Chapter 4 The birthing environment

A labouring woman’s sense of safety and privacy influences the birth process (Buckley 2004). This fundamental and life-changing event should therefore take place in an optimum environment. The environment for birth should take account of new developments in attitudes and practice while remaining mindful of safety for all concerned (Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) 1999).

HOSPITAL BIRTHING ROOMS

The importance of creating a home-like birth environment was shown in a systematic review by Hodnett et al (2005) which found that home-like settings significantly reduce the need for intrapartum analgesia, and increase spontaneous vaginal birth and maternal satisfaction.

Birthing rooms should be comfortable, decorated in a homely style and contain, or have access to, equipment that allows mobility and position change such as beanbags and floor mats. It is important to match facilities with workload and work within national guidelines. For example a cardiotocograph (CTG) must be used in conjunction with fetal blood sampling (National Institute for Clinical Excellence (NICE) 2001).

Towards Safer Childbirth (RCOG and RCM 1999) specifies the requirements for equipment in the case of emergency, which was supplemented on the basis of local experience. The full list of equipment is shown in Box 4.1.

Box 4.1 Equipment for hospital birthing rooms

Fetal assessment

• Two to four CTG machines per 1000 births (with facilities for monitoring twins)

• Pinard stethoscope/Doppler/hand held electrical auscultation device

• Access to fetal blood sampling

Neonatal resuscitation

• Flat surface with a heat source (radiant or/and mattress)

• Clock

• Suction

• Oxygen/air mix with variable regulated flow mix and adjustable pressure relief valve including positive end-expiratory pressure (PEEP) and neonatal size Ambu bag

• Neonatal laryngoscopes

• Endotracheal tubes

• Umbilical catheterisation pack, syringes scissors

• Drugs including surfactant

Maternal resuscitation

• Bed available for prompt resuscitation

• Oxygen and suction

• Equipment for intravenous access and resuscitation

• Drugs including oxytocics, and drugs for cardiac resuscitation and anaphylaxis

• Defibrillator

There should be guidelines in place for pathways of care and prompt access to high-dependency facilities such as adult and neonatal high-dependency unit/intensive care. An ultrasound scanner should be available for use by staff trained in its use. Beds should be easily adaptable for assisted birthing and be effortlessly mobile so in an emergency the woman can be transported while in her bed to a dedicated obstetric theatre. Emergency equipment should be out of view (for example in purpose-built cupboards) from the labouring woman and her partner or companion (Figure 4.1).

Figure 4.1 A fully equipped birthing room.

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