Thank you, Mary, for opening that one out. It was one of my first
thoughts too, on reading this thread.
A huge amount of money has gone into trying to make birthing units
'homely' (whatever that means), because there is an awareness that the
environment can have an important impact on physiology.

We've just had an article accepted by Midwifery which looks at
women-partner dyads, and their views of the environment and the care
received. In this paper we didn't explicitly tie this in with clinical
outcomes, but there is some evidence that the clinical environment does
affect clinical outcomes. In short, a hostile environment may hinder the
normal physiological process because it prevents the woman from
relaxing.
We discussed this in an earlier paper too: 

Symon A, Paul J, Butchart M, Carr V, Dugard P (2007) Self-rated
‘no’ and ‘low’ risk pregnancy: a comparison of outcomes
for women in obstetric-led and midwife-led units in England. Birth, 34
(4): 325-332

Environment is more than décor - it also includes perceptions of the
staff encountered. A bit tangential to your original query, Claire, but
it may open up another avenue for you.
Good luck with your research.

Andrew Symon






Dr. Andrew Symon
Senior Lecturer
School of Nursing & Midwifery
University of Dundee
01382 388553
http://dundee.academia.edu/AndrewSymon/


************************************************************
Please consider the environment.  Do you really need to print this
email?

>>> "Stewart, Mary" <[log in to unmask]> 21/10/2010 16:27
>>>
Hello Kirsty and Claire, and thank you to you both for opening this
interesting and important discussion.  My comment is a bit tangential,
to be honest, but there is a growing body of literature that explores
the concept of building design and health, particularly in relation to
hospitals, health centres etc.  This link gives a bit more information:
 http://www.adesignforhealth.co.uk/research2.php 

I think there is huge potential for inter-disciplinary and
inter-professional work e.g. collaboration with architects, art
therapists, geographers, social scientists as well as health
professionals and, most importantly, service users.  So much money is
spent on hospitals and other public buildings - it would be great if
there was a bit more holistic planning in the early stages of design.

Very best wishes

Mary


Mary Stewart
Consultant midwife
Room J334
Chelsea and Westminster Hospital NHS Foundation Trust
369 Fulham Road
London SW10 9NH
 
Tel: 07872 423085

-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Coxon,
Kirstie
Sent: Thursday, October 21, 2010 8:34 AM
To: [log in to unmask] 
Subject: Physiological disturbance

Hi 
thanks Claire for your email - I would be very keen to see Sarah
Buckley's paper, if you can send it to me ([log in to unmask]),
or if you send me the reference I should be able to track it down. 

To other Jiscmail colleagues, I responded to Claire's initial email
'off list' and said I'd be interested to know if she was aware of papers
or resources that discuss the concept of physiological disturbance
during birth. I am not a physiologist, but I am researching womens'
choice of place of birth, and apprehension about transfer or moving
during labour plays an important part in women's decisions, especially
when they are considering Freestanding Midwifery Unit or home birth,
less so with Alongside Midwifery Units and Obstetric Units (although in
some post -natal interviews, women then discuss the impact of multiple
moves within hospitals, so I think that it's unanticipated that they may
have to move often within hospitals, rather than it not affecting
hospital births). Having looked at this issue a while ago, I was
surprised to find that little is published, although I am aware of
Michel 
Odent's work and most recently, Fahy and colleagues' text on
Birth Territory and Midwifery Guardianship. 

As Claire has reassured me that she also is surprised that little is
published on this topic, I thought I might open my request up to the
list, (being normally quite shy and a bit of a list 'lurker'!) and
enquire if others know about research into the impact of different
places, or moving between places, on labour and birth - including
physiological disturbance.

many thanks

Kirstie

Kirstie Coxon

Research Associate & NIHR Research Training Fellow
Room 708
Department of Public Health and Primary Care Research
King's College, London
Capital House
42 Weston Street
London
SE1 3QD

Tel
07986 911814 (mobile and study contact number)
0207 848 6648
Fax 0207 848 6620
________________________________________
From: A forum for discussion on midwifery and reproductive health
research. [[log in to unmask]] On Behalf Of Claire Feeley
[[log in to unmask]] 
Sent: 20 October 2010 14:28
To: [log in to unmask] 
Subject: Re: New member

Hi, thanks for all your welcome messages!

I have got hold of Rixa's thesis thank you, its fab, and is a main
component of my dissertation.  There is another thesis by Lauren Brown
and a paper by Amy Miller. All from the US.  I have just submitted the
first draft of my dissertation so when its finally ready for submission
I shall be happy to post it, if it would be of interest.  It is a very
much under researched area.

A question I pose is what can midwives and obs learn from women who
freebirth?  For certainly much of my attraction to the subject has
stemmed from the iatrogenesis I have witnessed/been a part of whilst
training and it certainly has caused me to deeply reflect upon my
practice and role as a midwife.  It also has caused me to really get to
grips with my own birth experience, and although I mostly had a postive
experience, I did have some unresolved issues surrounding it.  Exploring
freebirthing has created new angles to examine it through which has been
interesting.


In reply to Kirsty, I find it fascinating that there is so little about
physiological disturbance out there!  Prior to my degree I read as much
Michel Odent as I could, and it just simply made sense to me.  Thank you
for the other pointers, I shall look up Nadine Edwards book, I have not
come across it yet.  The references that the women use in freebirthing
is mainly Odent and Sarah Buckley who writes about undisturbed birth,
she is a GP in Australia and I can send you her article if you wish?  I
remember Stephanie Meakin giving a wonderful talk at the ARM conference
2 years ago about the hormonal interplay, although I am not sure what
she has written.

Thanks again for all your welcomes.  This is certainly feeding my
interest in research!

Claire
3rd midwifery student

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