Discussion
ADVERSE EVENTS, COMPLICATIONS
The analysis of care providers’ experiences regarding the implementation of the new birthing room identified contextual elements, mechanisms and outcomes influencing the extent to which the room could be integrated as part of ordinary practice. Implementing the new room into the existing building raised the care providers’ awareness about the complex interplay between women’s birth physiology and the environment. This awareness had the potential to influence care providers to be more emotionally present with the woman and her companion, rather than to prioritise monitoring practices. However, the new room also evoked conflicting emotions as the care providers needed to negotiate between the health-promoting, personalised environment, and the prevailing biomedical paradigm of the labour ward context.It is known that people conform to and interact with built environments, and it is through these human interactions that space is created [The health-promoting view of birth reflected in the new room corresponded with care providers’ perceptions of what is supportive for labouring women in their transfer from home to the hospital. As described in the NPT framework [Our study demonstrates how the design of the new birthing room contrasted with the medico-technical environment in the standard rooms and the prevailing paradigm of the labour ward context. The new design aligned with a more integrative model of care, consistent with the social/midwifery model of care described in previous literature [Our findings also illustrate the challenge of implementing an intervention that was not entirely compatible with the established norms. Obstetricians and assistant nurses experienced a sense of exclusion or perceptions of the new room as occupied with irrelevant attributes, illustrating that the intervention was not fully aligned with their professional responsibility. These experiences contrasted with the midwives’ perception of the new room as helpful in their supportive activities and indicates conflicting preferences of what should be prioritised in built birth environments. Given that the new room reflected a more health-promoting view — which is in line with the scope of midwifery practice [Some of the care providers in the current study associated the new room with complications, which seemed to be related to their unfamiliarity with the room. The main outcome of the Room4Birth RCT did not confirm these notions. The findings showed no increase in medical interventions or adverse events in the new room [The design of the birthing room is one factor that may influence women’s experiences, birth physiology and care provision in a labour ward context. However, it is crucial to recognise that the prevailing paradigm and organisational decisions also play significant roles [