Laboring without the labor bed: It's a good thing

A University of Toronto pilot study that re-conceptualized the hospital labour room by removing the standard, clinical bed and adding relaxation-promoting equipment had a 28 per cent drop in infusions of artificial oxcytocin, a powerful drug used to advance slow labours.

The study, called PLACE (Pregnant and Labouring in an Ambient Clinical Environment) was published in the current edition of the journal Birth.

In addition, more than 65 percent of the labouring women in the ambient room, compared to 13 per cent in the standard labour room, reported they spent less than half their hospital labour in the standard labour bed.

Led by Dr. Ellen Hodnett, Bloomberg Faculty of Nursing professor and Heather M. Reisman Chair in Perinatal Nursing Research at the University of Toronto, PLACE included 62 women at two Toronto teaching hospitals.

Hodnett devised a set of simple, but radical modifications to the standard hospital labour room, with the intention of surrounding the women and their caregivers with specific types of auditory, visual and tactile stimuli.

"The removal of the standard hospital bed sent a message that this was not the only place a woman could labour," says Hodnett. A portable, double-sized mattress with several large, comfortable cushions was set up in the corner of the ambient room. Fluorescent lighting was dimmed, and DVDs of ocean beaches, waterfalls and other soothing vistas were projected onto a wall. A wide variety of music was also made available.

"The intent was to allow the women the ability to move about freely during their labour, to permit close contact with their support people, and to promote feelings of calm and confidence," says Hodnett.

Reaction to the ambient room was overwhelmingly positive, as respondents were pleased to have options for mobility and for helping to cope with their labour. They also indicated they received greater one-on-one attention and support from their nurses.

"This study raises questions about the assumptions underlying the design of the typical hospital labour room," says Hodnett. "The birth environment seems to affect the behaviour of everyone in it - the laboring women as well as those who provide care for her.

Hodnett hopes to further this study with a larger, randomized controlled trial.

More information: http://www3.interscience.wiley.com/cgi-bin/fulltext/122413904/HTMLSTART

Source: University of Toronto (news : web)

   

• tkjtkj - Jul 06, 2009
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  I should hope that the future 'controlled' study will isolate the parties responsible for managing the medical aspects of labor from the knowledge of just what sort of environment the patients are in! Its just too likely that the 'experiment' described here can be explained by a patient and professional population that are highly-motivated to try to minimize the possible effects of the 'institutional' settings of birthing hospitals. Were the patients more motivated? Was the staff more motivated? I might suggest that the future study include two sets of care-givers, one being the 'real' and responsible set, the other being some remote group whose role is to analyze objective data (monitor strips, labs, etc) with no knowledge of the actual physical settings of the experimental and the control patient populations. Not an easy job im sure, but i dont see how this can be done otherwise.
  
  
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• david_42 - Jul 06, 2009
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  And what about the machine that goes "Beep"? If we don't use it, we can't depreciate it.
  
  it would be interesting to know if the ambient room made any difference in labor times or C-sections, but the source is a subscription article.
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