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The hospital birth environment: Impacts on midwifery practice during labour and birth

      Alternative settings for birth, such as birth centres, are associated with reduced levels of intervention and a positive experience of labour and birth for women. In Australia, few women (approx 3%) give birth in alternative settings. Most Australian women give birth in a traditional hospital labour ward environment. In this environment, midwives are charged with the task of facilitating normal physiological birth. Although facilitation of normal physiological birth is supported by state health policy, rates of normal birth are low in the hospital environment. It is possible that the design of many hospital birth units does not support midwifery practice that facilitates normal physiological birth. Recent research suggests the environment impacts midwifery practice, although explicit design features that support facilitation of physiological birth have not been identified. At present, optimal birth unit design is not well investigated from the midwife's perspective. This study examines the midwives’ perspectives on birth unit design through two explicit aims – (1) Explore midwives thoughts, feelings and responses to the birth unit environment, (2) Identify design features that support or inhibit midwifery practice in the birth environment. This study employs a qualitative, exploratory design; data were collected through face-to-face interviews (n = 16). Data are subjected to discourse analysis utilising elements of the APPRAISAL linguistic analysis tool. The methodology of critical realism was employed. Critical realism gives equal weight to physical and non-physical phenomena, encompassing the art and science of midwifery. Preliminary analysis indicates midwives can identify environmental features that support facilitation of physiological birth. Exploring the impact of birth environment on midwifery practice may inform the design of birth units that better support normal physiological birth.
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