The birth companions’ experience of the birthing room and how it influences the supportive role: A qualitative study

Why does this study matter?
Research shows that receiving support from non-health-professional companions during birth results in healthier outcomes including fewer cesarean sections, lower likelihood of using analgesia, and lower likelihood of the baby having a low 5-minute APGAR score. However, there is a lack of information on what spatial features facilitate companion engagement. In this study, researchers explore the experience of companions during the birth process and how the physical environment influences their ability to provide support during labor.

How was the study done?
This qualitative study was conducted in Sweden and birthing companions were recruited from a university hospital, a transcultural doula organization serving non-Swedish speaking patients, and a midwife team that facilitated at-home births. Fifteen participants including eight fathers, four doulas, two relatives, and one friend were contacted by a specific researcher one week after birth for an interview about their experience. Interviews were semi-structured, with an informal tone allowing companions to describe their perceptions of the birthing room, how the room affected them, their level of comfort in the space, and then elaborate on any other topics that facilitated or distracted from their support role. All but one interview was done virtually and the average interaction lasted 36 minutes.     

So what do we learn from the study?
“Creating a supportive birth space in an unfamiliar environment” was an overarching theme representing companion perceptions of feeling out of place. Subtheme 1, not being in the way, captured participant perceptions that birthing room design engendered feelings that they were intruding so they sought places for themselves and their belongings that would not hinder staff activities. Medical equipment gave a sense of medical risk, subordinating the role of companions who felt that in order to offer support, they had to be out of the way. Subtheme 2, finding one’s role, depicts participants’ efforts to be present for their loved one in an unfamiliar context, describing it as visiting another country where they didn’t know the culture or behavior expectations. Companions’ basic needs were often neglected with getting rest, accessing convenient food, and private toileting mentioned as problematic. The final subtheme of being close to the person represented the need for companions to be physically near their partner so they could hold hands, provide massage, or make eye contact. Unfortunately, most companions perceived that the design of typical birthing rooms mitigated such closeness in favor of monitors, equipment, and beds that only accommodated one person.

Can we say the results are definitive?
Strengths of the study include researchers’ experience as midwives and study participants representing a variety of relationships with patients.  A limitation was that participants were recruited from a single hospital in Sweden and their experiences may not be generalizable to other contexts.

What’s the takeaway?
Recommendations for adapting existing or designing new facilities to better support companion presence during labor include: storage for patient and companion belongings, comfortable furnishings accommodating multiple people, windows with adjustable treatments to control the amount of daylight, a transitional space for those entering the birthing room to increase privacy, the ability to conceal medical equipment to foster a familiar, home environment, and clear signage directing companions to food, drink, and companion-dedicated toileting facilities. The ideal birthing room should be adaptable to individual needs and preferences allowing companions to identify their role, fulfill their needs, and facilitate physical closeness with their partner. 
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Summary of:
Nilvér, H., Berg, M., (2023) The birth companions’ experience of the birthing room and how it influences the supportive role: A qualitative study. HERD: Health Environments Research & Design Journal, Issue 3, Volume 16, Page(s) 156-167

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