att det primära kompositutfallet skulle uppfyllas hos fler kvinnor i testrummet, det vill säga: vaginal spontan födsel, ingen användning av oxytocindropp, positiv förlossningsupplevelse, samt blödning <1000ml. För att kunna påvisa en skillnad på 8% mellan de randomiserade grupperna i det primära utfallet, krävdes 1274 studiedeltagare. Bland sekundära utfall fanns andra perinatala utfall samt självskattad förlossningsupplevelse upp till ett år efter födsel. Resultat: Studien avslutades i förtid på grund av Covid-19-pandemin, vilket gjorde att 406 kvinnor randomiserades totalt. Därav uppnåddes inte tillräcklig styrka för att kunna påvisa en statistiskt signifikant skillnad mellan grupperna avseende det primära utfallet. I testrummet uppfylldes det primära utfallet hos 42% av kvinnorna jämfört med 35% i standardrummet (odds ratio: 1.35, 95% CI 0.90–2.01). Kvinnor i testrummet använde epiduralanalgesi i lägre utsträckning. De rapporterade även mer positiva förlossningsupplevelser 3 och 12 månader efter födsel i jämförelse med kvinnor i standardrummen. Konklusion: Denna för tidigt avslutade studie kunde inte verifiera om testrummet förbättrar det primära utfallet. Däremot använde kvinnor i det testrummet i lägre grad farmakologisk smärtlindring och skattade bättre förlossningsupplevelse över tid. Finansiering: Vetenskapsrådet (2018–02406), Institutionen för Vårdvetenskap och Hälsa, Göteborgs Universitet.
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| 7. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial
- 2023
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 16:1, s. 200-218
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the effect of the birthing room design on nulliparous women’s childbirth experience up to 1 year after birth. Background: Although it is known that the birth environment can support or hinder birth processes, the impact of the birthing room design on maternal childbirth experience over time is insufficiently studied. Methods: The Room4Birth randomized controlled trial was conducted at a labor ward in Sweden. Nulliparous women in active stage of spontaneous labor were randomized (n = 406) to either a regular birthing room (n = 202) or a new birthing room designed with more person-centered considerations (n = 204). Childbirth experiences were measured 2 hr, 3 months, and 12 months after birth by using a Visual Analogue Scale of Overall Childbirth Experience (VAS-OCE), the Fear of Birth Scale (FOBS), and the Childbirth Experience Questionnaire (CEQ2). Results: Women randomized to the new room had a more positive childbirth experience reported on the VAS-OCE 3 months (p =.002) and 12 months (p =.021) after birth compared to women randomized to a regular room. Women in the new room also scored higher in the total CEQ2 score (p =.039) and within the CEQ2 subdomain own capacity after 3 months (p =.028). The remaining CEQ2 domains and the FOBS scores did not differ between the groups. Conclusions: These findings show that a birthing room offering more possibilities to change features and functions in the room according to personal needs and requirements, positively affects the childbirth experience of nulliparous women 3 and 12 months after they have given birth.
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| 8. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Impact of the built environment on labour and birth outcomes: the Swedish Room4Birth randomised trial
- 2023
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Ingår i: 33rd ICM Triennal Congress, Bali, Indonesia, 11-14 June 2023.
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Konferensbidrag (refereegranskat)abstract
- 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.
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| 9. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Implementing a new birthing room design: a qualitative study with a care provider perspective.
- 2023
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Ingår i: BMC health services research. - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology.This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n=21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome.The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice.Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment.ClinicalTrials.gov: NCT03948815, 14/05/2019.
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| 10. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Room4Birth – The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial
- 2022
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5764 .- 1877-5756. ; 32
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. Methods: A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. Results: A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90–2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71–0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). Conclusions: The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
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