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Babies, not burgers: why we need better-designed labour wards

Women report that the birth environment is a key factor in how easy or hard it is to give birth. Image from

I recently visited a new McDonald’s outlet on the northern fringes of Sydney. What I found inside left me gawping in astonishment: soft lighting, views of nature, a mixture of private and communal spaces, adaptable furnishings, excellent way-finding, warm colours, natural materials, positive distractions!

Everywhere I looked I saw evidence-based design features that, when translated to the hospital environment, have been shown to improve experiences and outcomes for users. But this was a McDonald’s store… so why did it feel better designed for low-risk maternity care than most hospitals?

The answer is simple. McDonald’s is using design to create spaces that support an optimal consumer experience.

The influence of design

In the maternity care setting, the childbearing woman is the primary consumer. And from a health perspective, the optimal experience and outcome for most women is a normal birth – without medical intervention.

But despite this, medical intervention is at an all-time high in this country, with caesarean sections now accounting for 33% of all births.

About 97% of Australian women give birth in conventional hospital labour ward rooms. These rooms are commonly designed with a narrow bed as the focal point, contain multiple pieces of medical equipment and display a clinical aesthetic.

According to a Cochrane Review, women who labour in conventional birth rooms are more likely to experience interventions including caesarean section. Women who labour in alternatively designed, or ambient, rooms use less epidural pain relief, have fewer medical interventions and a higher chance of having a normal birth.

Women have reported that the birth environment is a key factor in how easy or hard it is to give birth. Remarkably, one UK study found that simply obscuring medical equipment from view with a painted screen, shortened the duration of labour by two hours and reduced requests for epidural pain relief by 7%.

National guidelines state women should be able to use birth rooms much like they’d use their own home. AmySelleck, CC BY

Although the reasons that underlie birth outcomes are complex, design is likely to play a role. This is partly because the designed environment has widely acknowledged effects on human neurobiology. The complex hormonal system that controls labour is disrupted when part of the brain called the neocortex is stimulated.

A range of environmental factors can stimulate the neocortex including bright lights, loud noises, unknown people and places that are perceived as hostile or frightening. By adapting the design of hospital birth rooms to minimise these factors, we give women a better chance of achieving a normal birth and optimal health outcomes.

Spaces for an optimal experience

Maternity care providers are now implementing strategies to increase the normal birth rate and decrease caesarean sections. The NSW Health policy directive Towards Normal Birth, for instance, states that all women giving birth in hospital should have access to an environment that “is conducive to facilitating/promoting normal birth.”

This is reinforced in the Australasian Health Facility Guidelines for maternity units. They state that birth rooms should be designed so that “women may use them much as they would use their own homes”. The guidelines clarify that the bed should not be the focal point of the room and a calm, private, ambient space is the ideal.

The cost of refurbishing or rebuilding maternity units to reflect these guidelines is perceived as a barrier to the provision birth rooms that support optimal outcomes. However, many design features that facilitate normal birth such as wall-mounted bars, benches of various heights, birth stools and inflatable birth pools can be added to existing birth rooms without major alterations to architecture or infrastructure.

Simple changes to enhance ambience can be made by altering colour, lighting and room layout. These changes may ultimately reduce health expenditure by lowering the number of costly interventions performed during labour and birth.

Even simple changes to enhance ambience can make a difference. Mercy Health, CC BY-NC-ND

Designing for health

Over the past 30 years, research into the field of evidence-based design has significantly altered how we think about the design and function of health-care facilities. Coupled with advances in neuroscience, cellular biology and epigenetics, a clear message has emerged that the designed environment has measurable therapeutic and practical benefits.

Innovative, evidence-based hospital birth room design has been incorporated into a handful of new maternity units around the country, such as the Centenary Hospital for Women and Children in the ACT and at the (yet-to-open) Royal North Shore Hospital in Sydney. In these units, rooms incorporate the needs of healthy, active women while still providing safe emergency options.

These units show that normal birth and unexpected outcomes can be catered for in the same space by implementing thoughtful design. Hopefully these advances inspire further change around the country. Let’s face it: if you can get good design when you’re having a burger, you should really be able to get it when you’re having a baby.

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