July 6, 2009
Laboring Without The Labor Bed
Pilot study removes standard hospital bed as focal point of labor
A University of Toronto pilot study that re-conceptualized the hospital labor room by removing the standard, clinical bed and adding relaxation-promoting equipment had a 28 per cent drop in infusions of artificial oxytocin, a powerful drug used to advance slow labors.
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 laboring women in the ambient room, compared to 13 per cent in the standard labor room, reported they spent less than half their hospital labor in the standard labor 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 labor 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 labor," 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 labor, 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 labor. 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 labor 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.
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