Doctors and midwives agree it's better for a woman to move around while she's in labor. Walking and changing position makes her more comfortable and helps the labor progress. But in many countries, women giving birth in hospitals are often instructed to lie in bed while their labor progresses.
University of Toronto nursing professor Ellen Hodnett observed that in many modern - and even some not-so-modern hospitals - a bed was at the center of the labor room.
"That bed is a problem," Hodnett says. "Because it's a central focus of the room, and it sends messages that that's where you're supposed to be in labor. And yet, we have pretty good evidence that spending long periods of time in bed, particularly confined in the way that a hospital labor bed confines you, is not conducive to normal, healthy labor progress."
Hodnett has spent years investigating how environment affects the health outcomes for her patients. She began to believe that beds in labor rooms were more for the convenience of the medical and nursing staff than the health of the mothers.
Hodnett compared these women's experiences to those of women who gave birth at home.
"They used a dining room table to lean over. They used the bathtub. They walked around the garden. They were moving, or on all fours, or side-lying on a mat on the floor… a variety of things…" she says.
"And that struck me, even then, that there were more opportunities, more ways for a woman to help herself to be more comfortable and perhaps her labor to be more effective if she were not confined to a bed."
Hodnett convinced several hospitals to change the configuration of their labor rooms. Instead of a high bed in the middle of the room, she put a mattress on the floor, in the corner, with lots of pillows. She also dimmed the lights and had a selection of soothing music and videos of nature scenes for the women to listen to and watch as they went through labor.
The result: The women had an easier time, requiring fewer medical interventions. Most significantly, fewer women needed the use of the artificial hormone oxytocin for their labor to progress. And the women who did require oxytocin required less of the drug.
"[This] suggests that the labor for the women in this ambient or modified room was actually more effective than labor in the traditional hospital room," Hodnett concludes.
"But more importantly, if you look at the results in terms of length of time in labor, the women in the ambient room … their labors were about an hour and a quarter shorter than those in the standard rooms."
Hodnett says one of the biggest obstacles to trying these different methods has been getting health care providers to go along. She says several hospitals would not even consider altering the configuration of labor rooms so she could study the effects.
She hopes that results such as these will make doctors and nurses more willing to try new ways of configuring the places where women give birth.
Her research is published in the journal Birth.