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The Room4Birth research project – a multi-disciplinary programme

The Room4Birth research project is an interdisciplinary activity conducted by the Institute of Health and Care 91̽��s at the Sahlgrenska Academy, University 91̽��.

The Principle Investigaor is Professor Marie Berg.

Most studies are conducted in Sweden, and a few in the Democratic Republic of Congo. The Room4Birth programme also includes several development studies, pedagogical projects and master theses.

Collaborating partners:

• Centre for Healthcare Architecture, Chalmers University of Technology. Gothenburg Sweden School of Nursing & Midwifery, Trinity College Dublin, Ireland
• Evangelical University in Africa, D.R. Congo
• University of Borås Sweden
• Sahlgrenska University Hospital Gothenburg Sweden
• Panzi general referral hospital, Bukavu, D.R Congo, and Birth Rights Sweden.

Motif and theoretical basis

To give birth is a central life event that is remembered and affects the woman throughout her life. It is an innate, biological, instinctive process that has always been, and still is, linked to certain risks. Therefore, mammalian mothers, including human beings, have instinctively always chosen to give birth in an environment perceived as safe, secure, and private. When a woman in labour arrives at the hospital, fear and defense functions may be activated (by such factors as loud noise, light, a strange, unfriendly environment), and the activity of some parts of the brain cortex and amygdala that signal danger can increase. Consequently, the activity of the body's stress and defence system also increases (the HPA axis). Under such circumstances, oxytocin release may be inhibited, and/or the sympathetic nervous system activity may increase. Consequently, labour contractions can become too strong and painful, or even cease, leading to medical intervention, and to a remaining fear of giving birth again.

The opposite also applies; if the cortex and amygdala perceive the environment as safe, harmless, friendly, and inviting, this leads to physical and mental relaxation, and to decreased fear and stress responses. Oxytocin release increases together with the activity of the parasympathetic nervous system. This leads to more effective labour contractions and to a good blood circulation in the uterus, which positively affects the progress of childbirth, increases oxygenation of the fetus, and prevents postpartum hemorrhage. In addition, it is more beneficial to give birth at night16. The hormone melatonin, more often released during darkness, promotes labour and birth by decreasing the effect of the sympathetic nervous system and increasing the effect of the parasympathetic nervous system, which facilitates oxytocin-induced uterine contractions. Touch, warmth and closeness also promote the release of oxytocin, increase the function of the parasympathetic nervous system and decrease stress levels.

Giving birth can be a strengthening force for women who experience safety and who are able to give way to the labour flow. It can also leave negative impressions such as feelings of helplessness, loss of control, insecurity, fear, and objectification. Historically, women have generally been attended and supported by other women (lay or professionals) during labour. In later years, fathers to be/partners have often taken over this role.

In Sweden women give birth mainly at hospitals. The goal is that the majority of the women have a spontaneous vaginal birth without instrumental interventions. However, statistics show that caesarean sections and extractions with vacuum suction have increased in recent decades. This trend towards less spontaneous vaginal, non- instrumental births is unfortunately similar in low-income countries such as in D.R. Congo.

Experience of non-empathetic treatment by healthcare professionals that work in threatening or over-medicalised environments can further influence negative impressions. A negative experience of childbirth can cause ill-health in women such as posttraumatic stress disorder, depression, and persistent intense fear of childbirth, and may be related to a delayed subsequent pregnancy and to demands for future operative birth.

The healthcare environment affects the patient's recovery and health, however the healthcare environment in relation to birth is sparingly studied.

Publications and presentations

Scientific papers

Goldkuhl, L., Tistad, M., Gyllensten, H., & Berg, M. (2023). Implementing a new birthing room design: a qualitative study with a care provider perspective. BMC Health Serv Res, 23(1), 1122.

Nilver, H., & Berg, M. (2023). The Birth Companions' Experience of the Birthing Room and How It Influences the Supportive Role: A Qualitative Study. HERD, 16(3), 156-167.

Berg, M., Berg, U., Mapatano, E., & Mukwege, D. (2023). Caesarean section rate reduced by a redesigned birthing room. Results of a quality improvement intervention at a hospital in Democratic Republic of Congo. Sexual & Reproductive Healthcare: 39, 100925.

Goldkuhl L, Gyllensten H, Begley C, Nilsson, C., Wijk, H., Lindahl, G., Uvnäs-Moberg, K., Berg, M. (2023) Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial. HERD. 16(1):200-218. doi:10.1177/19375867221124232

Goldkuhl, L., Gyllensten, H., Begley, C., Wijk, H., Nilsson, C., Lindahl, G., Ringqvist, A.-K., Uvnäs-Moberg, K., Berg, M. (2022). Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centered considerations: A Swedish randomised controlled trial. Sexual and Reproductive HealthCare, 32, 100731. doi:10.1016/j.srhc.2022.100731.

Skogstrom, L. B., Vithal, E., Wijk, H., Lindahl, G., & Berg, M. (2022). HERD, Mar 16:19375867221077097. doi:10.1177/19375867221077097

Goldkuhl, L., Dellenborg, L., Berg, M., Wijk, H., & Nilsson, C. (2021). T doi:10.1016/j.wombi.2021.07.005

Andrén, A., Begley, C., Dahlberg, H., & Berg, M. (2021).  Int J Qual Stud Health Well-being, 16(1), 1939937. doi:10.1080/17482631.2021.1939937

Nilsson, C., Wijk, H., Hoglund, L., Sjoblom, H., Hessman, E., & Berg, M. (2020).Effects of Birthing Room Design on Maternal and Neonate Outcomes: A Systematic Review HERD, 13(3), 198-214. doi:10.1177/1937586720903689

Berg M, Goldkuhl L, Nilsson C, Wijk H, Gyllensten H, Lindahl G, Uvnäs-Moberg K, Begley C. (2019) . Trials. Nov 19;20(1):629. doi: 10.1186/s13063-019-3765-x

Master´s theses

Lisa Björnson Skogström & Emma Vithal (2021). Women’s experience of physical features in a specially designed birthing room – a mixed method study in Sweden. Master Thesis in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden.

Andrén Anna (2020). Midwives´experience of the birthing room and its influence on the promotion of a normal vaginal birth - a qualitative interview study in Sweden. / Förlossningsrummets påverkan på barnmorskans främjande av normalfysiologisk vaginal födsel - en kvalitativ intervjustudie med barnmorskor på en förlossningsklinik i Sverige. Master Thesis in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden

Ida Johansson, Linnea Maxon (2020). Like entering another world – Midwives´ experience of caring for women in labor and birth in a specially designed delivery room – a phenomenological interview study. / Som att komma in i en annan värld. Barnmorskors upplevelse av att vårda kvinnor i förlossningsarbete i ett specialdesignat förlossningsrum – en fenomenologisk intervjustudie. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden. 

Johansson Caroline, Söndergaard Julia (2019). To compose and test the Room4Birth Study - A feasibility study / Utarbetning och test av room4birth studien - en genomförbarhetsstudie. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden.

Gasslander Emma, Kamber Nesrin (2018). Translation of the tool BUDSET from English to Swedish - a valuation tool of the birth environment. / Översättning av BUDSET från engelska till svenska - ett verktyg för utvärdering av förlossningsmiljön. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden. 

Angervall Josephine, Wennerbäck Evelina (2018). Developing the healthcare environment to promote the health of mother and child – a description of a multidiciplinary project at Panzi hospital in The Democratic Republic of Congo / Att utveckla vårdmiljön för att främja hälsa hos mor och barn - beskrivning av ett multidisciplinärt projekt på Panzisjukhuset i Demokratiska Republiken. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden. 

Höglund Lina (2017). The Significance of the birthing room for physical and mental health – A integrative literature study / Förlossningsrummets betydelse för fysisk och psykisk hälsa - En integrativ litteraturstudie. Master thesis in Reproductive and Perinatal health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden.  

Lundgren Caroline (2017). Birthing room experiences – a qualitative interview study of women who have given birth. Master Thesis May 2017. Master thesis in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden

Wibeck Axelsson Lisa (2017). Experiences of the birthing room – from the perspective of non-Swedish speaking women. / Upplevelser av förlossningsrummet - Ur icke svensktalande kvinnors perspektiv. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden. 

Lundgren Caroline, Löfqvist Jennie (2017). Towards the ideal delivery room, women´s experience and desires. / Vägen mot det ideala förlossningsrummet. Kvinnors upplevelser och önskningar. Master one year thesis (“magister” 15 credits) in Reproductive and Perinatal Health. Institute of Health and Care 91̽��s, Sahlgrenska Academy, University 91̽��, Sweden. 

Congress presentations, peer reviewed

Lisa Goldkuhl, Caroline Johansson, Lisa Björnson Skogström, Marie Berg. An adaptable birthing room and its effect on labour and birth – feasibility study for the randomised controlled trial; Room4Birth in Sweden. 32'nd ICM Triennial Virtual Congress June 2021. (Abstract. Poster presentation by Lisa Goldkuhl)

Berg Marie, Ringqvist Anna-Karin, Wijk Helle, Johansson Caroline, Begley Cecily, Lindahl Göran, Nilsson Christina. A randomised controlled trial in Sweden comparing an innovative person-centered adaptable birthing room with standard birthing rooms – A study protocol. Nordic Jordemor (Midwife) Federation Congress Reykjavik 2-4 May 2019.  (Poster presentation, P35 Marie Berg)

Caria Cristiana, Orstadius Agnes, Berg Marie (2018). Concept design for a New Mother and Baby Unit at Panzi Hospital, in Bukavu, DRC. European HealthCare Design Research Policy and Practice. Royal College of Physicians London 12 June 2018. (Oral presentation by Caira, Orstadius Berg). https://www.salus.global/article-show/concept-design-for-a-new-mother-and-baby-unit-at-panzi-hospital-bukavu-dr-congo

Popular science publications and presentations

Lisa Björnson Skogström och Göran Lindahl. Förlossningsrummet – erfarenheter från ett projekt. Muntlig presentation vid konferens: Dagens Medicin ”Smarta sjukhus” 2021-10-12.

Lisa Goldkuhl (2020). Förlossningsrumsstudien. Jordemodern 2020 No. 5, s 12-13.

A masterplan for a new mother baby unit at Panzi hospital. Presentation for Dr Denis Mukwege and team at Panzi General Referral Hospital at a workshop in Oslo 6th May 2017.  Oral presentation by Berg Marie, Cairo Cristiana, Saga Karlsson. 

Berg Marie, Fröst Peter, Hogenäs Maria (2016). Written report based on design workshop on developing an excellent maternal neonatal service at the Referral hospital of Panzi.  / Rapport Design Workshops concernant un Service Mère-Enfant à l´Hôpital de Panzi, Bukavu, D.R. Congo 31 Mars – 2 Avril 2016. University 91̽�� and Chalmers University of Technology.

Other medial publications