By Caroline Flint

Labour wards should be comfortable, home-like places, says Caroline Flint. Here she makes some suggestions on how to improve them

Throughout the country we are trying to `humanize' our labour wards. We are trying to make them more comfortable, more relaxed, cosier and more like home.

I lay in bed this morning and tried to think of what the essence of a bedroom is. I looked around my own familiar bedroom and in my imagination tried to transport myself to a delivery room in our hospital, and then I compared the difference.

First, and probably most importantly, no strangers ever come into my bedroom. The door never flies open letting a stranger in, either to borrow some equipment or to check me over or to discuss anything with my companion. People only enter my bedroom by invitation' even my children knock and wait for permission before coming in to look for their socks in the airing cupboard, or to ask for their dinner money.

I thought about being in a delivery room/my bedroom and being in labour and realised that if I transferred my bedroom to the labour ward I'd want to be able to bolt or lock the door to stop strangers from walking in especially if I were undressing, having a vaginal examination, having my abdomen palpated, using a bedpan or being emotional and was being comforted by a midwife, companion or husband.

The lack of privacy in labour wards, even in the most enlightened of hospitals, came over very strongly recently. We had a woman in labour and her contractions were going off; we suggested that her husband should stimulate her nipples and that we would leave them in private for 15 minutes.'

The other invasion of privacy in most delivery wards are the grills in the doors, similar to the peepholes in prison cells. Most enlightened hospitals have covered their 'spyholes' with paper or had them removed, but it is worth imagining the effect that these 'spy-holes' would have on you if there were one in your own bedroom door and when you looked up there was a pair of strange eyes looking at you. Hardly conducive to the relaxed release of oxytocin by a labouring woman.

The most important feature in most bedrooms is the bed. I imagined the bed in my transported bedroom/delivery room. The essence of my bed is that it is comfortable, I can lie in it for eight, 10, or even 12 hours with comfort. When I had `flu two months ago I lay in bed for four days and suffered no stiffness, no pressure sores, no discomfort. The other great pleasure of my bed is that it is cosy, when I stretch out there is the warm and reassuring presence of my beloved husband. Double beds are perhaps the most companionable places ever designed and for people who have been sharing their lives with a partner this is perhaps the greatest deprivation of all when they come into hospital.

I remember, when I was a nurse working at night in a gynaecological ward, I heard little sobs coming from the far end of the ward, and when I went to investigate I found a woman in tears, who said, `I put my hand out to find him, and he wasn't there'. Even as a young nurse with no experience of sharing a bed it moved me to tears.

Other memories come flooding back. After our first baby was born at home, one of the most magical experiences for both of us was the new family, snuggling down in bed together with arms around each other listening to baby Matthew snuffling and sucking his fist. I often think of that when fathers who have just gone through the same experience, say goodbye to their new baby and their partner who lies pristinely in her single bed in the postnatal ward.

Another memory is very recent. Two weeks ago when a couple had given birth to a stillborn baby, like all caring hospitals nowadays, the husband was allowed - even encouraged - to stay to support and share their grief together. When I knocked and came into their bedroom the morning after their tragedy, the wife was already awake. Lying at the end of her bed on one of the hospital's little portable beds was her husband, sleeping soundly. I asked her how she had slept and she said wistfully, `I really missed Derek; he seemed so far away. We tried with both of us lying in the bed, but it was too precarious.' My heart went out to her, this grieving woman who only wanted someone's arms around her. If only she had been in a double bed this would have happened without thought or effort.

Another memory is of a couple whose baby I had delivered who had a breathing problem. The baby was in the special care baby unit. The mother, now past her 10 days, was staying in the mother's bedroom in the SCBU. I knocked on the door, timidly, I knew that the news was not good. When I was invited in, a touching scene was revealed. Mother and father had managed to snuggle together on the narrow bed in order to cuddle and comfort each other.

In many labour wards great efforts are being made with wallpaper, pictures and pretty bedspreads. If the bedspreads are going on the hard platforms which are more reminiscent of an ironing board than a bed, then is there really any point? I often feel that we midwives and our colleagues should all spend one night's `sleep' on one of our delivery `beds' and see how we feel in the morning. I imagine we should all feel stiff bruised and uncomfortable.

Many hospitals have of course recognized the inadequacies of the conventiona delivery bed and they are spending several thousands of pounds on highly sophisticate( `birthing beds' or `birthing chairs' which turn into beds complete with lithotomy poles a the touch of a switch. In frustration, the As sociation of Radical Midwives, having real ized that most women are still giving bird on these hard platforms, has designed a cheat birthing bar which will slot into the holes where the lithotomy poles go, so that women will have more opportunity to move around during labour even when confined to the bed.

At our own hospital we are blessed with soft mats which we put on the floor and cov er with a clean sheet so that women can crawl squat or flop as they please. We also have wonderful plastic-covered beanbags whicl they lie back in to deliver, or lean against to deliver on all fours. We keep the convention al delivery beds just outside the door, readily available if complications occur and we nee to put the woman into the lithotomy position

All the beds are on wheels so it only takes second to bring them into the delivery room. My suggestions for `humanizing' the labour ward are simple and above all cheap Labour wards will only become `cosy' when we buy double beds so that during labour and after the birth, a couple can cuddle and sup port each other. The cost of a double bed is only £400 at the most; a lock or bolt only costs a couple of pounds but think of the dif ference they would both make!

Reference

1. Lenke, R.R., Nemes, J.M. (1984). `Use of nipple stimulation to obtain contraction stress test.' American Journal of Obtetrics and Gynaecology; Vol. 63: No 3.

June 13, 1984