Listening to the Voices of Healthcare Providers Who Involved in a New Birthing Room Design: An Interpretative Phenomenological Analysis Study

Listening to the Voices of Healthcare Providers Who Involved in a New Birthing Room Design: An Interpretative Phenomenological Analysis Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Listening to the Voices of Healthcare Providers Who Involved in a New Birthing Room Design: An Interpretative Phenomenological Analysis Study Anwar Nader AlKhunaizi, Areej Ghalib Al-Otaibi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4714570/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Dec, 2025 Read the published version in BMC Health Services Research → Version 1 posted 17 You are reading this latest preprint version Abstract Background Birth is a process which encompasses neurohormonal, physiological and psychological elements, but is mainly controlled by oxytocinergic mechanisms. Neurohormonal processes can be impacted negatively by the external environment, since an unknown and stressful environment can trigger the sympathetic nervous system, and thus repress the amount of endogenous oxytocin being released. This, in turn, can weaken or even stop labor contractions. Alternative birth environments can not only reduce the effects of negative healthcare, but can also result in women having a positive perception of patient-centered care and its capacity to meet the health and social care needs of future generations. Methods An interpretative phenomenological qualitative approach was conducted in a government hospital in the Eastern Province of Saudi Arabia. Data collection involved conducting semi-structured interviews with 15 participants. The sample consisted of physicians, and midwives, ensuring a diverse range of perspectives. Results An interpretative phenomenological analysis was conducted for data analysis. One core category Supportive Birth Environment for Natural Childbirth with four emerged from the data analysis. The four themes are: supporting natural birth through room design; providing private space through the new design; the influence of birthing room design on midwives’ roles; and suggestions and recommendations. Conclusion All participants demonstrated awareness of the advantages of the new birth room design for the mothers' psychological well-being and normal, natural childbirth, which can help contribute to a positive experience during their hospital stay. However, additional efforts are required to deliver massage to the decision-makers and responsible authorities at the Ministry of Health about the significance of the new birthing room design on the mothers’ experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level. Birth room design Interpretative phenomenological analysis Natural birth Psychological wellbeing Midwives’ roles Semi-structured interviews Background Birth is a process which encompasses neurohormonal, physiological and psychological elements, but is mainly controlled by oxytocinergic mechanisms. The latter are affected by sensory stimuli for example those coming from the uterus and the support which is offered by a birth companion. Neurohormonal processes can be impacted negatively by the external environment, since an unknown and stressful environment can trigger the sympathetic nervous system, and thus repress the amount of endogenous oxytocin being released. This, in turn, can weaken or even stop labor contractions. In contrast, women who give birth in a safe, peaceful and private setting will experience lower levels of stress, which will improve the release of endogenous oxytocin and thereby increase the likelihood of a relaxed and efficient labor [ 1 , 2 ]. Townsend et al. [ 3 ] state that there is a growing body of evidence which supports the view that the birth environment plays a major role in determining how women experience labor, birth and the practice of midwifery. According to Nielsen and Overgaard [ 4 ], alternative birth environments can not only reduce the effects of negative healthcare, but can also result in women having a positive perception of patient-centered care and its capacity to meet the health and social care needs of future generations. Goldkuhl et al. [ 5 ] note that there is evidence which shows that hospital birthing rooms which have been designed to provide a comforting and familiar space, with supportive multisensory features such as calming lighting and sounds, and cozy furniture, make it less likely that women will request epidural analgesia in labor. Wronding et al. [ 6 ] add that this type of environment also lowers cesarean birth rates. Research into the design of birthing rooms is a relatively new and exciting development in the study of obstetric care, its risks and technological tools, in many countries. Andrén et al. [ 7 ] and Hodnett et al. [ 8 ] note that this fresh perspective is mirrored in how birthing rooms are designed and equipped. Bowden et al. [ 9 ] carried out a groundbreaking study which examined internet images of birthing rooms found in developed countries. Their research identified three different styles of room, and offered us a new understanding of these settings. The researchers found that approximately 50 per cent of the rooms prioritized technology, placing an electrically-operated birthing bed in the middle of the room, and a range of technical equipment- such as a cardiotocography machine (CTG), neonatal resuscitation unit, and surgical lamp -where the mother could see them. The second type of birthing room was less common and aimed to create a homely atmosphere, by using warm colors and lighting and comfortable furniture, and not placing the bed and the equipment in the middle of the room. Finally, a third type of birthing room used features of both forms, and although it usually situated the bed in the middle, the room also featured comfortable furniture and splashes of color [ 9 ]. These findings should act as a stimulus to undertaking further studies of birthing room design and functions from a new perspective. However, Lorentzen et al. [ 10 ] point out that many of the birthing settings which feature in trials also reflect a number of other features, such as continuity of care, in their organizational model, and this could have a positive impact on birth outcomes. At present it is clear that there is a knowledge gap and a need for further scientific evidence of how the birth environment affects labor, with particular emphasis on the role of the birthing room [11,12 ].Nilsson et al. [ 11 ] conducted a literature review into how birthing room design influences maternal and newborn outcomes, highlighting four themes: means of distraction, comfort and relaxation; raising the temperature in the birthing room; familiar features in the setting; and reducing the technocratic emphasis in the environment. The review concluded that healthcare professionals, architects and researchers all have a key role to play in influencing the design of birthing rooms, to support the health of birthing women and their babies, above all in hospital labor wards [ 11 ]. Nilsson et al. [ 11 ] underscored the importance of studying and determining the long-term effects of the build setting on how women experience childbirth. Given the lack of comprehensive information on this topic, it is vital to ensure that researchers carry out comprehensive research in this area. This study sets out to gain a detailed understanding of how healthcare providers view the new birthing room design, and how it impacts on mothers’ natural instinctive experience of childbirth. Method Design The present study utilized an interpretative phenomenology research design to provide important insight into the perceptions of healthcare providers regarding the new birthing room design and its influence on mothers’ natural instinctive childbirth. This approach was deemed to be most suitable as it is highly effective in describing, interpreting, and understanding the lived experiences of participants. Smith et al. [ 13 ] explain that interpretative phenomenology analysis focuses on uncovering personal lived experience and engagement in a specific event [ 13 ]. Setting The participants were selected from a governmental hospital in Eastern Province, Saudi Arabia. The hospital, which has a 400-bed capacity and serves approximately one thousand mothers to give birth monthly, is considered the largest in the area. It is recognized as a mother baby family friendly hospital as it provides maternal care services with high standards and quality [ 14 ]. Participants and recruitment The study consisted of two groups: Seven physicians (including obstetricians and gynecologists), and eight midwives. The inclusion criteria included healthcare providers with English fluency. Though the official spoken language in Saudi Arabia is Arabic, the interview was conducted in English as it is the official language of physicians and midwives in the hospitals in the country. We adapted a purposeful sampling strategy to identify and select information-rich cases and individuals especially knowledgeable about the phenomenon of interest [ 15 ]. The data saturation approach was used to determine the required sample size; data collection was stopped when additional participants no longer provided further insight [ 16 ]. The research team ensured diversity among the healthcare providers in terms of job title and specialty. The healthcare providers were required to have a minimum of five years of experience in maternity units and who worked in the birth room. These criteria aimed to capture diverse and comprehensive lived experiences related to birthing room design. Data Collection An announcement about the coming study was placed on the hospital bulletin boards, and details were sent by email to the target population. Participants were also recruited by word-of-mouth strategy. The interviews took place in May 2024, and were conducted individually, to safeguard privacy as well as confidentiality. The questions were semi-structured, and the interviewer also had a list of points to cover see (Table 1 ). The interviews were carried out in a place convenient to the participants and took between 40 and 60 minutes. participants’ answers were recorded and supplementary questions such as “Why?”, “How?” and “What exactly do you mean?” were asked, to clarify and expand on the interviewees’ answers. Table 1 Interview Guide 1. What is your definition of natural, instinctive birth? 2. In your opinion, is there a need to redesign the delivery room? Explain more? 3. Through your experience, how do you feel the birthing room affects your ability to promote a normal physiological birth? 4. What practices will change as result of redesigning delivery rooms? 5. What are the requirements for re-implementing childbirth after redesigning the delivery room? 6. What is the value of redesigning delivery rooms to respect the presence of a companion with the mother? 7. In your view, what is the importance of redesigning the birthing room? 8. Discuss the ways how nurses can support normal natural instinctive childbirth? Study Trustworthiness Four methods, including credibility, dependability, confirmability, and transferability, were employed to determine the quality of the collected qualitative data [ 17 ]. The researchers conferred with the interviewees and requested feedback from their perspectives on the transcripts to ensure credibility, as the participants' perspectives are crucial in judging the credibility of the data. Dependability, based on the assumption of replicability or repeatability, was ensured by sharing the findings with healthcare providers not involved in this study for verification, thereby providing external validation of the findings. To ensure confirmability, participants were asked to check and recheck the narrative data throughout the study, thereby ensuring the accuracy that reflected their true feelings and opinions. Finally, to assess transferability, we determined whether the results could be transferred to other contexts, such as different regions in Saudi Arabia. By employing these methods, we were able to ensure the rigor of the findings. Data Analysis Once the recorded interviews were completed, they were transcribed verbatim. In order to avoid bias from the participants when providing feedback, all the interviews followed a list of research questions The data gathered from each participant was analyzed using an iterative approach, so that revisions could be made on the basis of earlier interpretations. When all the interviews were recorded and transcribed, an interpretive, phenomenological analysis was undertaken [18]. This form of methodology aims to discover the participants’ views and attitudes, and to gain a detailed and thorough understanding of their experiences by using an inductive, idiographic approach. Idiographic methodology aims to understand specific cases and individuals [19]. Table 2 , lists the steps required by interpretative phenomenological analysis. Finally, the analysis process and findings were reviewed and validated by an expert in qualitative studies. Table 2 Step by step to conducting IPA analysis. Step 1 Starting with the first case: reading and rereading Step 2 Explanatory notes Step 3 Constructing experiential statements Step 4 Searching for connections across experiential statements Step 5 Naming the personal experiential themes and consolidate Step 6 Continuing the individual analysis of other cases Step 7 Working with personal experiential themes to develop group experiential themes across cases Results Sample Characteristics Altogether, seven physicians and eight midwives working in the obstetrics and gynecology departments opted to take part in the interviews. Semi-Structured Interview Findings As all of the group experience themes are related to the significance of redesigning hospital birth rooms and its impacts on supporting and promoting normal and natural childbirth in low-risk mothers, they can all be grouped under the core category of Supportive Birth Environment for Natural Childbirth. Moreover, it is important to note here that the design of the birthing room also impacts mothers’ experiences and the roles of the midwives. After examining the findings, four relevant themes and thirteen subthemes associated with the birthing room design were identified. The four themes are: supporting natural birth through room design; providing private space through the new design; the influence of birthing room design on midwives’ roles; and suggestions and recommendations as presented in Table 3 . Table 3: Core Category with Themes and Sub-themes Theme 1: Supporting Natural Birth Through Room Design After exploring the opinions of healthcare providers, this emerging concept was created to help low-risk mothers give birth to children naturally without needless medical procedures or updated room layouts. The participants discussed about natural childbirth and its meaning, as well as how birth rooms are designed and how these factors affect mothers psychological well-being. Three sub-themes were covered in this theme: Meaning of Natural childbirth , previous birth room design , and Mothers Psychological well-being Meaning of Natural Childbirth. A natural childbirth typically follows a healthy pregnancy in mothers who have not experienced health issues or chronic diseases that could prevent such a childbirth, which was noted by many of the participants. For example: “A mother can have a natural childbirth in the ninth month of pregnancy if they do not have health problems or chronic illnesses that impact childbirth and commences the childbirth journey with a natural cervical dilatation without incident or postpartum bleeding.” (P1, Physician) “Instinctive natural birth occurs spontaneously with no complications.” (P2, Physician) “The mother must have good psychological and physical health to have a natural, instinctive childbirth, without medications or unnecessary medical procedures and with a companion present in the birthing room to support the natural birth.” (P8, Midwife) Previous Birth Room Design . Natural, instinctive childbirth is not promoted by the design of the previous birth room design, which often has multiple mothers in the same room, which has a negative impact on the presence of a companion and disrupts the comfort of the mother. This was noted by several participants. For example: “A number of practices can promote natural instinctive birth. However, the previous design does not. This is because the previous design was a small room with a bed that only enables the mother to sleep in the lithotomy position throughout the delivery process.” (P11, Midwife) “In the previous hospital rooms, multiple women were placed in the same room. In turn, this adversely impacts the presence of a companion in the room and disrupts the comfort of the mother.” (P15, Midwife) Psychological Wellbeing of the Mother. The birthing room design influences the psychological state of mothers throughout the birthing process. Example comments are provided as follow: “The design of the birthing room impacts the mothers' psychological state during childbirth. For instance, the mother's thoughts and feelings are influenced by the room's decoration, which can lessen the pain of childbirth” (P10, Midwife) “The color and brightness of the delivery room can also impact the mother's mental state during labor and delivery because they enable her to cope with the pain of birth. Windows that allow daylight to shine through during the day are crucial since they impact the mother's mental health.” (P1, physician) Theme 2. Creating Privacy Through the New Design The second theme was established after examining the opinions of healthcare providers, who felt that a birthing room should feel comfortable and safe for women. A hospital-style room is not homely at all but is rather created from a business and care perspective, taking into account the risks and dangers of childbirth. A hospital room can never be truly homelike, but there are some features that can help to make the space more comfortable, such as adding natural features, light, and personal belongings. Light plays a key role here in establishing a cozy atmosphere. Dimmable lights produce a comfortable, serene, and enveloping atmosphere. A homely feeling can also be facilitated through bright colors on the walls, nice posters, or even green plants. Three sub-themes were identified alongside this main theme, namely Suggested new birth room design , Controlling Labor, Companion Involvement, and Positive Distraction. Suggested new birth room design. All of the healthcare providers believed that the cozy features of the newly designed space facilitated a homely setting that would be advantageous for expectant mothers. In turn, this generated a feeling of solitude, and the transfer from home to the hospital went well. Moreover, the mothers would likely have more confidence in the professional conclusions if they were made to feel at home in a familiar setting. Furthermore, sufficient space in the delivery room encourages the mother to move around and decide on the positions that she feels most comfortable in during childbirth. For example, the placement of yoga mats, rope, and a bathtub in the room can be particularly effective. As mentioned by most of the participants, placing pictures and wall speakers in the room, ensuring that there is effective lighting, and taking into consideration the presence of green plants also play a critical role here. “It is important that the space reminds her of her home environment, facilitating total privacy. The mother’s birth hormones are impacted by her psychological comfort throughout the labor process, which stimulates her natural birth hormones. Thus, the birth must take place in a safe setting so that the mother can have a positive experience.” (P13, midwife) “It is important that we promote the use of birthing balls and a rope that enable mothers to perform exercises and squats. The presence of a bathtub with warm water should also be considered during the childbirth process.” (P1, Physician) “As gravity facilitates the fetus' descent into the pelvis and helps the mother give birth naturally, the layout of the room also helps the mother to move when exercising and walking around. Placing photos of the sea or other relaxing scenes in the delivery room can help the mother feel at ease. It is also beneficial to think about installing wall speakers and using green designs to allow the mother to listen to music or the Qur'an whenever she wants.” (P3, Physician) “We must redesign birthing rooms so that they support natural and instinctive childbirth. Medical devices must be hidden behind walls and the mother must have full control of the lighting in the room. It is also important that the walls are brightly colored to represent the happiness of childbirth.” (P14, Midwife). Controlling the Labor. It is important that mothers have the capacity to control the labor and select the position that they find the most comfortable. This was mentioned by several participants. For example: “Once the birth rooms had been redesigned, mothers were given a separate room to use throughout labor and delivery. The new rooms also enable mothers to exercise throughout labor and give birth in the same room, which has helped many women to have a pleasant delivery experience and promoted natural birth practices as mothers have progressed to managing the labor stage.” (P6, Physician) “A birthing chair should be provided in the new rooms to afford mothers the freedom to take control of the labor by selecting the most comfortable birthing positions.” (P4, Physician) Companion Involvement. Some of the participants mentioned a recommended delivery room design, which included a coffee machine, soft bed, and chair to encourage mothers and their companions to participate in an instinctual and natural childbirth. “Hospital rooms with a comfortable bed and chair support the presence of a companion during the birthing process.” (P1, Physician) “It is important to have more space in the delivery room so that mothers can move around and walk with their companions. It also gives the companion an opportunity to rest inside the room.” (P2, Physician) “A companion can help the mother by massaging their back and offering words of support, which will help her get through the agony and exhaustion of giving birth. Thus, ensuring that the birthing room is designed to accommodate the mother and a companion is paramount. In turn, this will increase the chances that the mother will give birth naturally in a supportive and comfortable environment.” (P3, Physician) “Rooms must be designed to be spacious and contain snacks and coffee machines for the companion, which will help them to support the mother throughout the labor process. The companion can help the mother by massaging her and applying warm compresses.” (P14, Midwife) “Television screens should also be installed, as well as spaces for tea and coffee provisions, mobile chargers and free internet for the companions to use.” (P5, Physician) Positive Distraction. Some participants stated that the new design of the birthing rooms should offer privacy to expectant mothers and should be painted in bright colors that promote happiness and joy. “The renovated rooms must include pictures that diver the mother's attention away from her pain and suffering during labor and render it a more pleasant experience. It is also important to provide headphones or speakers so that the mother can listen to music while giving birth. The provision of exercise balls and a bathtub in the rooms can also help to alleviate the pain of the mother.” (P8, Midwife) “Images should also be displayed that explain the story of pregnancy, from conception to birth, which distracts the mother away from her pain and promotes the arrival of the baby.” (P10, Midwife) Theme 3: Influence of the Delivery Room Design on Midwives’ Roles The participants referred to the influence that the delivery room design has on the role of the midwives. Two sub-themes have been identified for this primary theme, namely the midwife’s role and responsibility, and the Midwife Shortage. The Midwife’s Roles and Responsibilities. This key component refers to how the birthing room and its surroundings help the midwife to perform their role and undertake their responsibilities whilst promoting natural and instinctive birth. "Midwives are skilled and trained to promote spontaneous, instinctive delivery through non-pharmacological approaches including massage, warm baths, breathing exercises, and the use of natural aromatic scents such as lavender. The ideal delivery room layout will help midwives to promote and facilitate spontaneous, instinctual childbirth.” (P11, Midwife) “A key role of the midwife is to offer words of encouragement to the mother. For example, they may tell her that she is a hero or that she is very strong. The midwife must also remind the mother to breathe during the labor and provide her with water, fruit, and other sources of energy. Thus, the design of the room ultimately helps them to perform their roles.” (P13, Midwife) “After the hospital was redesigned, balls were placed in the delivery room, and this significantly reduced the pain and discomfort felt by mothers during childbirth. Moreover, the presence of midwives supporting and promoting natural birth positively transformed the experiences of expectant mothers throughout the birthing process.” (P8, Midwife) Midwife Shortage. A number of physicians stated that more midwives were needed to support normal and natural childbirth: "We need more midwives to support each low-risk mother and encourage them to undertake an instinctive and natural childbirth.” (P5, Physician) “It is imperative to employ more midwives so that we can establish a one-to-one ratio between midwife and mother.” (P2, Physician) Theme 4: Suggestions and Recommendations This last theme examines the recommendations made by healthcare providers. Four sub-themes were identified for this primary theme, namely Birth Room Visits, Community Awareness, Massage to Decision Makers and Authority, and the Training of Healthcare Providers. Birth Room Visits. The physicians recommended that childbirth education classes involve real-life visits to birth rooms in order to reduce the anxiety and stress of expectant mothers: "I also propose adding a visit to the birth rooms to the curriculum of education classes for natural childbirth, as this will help to reduce the stress and anxiety felt by mothers on the day of delivery." (P2, Physician) “Without a doubt, we need to provide childbirth education courses that include birth room visits, as this helps to promote natural, instinctive childbirth. In other words, childbirth will be easier if the mother is more knowledgeable about the birthing process.” (P5, Physician) Community Awareness. The theme of promoting community awareness about the significance of birthing room design emerged during the interviews and was highlighted by healthcare providers: “To ensure that pregnant mothers' are cooperative during labor, we need to raise awareness in our community about the significance of delivery room design and how it affects natural, instinctive childbirth. I also propose opening a dedicated channel to teach expectant mothers about these concepts.” (P5, Physician) “It is critical to spread awareness about the importance of designing delivery rooms and how this influences the psychological states of mothers during childbirth.” (P15, Midwife) Massage to Decision Makers and Authority. The healthcare providers involved in the study provided recommendations relating to decision-makers and responsible authorities. For example, some healthcare providers stated that: “The design of delivery rooms should be presented in a proposed form to the responsible parties at the Ministry of Health so that they understand the importance of the issue. We must raise awareness of the issue with the Ministry of Health.” (P6, Physician) “Midwives must ensure that hospital decision-makers hear their opinions regarding the significance of the birthing room design and the positive influence that it has on birthing experiences.” (P10, Midwife) Training Healthcare Providers. Once the delivery rooms have been redesigned, we must train healthcare providers. The importance of this has been highlighted by healthcare providers in the study: “In order for everyone to understand their roles, responsibilities, and duties in supporting natural birth, training sessions for healthcare providers and pregnant mothers with companions are required after the delivery rooms are redesigned. Additionally, it is imperative that all healthcare providers understand clear policies and guidelines.” (P3, Physician) “Following the redesign, all healthcare providers must be trained so that they can effectively support natural childbirth.” (P5, Physician) “Educating healthcare providers (including physicians, nurses, and midwives) is critical in ensuring that they support new practices and help the mother to eat, drink, and move during labor. It is also important that they understand the importance of allowing the mother to choose different birth positions, which is still a new concept to us.” (P15, Midwife) Discussion This study used an interpretative phenomenology research design to understand healthcare providers' perspectives on the new birthing room design and its influence on mothers' natural instinctive childbirth. The findings included a core category of supportive birth environment for natural childbirth with four themes: supporting natural birth through room design, providing private space through the new design, the influence of birthing room design on midwives' roles, and suggestions and recommendations. The analysis yielded themes that provide insight into the importance of listening to the voices of healthcare providers who participated in a new birthing room design in Saudi Arabia. The findings show that the participants discussed natural childbirth and its meaning, as well as how birth rooms are designed and how these factors affect mothers' psychological well-being. Other studies have highlighted similar findings. A study showed that a calm, private, and safe environment can reduce stress and enhance the release of endogenous oxytocin, potentially leading to more comfortable and efficient labor, which leads to natural childbirth [ 2 ]. Similarly, specially designed hospital birthing rooms, which offer a sense of such as bolstering lighting, comfortable furniture, and calming sounds, can reduce women's requirements for epidural analgesia during labor [ 5 ] and lower cesarean birth rates [ 6 ]. Furthermore, women's experiences of birth environment influence their mental health and well-being [20]. In most countries, homelike environment/family-centered care units are designed for uncomplicated deliveries. The evidence shows that despite the global efforts toward the development of physiologic delivery in the maternity unit, which refers to a birth process that is not interfered with unless necessary, the design of the delivery environment still needs reforms. A study in Nigeria showed that the staff's clamor to control the situation transferred the staff's stress to the parturient women [21]. Additionally, our findings indicated that the presence of a hospital-style room is not homely at all but is rather created from a business and care perspective, taking into account the risks and dangers of childbirth. A hospital room can never be truly homelike, but some features can help make the space more comfortable, such as adding natural features, light, and personal belongings. Light plays a key role here in establishing a cozy atmosphere. Dimmable lights produce a comfortable, serene, and enveloping atmosphere. Some participants commented that a homely feeling can also be facilitated through bright colors on the walls, nice posters, or even green plants. Similarly, a previous study opened up new avenues for understanding and designing birthing rooms and concluded that a homelike childbirth room was characterized by warm colors, warm lighting, and comfortable furniture; the bed and medical equipment were not placed in the center of the room [ 9 ]. Goldkuhl et al., [ 5 ] also found that specially designed hospital birthing rooms with comfortable furniture can reduce women's requirements for epidural analgesia during labor. Moreover, in the birthing environment, the birth spaces' psychological and sensory features can influence health outcomes and affect physiological birth by limiting interventions [22,23]. Additionally, the authors demonstrated that some participants mentioned a recommended delivery room design, which included a coffee machine, soft bed, and chair to encourage mothers and their companions to participate in instinctual and natural childbirth. Similarly, a study conducted by AlKhunaizi et al., [24] showed that the active participation of birth attendants and providing adequate support and resources can help enhance mothers' well-being and contribute to a positive experience during their hospital stay. The concept of the influence of birthing room design on midwives' roles emerged as a key theme in our study. Midwives spend a large proportion of their working hours in the birthing room, which thus represents an important component of their physical working environment [25]. The participants referred to the influence that the delivery room design has on the role of the midwives such as the midwife's role and responsibility, and the midwife shortage. According to a study conducted by Townsend and colleagues, the birth environment can influence women's experiences of labor and birth and midwifery practice [ 3 ]. Moreover, a study showed that insufficient numbers of midwives in the workplace increased the effort necessary to complete their work, the general workload, and the time required to fulfill their responsibilities [ 16 ]. However, these findings contradict another study that showed that midwives were less likely to agree that they had everything they needed in case of an emergency and were also less likely to react appropriately in an emergency [27]. Goldkuhl et al. [20] also noted uncertainties in addition to the positive effects of redesigning birthing spaces. The uncertainties related to task performance may have a negative impact on midwives' job satisfaction, while the positive effects could include improved patient outcomes and a more comfortable working environment. Furthermore, our research identified several suggestions and recommendations. These suggestions encompassed issues such as birth room visits, community awareness, massage to decision makers and authority, and the training of healthcare providers. The participants stressed the importance of community awareness in promoting the benefits of the new birthing room design, making the audience feel responsible and engaged in this crucial aspect of maternal well being. They recommended that childbirth education classes involve real-life visits to birth rooms in order to reduce the anxiety and stress of expectant mothers. Similarly, a study conducted by Rashed et al., [26] recognized that the participation in childbirth classes has the potential to increase women's knowledge about childbirth while also reducing anxiety and fear. Similarly, a literature review on the influence of birthing room design on maternal and neonate outcomes revealed a crucial role of healthcare professionals, architects, and researchers in shaping birthing room design to promote health in birthing women and their babies, particularly in hospital-based labor wards. This research underscores the vital role of healthcare providers in this process, highlighting their value and importance in the design and implementation of birthing room changes [ 11 ]. Based on our research, hospital decision-makers must hear their opinions regarding the birthing room design's significance and its positive influence on birthing experiences. To ensure a comfortable and homelike environment for mothers, redesigning birthing rooms must be made and unified in the Ministry of Health maternity hospitals. This may involve the placement of yoga mats, rope, a bathtub in the room, pictures, and wall speakers in the room, ensuring adequate lighting, and considering the presence of green plants, which also play a critical role here. Ultimately, hospital policymakers must train healthcare providers to understand their roles, responsibilities, and duties in supporting natural birth; training sessions for healthcare providers and pregnant mothers with companions are required after the delivery rooms are redesigned. Strength and limitations This study has several strengths. It addresses the question of information needs regarding the perspective of healthcare providers on the new birthing room design and its influence on mothers’ natural instinctive childbirth. The participants had exclusive experience with the previous and the new birthing room designs. The qualitative approach, which allowed for a deep and thorough understanding of the perceptions of healthcare providers as they provided during the interviews, is a reassuring aspect of this study. Qualitative research relies on participants’ experiences and opinions and researchers’ interpretations and subjective judgments, so some subjectivity and interpretation challenges may be introduced as the limitations of this study. What this study adds The findings have added to the evidence on the positive influence of the new birthing room design on mothers' psychological well-being. Our study also highlights the potential positive impact on natural childbirth. Furthermore, we offer new insights into the importance of proposing the new birthing room design to the decision-makers and responsible authorities at the Ministry of Health. We emphasize the significance of the new birthing room design on the mothers’ experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level. Implications for practice Our findings support the redesign of birthing rooms in all hospitals to support low-risk mothers in having a natural, instinctive childbirth. This redesign should ensure space for the mothers’ companion and provide facilities that enhance relaxation and physical comfort, such as home-like furniture, light, space, bathtub, yoga mat, rope, and green plants. However, amidst all these changes, one thing remains crucial-the one-to-one care of the midwives. It's not just important, it's a key factor in the mothers' birth experience, and it's something that should be ensured and maintained. Conclusion This qualitative study explored the perceptions of healthcare providers regarding the new birthing room design. All participants demonstrated awareness of the advantages of the new birth room design for the mothers' psychological well-being and normal, natural childbirth, which can help contribute to a positive experience during their hospital stay. However, additional efforts are required to deliver massage to the decision-makers and responsible authorities at the Ministry of Health about the significance of the new birthing room design on the mothers’ experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level. Declarations Acknowledgments The authors extend their appreciation to the Deanship of Scientific Research through the Research Center at College of Nursing, King Saud University, for logistically supporting this study. Ethics approval and consent to participate This study was approved by the institutional review board Alahsa Health Cluster IRB MCH No. (H-05-HS-137) and King Saud University (Reference # KSU-HE-24-570). The participants were fully informed about the study procedure and were given the opportunity to participate voluntarily, with the reminder of their right to withdraw at any time without any consequence. They were assured that their responses would be kept confidential and only accessible to the members of the research team. To maintain confidentiality, participants were assigned codes to use instead of their names. Finally, all participants agreed to be audio recorded, and they were assured that all responses and transcripts would be securely destroyed. Informed consent was obtained from all participants. Consent for publications Not applicable. Authors’ contributions Conceptualization, A.N.A and A.G.A.-O and; methodology, A.N.A and A.G.A.-O; validation, A.G.A.-O; formal analysis, A.N.A and A.G.A.-O; investigation, A.N.A.; data curation, A.N.A and A.G.A.-O; writing—original draft preparation, A.N.A and A.G.A.-O.; writing—review and editing, A.N.A and A.G.A.-O. Both authors guarantee the integrity of the content and the study. Authors have read and agreed to the published version of the manuscript. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to considerations on privacy of participants but are available from the corresponding author on reasonable request. Consent for publication Participants gave their informed written consent for their data to be coded for analysis, and for certain anonymous citations to be included in the publication, while respecting their confidentiality. Competing interests The authors declare that they have no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article. Author details 1 Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; [email protected] (A.N.A); 2 Fundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal Uviversity, Dammam 34212, Saudi Arabia; [email protected] (A.G.A.-O). References Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. Plos one. 2020 Jul 28;15(7):e0230992. Uvnäs-Moberg K, Ekström-Bergström A, Berg M, Buckley S, Pajalic Z, Hadjigeorgiou E, Kotłowska A, Lengler L, Kielbratowska B, Leon-Larios F, Magistretti CM. Maternal plasma levels of oxytocin during physiological childbirth–a systematic review with implications for uterine contractions and central actions of oxytocin. BMC pregnancy and childbirth. 2019 Dec;19:1-7. Townsend B, Fenwick J, Thomson V, Foureur M. The birth bed: A qualitative study on the views of midwives regarding the use of the bed in the birth space. Women and Birth. 2016 Feb 1;29(1):80-4. Nielsen JH, Overgaard C. Healing architecture and Snoezelen in delivery room design: a qualitative study of women’s birth experiences and patient-centeredness of care. BMC pregnancy and childbirth. 2020 Dec;20:1-1. Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Room4Birth–the effect of giving birth in a hospital birthing room designed with person-centred considerations: a swedish randomised controlled trial. Sexual & Reproductive Healthcare. 2022 Jun 1;32:100731. Wronding T, Argyraki A, Petersen JF, Topsøe MF, Petersen PM, Lokkegaard EC. The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions–an observational retrospective cohort study. Scientific reports. 2019 Jan 22;9(1):303. Andrén A, Begley C, Dahlberg H, Berg M. The birthing room and its influence on the promotion of a normal physiological childbirth-a qualitative interview study with midwives in Sweden. International journal of qualitative studies on health and well-being. 2021 Jan 1;16(1):1939937. Hodnett ED, Stremler R, Weston JA, McKeever P. Re‐conceptualizing the hospital labor room: the PLACE (pregnant and laboring in an ambient clinical environment) pilot trial. Birth. 2009 Jun;36(2):159-66. Bowden C, Sheehan A, Foureur M. Birth room images: What they tell us about childbirth. A discourse analysis of birth rooms in developed countries. Midwifery. 2016 Apr 1;35:71-7. Lorentzen IP, Andersen CS, Jensen HS, Fogsgaard A, Foureur M, Lauszus FF, Nohr EA. Does giving birth in a “birth environment room” versus a standard birth room lower augmentation of labor?–Results from a randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology: X. 2021 Apr 1;10:100125. Nilsson C, Wijk H, Höglund L, Sjöblom H, Hessman E, Berg M. Effects of birthing room design on maternal and neonate outcomes: A systematic review. HERD: Health Environments Research & Design Journal. 2020 Jul;13(3):198-214. Setola N, Naldi E, Cocina GG, Eide LB, Iannuzzi L, Daly D. The impact of the physical environment on intrapartum maternity care: identification of eight crucial building spaces. HERD: Health Environments Research & Design Journal. 2019 Oct;12(4):67-98. Smith JA, Nizza IE. Essentials of interpretative phenomenological analysis. American Psychological Association; 2022. Takrouni EO, Al Dawlah RA, Khalifah S, Ali GY, Al-Aithan FM. Impact of Hospital Breast Feeding Awareness Among Lactating Mothers in Maternal and Children Hospital, AL-Hassa, Kingdom of Saudi Arabia. Global Journal of Health Science. 2019 Mar 11;11(4):32. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and policy in mental health and mental health services research. 2015 Sep;42:533-44. Al-Otaibi AG, Alyousef SM, Alhamidi SA, Almoammar DN, Alanazi NH. Exploring Nurse perceptions of structural empowerment in midwifery practice in Saudi Arabia: A qualitative study. Health Care for Women International. 2024 Jan 31:1-5. Lincoln YS, Guba EG. Naturalistic inquiry. sage; 1985.; Available online: https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842 . Jang MS, Kim S. Person-centered relational care experienced by critical care nurses: an interpretative phenomenological analysis study. Journal of Korean Academy of Nursing. 2019 Aug 1;49(4):423-36. Peck B, Mummery J. Recovering the" individual" for qualitative research: an idiographic approach. InForum Qualitative Sozialforschung/Forum: Qualitative Social Research 2019 Sep 26 (Vol. 20, No. 3). Kazemi A, Beigi M, Najafabadi HE. Environmental factors influencing women’s childbirth experiences in labor–delivery–recovery–postpartum unit: a qualitative cross-sectional study. BMC Pregnancy and Childbirth. 2023 Mar 13;23(1):169. Bohren MA, Vogel JP, Tunçalp Ö, Fawole B, Titiloye MA, Olutayo AO, Ogunlade M, Oyeniran AA, Osunsan OR, Metiboba L, Idris HA. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reproductive health. 2017 Dec;14:1-3. Aburas R, Pati D, Casanova R, Adams NG. The influence of nature stimulus in enhancing the birth experience. HERD: Health Environments Research & Design Journal. 2017 Jan;10(2):81-100. Nicoletta S, Eletta N, Cardinali P, Migliorini L. A broad study to develop maternity units design knowledge combining spatial analysis and mothers’ and midwives’ perception of the Birth Environment. HERD: Health Environments Research & Design Journal. 2022 Oct;15(4):204-32. AlKhunaizi AN, Al-Otaibi AG, Alharbi MF, Bahari G. Exploring Healthcare Providers’ and Women’s Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study. InHealthcare 2024 Apr 23 (Vol. 12, No. 9, p. 869). MDPI. Wangler S, Simon A, Meyer G, Ayerle GM. Influence of the birthing room design on midwives' job satisfaction–A cross-sectional online survey embedded in the ‘Be-Up’study. Sexual & Reproductive Healthcare. 2023 Sep 1;37:100867. Rashed MS, Nour SA, Mohamed HS, Ragab AR, Salama NS, Nasr EH. Effectiveness of childbirth education on primigravida womens’ knowledge about childbirth preparation. Port Said Scientific Journal of Nursing. 2023 Jun 30;10(2):95-113. Supplementary Files InterviewQuestionBMC.pdf Cite Share Download PDF Status: Published Journal Publication published 26 Dec, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 23 Jun, 2025 Reviews received at journal 19 Jun, 2025 Reviews received at journal 15 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviews received at journal 11 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviewers agreed at journal 07 Sep, 2024 Reviews received at journal 03 Sep, 2024 Reviewers agreed at journal 31 Aug, 2024 Reviewers agreed at journal 31 Aug, 2024 Reviewers agreed at journal 24 Aug, 2024 Reviewers invited by journal 22 Aug, 2024 Editor assigned by journal 06 Aug, 2024 Editor invited by journal 17 Jul, 2024 Submission checks completed at journal 17 Jul, 2024 First submitted to journal 17 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4714570","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447656535,"identity":"c3baf013-33f5-4d4b-bec8-2c03e511e540","order_by":0,"name":"Anwar Nader AlKhunaizi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYFAC5mZmEMXGwNj4sAEskkBICyNcS7MhaVpAuiSJ0sLffrDZuLDtjjwf/+G2yhl/DjPws+cYMP6owa1F4kxic/LMtmeGbQwH225ubDvMINnzxoCZ5xgeaw4kNh/mbTvM2MbY2HbzYcNhBoMbOQbMQK/hBPLnH4K12LcxM7YVPgA6zP4GyGH/cGsxuAF0GFBLYhsb0KINbEBbJHIMGHjbcGsxvPGw2Zjn3OHkNh7GZsmZbek8EmeeFRzm7cOtRe588mFpnrLDtvP7jz/82PPHWo6/PXnjwx/f8HgfHfCAiAMkaBgFo2AUjIJRgAUAANsBVHjZ7TKjAAAAAElFTkSuQmCC","orcid":"","institution":"Maternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia","correspondingAuthor":true,"prefix":"","firstName":"Anwar","middleName":"Nader","lastName":"AlKhunaizi","suffix":""},{"id":447656536,"identity":"b15534a9-edc0-4932-9500-1537cca3dbb5","order_by":1,"name":"Areej Ghalib Al-Otaibi","email":"","orcid":"","institution":"Fundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal Uviversity, Dammam 34212, Saudi Arabia","correspondingAuthor":false,"prefix":"","firstName":"Areej","middleName":"Ghalib","lastName":"Al-Otaibi","suffix":""}],"badges":[],"createdAt":"2024-07-09 23:14:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4714570/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4714570/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13950-9","type":"published","date":"2025-12-26T15:57:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":99172283,"identity":"9d829cd9-3a96-4b44-a305-5d5c366d71f5","added_by":"auto","created_at":"2025-12-29 16:07:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":872000,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4714570/v1/3377ab25-6c75-4c10-a71f-4126da8805b9.pdf"},{"id":81546931,"identity":"220d5362-9ffa-4d37-9e93-598b7ba7c867","added_by":"auto","created_at":"2025-04-28 12:03:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":268312,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewQuestionBMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4714570/v1/c4619d014e7acea9ad192237.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eListening to the Voices of Healthcare Providers Who Involved in a New Birthing Room Design: An Interpretative Phenomenological Analysis Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eBirth is a process which encompasses neurohormonal, physiological and psychological elements, but is mainly controlled by oxytocinergic mechanisms. The latter are affected by sensory stimuli for example those coming from the uterus and the support which is offered by a birth companion. Neurohormonal processes can be impacted negatively by the external environment, since an unknown and stressful environment can trigger the sympathetic nervous system, and thus repress the amount of endogenous oxytocin being released. This, in turn, can weaken or even stop labor contractions. In contrast, women who give birth in a safe, peaceful and private setting will experience lower levels of stress, which will improve the release of endogenous oxytocin and thereby increase the likelihood of a relaxed and efficient labor [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Townsend et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] state that there is a growing body of evidence which supports the view that the birth environment plays a major role in determining how women experience labor, birth and the practice of midwifery.\u003c/p\u003e \u003cp\u003eAccording to Nielsen and Overgaard [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], alternative birth environments can not only reduce the effects of negative healthcare, but can also result in women having a positive perception of patient-centered care and its capacity to meet the health and social care needs of future generations. Goldkuhl et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] note that there is evidence which shows that hospital birthing rooms which have been designed to provide a comforting and familiar space, with supportive multisensory features such as calming lighting and sounds, and cozy furniture, make it less likely that women will request epidural analgesia in labor. Wronding et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] add that this type of environment also lowers cesarean birth rates. Research into the design of birthing rooms is a relatively new and exciting development in the study of obstetric care, its risks and technological tools, in many countries. Andr\u0026eacute;n et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Hodnett et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] note that this fresh perspective is mirrored in how birthing rooms are designed and equipped. Bowden et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] carried out a groundbreaking study which examined internet images of birthing rooms found in developed countries. Their research identified three different styles of room, and offered us a new understanding of these settings. The researchers found that approximately 50 per cent of the rooms prioritized technology, placing an electrically-operated birthing bed in the middle of the room, and a range of technical equipment- such as a cardiotocography machine (CTG), neonatal resuscitation unit, and surgical lamp -where the mother could see them. The second type of birthing room was less common and aimed to create a homely atmosphere, by using warm colors and lighting and comfortable furniture, and not placing the bed and the equipment in the middle of the room. Finally, a third type of birthing room used features of both forms, and although it usually situated the bed in the middle, the room also featured comfortable furniture and splashes of color [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These findings should act as a stimulus to undertaking further studies of birthing room design and functions from a new perspective. However, Lorentzen et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] point out that many of the birthing settings which feature in trials also reflect a number of other features, such as continuity of care, in their organizational model, and this could have a positive impact on birth outcomes.\u003c/p\u003e \u003cp\u003eAt present it is clear that there is a knowledge gap and a need for further scientific evidence of how the birth environment affects labor, with particular emphasis on the role of the birthing room [11,12 ].Nilsson et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] conducted a literature review into how birthing room design influences maternal and newborn outcomes, highlighting four themes: means of distraction, comfort and relaxation; raising the temperature in the birthing room; familiar features in the setting; and reducing the technocratic emphasis in the environment. The review concluded that healthcare professionals, architects and researchers all have a key role to play in influencing the design of birthing rooms, to support the health of birthing women and their babies, above all in hospital labor wards [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNilsson et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] underscored the importance of studying and determining the long-term effects of the build setting on how women experience childbirth. Given the lack of comprehensive information on this topic, it is vital to ensure that researchers carry out comprehensive research in this area. This study sets out to gain a detailed understanding of how healthcare providers view the new birthing room design, and how it impacts on mothers\u0026rsquo; natural instinctive experience of childbirth.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThe present study utilized an interpretative phenomenology research design to provide important insight into the perceptions of healthcare providers regarding the new birthing room design and its influence on mothers\u0026rsquo; natural instinctive childbirth. This approach was deemed to be most suitable as it is highly effective in describing, interpreting, and understanding the lived experiences of participants. Smith et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] explain that interpretative phenomenology analysis focuses on uncovering personal lived experience and engagement in a specific event [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThe participants were selected from a governmental hospital in Eastern Province, Saudi Arabia. The hospital, which has a 400-bed capacity and serves approximately one thousand mothers to give birth monthly, is considered the largest in the area. It is recognized as a mother baby family friendly hospital as it provides maternal care services with high standards and quality [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and recruitment\u003c/h2\u003e \u003cp\u003eThe study consisted of two groups: Seven physicians (including obstetricians and gynecologists), and eight midwives. The inclusion criteria included healthcare providers with English fluency. Though the official spoken language in Saudi Arabia is Arabic, the interview was conducted in English as it is the official language of physicians and midwives in the hospitals in the country. We adapted a purposeful sampling strategy to identify and select information-rich cases and individuals especially knowledgeable about the phenomenon of interest [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The data saturation approach was used to determine the required sample size; data collection was stopped when additional participants no longer provided further insight [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The research team ensured diversity among the healthcare providers in terms of job title and specialty. The healthcare providers were required to have a minimum of five years of experience in maternity units and who worked in the birth room. These criteria aimed to capture diverse and comprehensive lived experiences related to birthing room design.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eAn announcement about the coming study was placed on the hospital bulletin boards, and details were sent by email to the target population. Participants were also recruited by word-of-mouth strategy. The interviews took place in May 2024, and were conducted individually, to safeguard privacy as well as confidentiality. The questions were semi-structured, and the interviewer also had a list of points to cover see (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The interviews were carried out in a place convenient to the participants and took between 40 and 60 minutes. participants\u0026rsquo; answers were recorded and supplementary questions such as \u0026ldquo;Why?\u0026rdquo;, \u0026ldquo;How?\u0026rdquo; and \u0026ldquo;What exactly do you mean?\u0026rdquo; were asked, to clarify and expand on the interviewees\u0026rsquo; answers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview Guide\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. What is your definition of natural, instinctive birth?\u003c/p\u003e \u003cp\u003e2. In your opinion, is there a need to redesign the delivery room? Explain more?\u003c/p\u003e \u003cp\u003e3. Through your experience, how do you feel the birthing room affects your ability to promote a normal physiological birth?\u003c/p\u003e \u003cp\u003e4. What practices will change as result of redesigning delivery rooms?\u003c/p\u003e \u003cp\u003e5. What are the requirements for re-implementing childbirth after redesigning the delivery room?\u003c/p\u003e \u003cp\u003e6. What is the value of redesigning delivery rooms to respect the presence of a companion with the mother?\u003c/p\u003e \u003cp\u003e7. In your view, what is the importance of redesigning the birthing room?\u003c/p\u003e \u003cp\u003e8. Discuss the ways how nurses can support normal natural instinctive childbirth?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Trustworthiness\u003c/h2\u003e \u003cp\u003eFour methods, including credibility, dependability, confirmability, and transferability, were employed to determine the quality of the collected qualitative data [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The researchers conferred with the interviewees and requested feedback from their perspectives on the transcripts to ensure credibility, as the participants' perspectives are crucial in judging the credibility of the data. Dependability, based on the assumption of replicability or repeatability, was ensured by sharing the findings with healthcare providers not involved in this study for verification, thereby providing external validation of the findings. To ensure confirmability, participants were asked to check and recheck the narrative data throughout the study, thereby ensuring the accuracy that reflected their true feelings and opinions. Finally, to assess transferability, we determined whether the results could be transferred to other contexts, such as different regions in Saudi Arabia. By employing these methods, we were able to ensure the rigor of the findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eOnce the recorded interviews were completed, they were transcribed verbatim. In order to avoid bias from the participants when providing feedback, all the interviews followed a list of research questions The data gathered from each participant was analyzed using an iterative approach, so that revisions could be made on the basis of earlier interpretations. When all the interviews were recorded and transcribed, an interpretive, phenomenological analysis was undertaken [18]. This form of methodology aims to discover the participants\u0026rsquo; views and attitudes, and to gain a detailed and thorough understanding of their experiences by using an inductive, idiographic approach. Idiographic methodology aims to understand specific cases and individuals [19]. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, lists the steps required by interpretative phenomenological analysis. Finally, the analysis process and findings were reviewed and validated by an expert in qualitative studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStep by step to conducting IPA analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStarting with the first case: reading and rereading\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExplanatory notes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConstructing experiential statements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSearching for connections across experiential statements\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNaming the personal experiential themes and consolidate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuing the individual analysis of other cases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking with personal experiential themes to develop group experiential themes across cases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Characteristics\u003c/h2\u003e\n \u003cp\u003eAltogether, seven physicians and eight midwives working in the obstetrics and gynecology departments opted to take part in the interviews.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSemi-Structured Interview Findings\u003c/h2\u003e\n \u003cp\u003eAs all of the group experience themes are related to the significance of redesigning hospital birth rooms and its impacts on supporting and promoting normal and natural childbirth in low-risk mothers, they can all be grouped under the core category of Supportive Birth Environment for Natural Childbirth. Moreover, it is important to note here that the design of the birthing room also impacts mothers\u0026rsquo; experiences and the roles of the midwives.\u003c/p\u003e\n \u003cp\u003eAfter examining the findings, four relevant themes and thirteen subthemes associated with the birthing room design were identified. The four themes are: supporting natural birth through room design; providing private space through the new design; the influence of birthing room design on midwives\u0026rsquo; roles; and suggestions and recommendations as presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eCore Category with Themes and Sub-themes\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg 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\"\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eTheme 1: Supporting Natural Birth Through Room Design\u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003cp\u003eAfter exploring the opinions of healthcare providers, this emerging concept was created to help low-risk mothers give birth to children naturally without needless medical procedures or updated room layouts. The participants discussed about natural childbirth and its meaning, as well as how birth rooms are designed and how these factors affect mothers psychological well-being.\u003c/p\u003e\n \u003cp\u003eThree sub-themes were covered in this theme: \u003cem\u003eMeaning of Natural childbirth\u003c/em\u003e, \u003cem\u003eprevious birth room design\u003c/em\u003e, and \u003cem\u003eMothers Psychological well-being\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMeaning of Natural Childbirth.\u003c/strong\u003e A natural childbirth typically follows a healthy pregnancy in mothers who have not experienced health issues or chronic diseases that could prevent such a childbirth, which was noted by many of the participants. For example:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A mother can have a natural childbirth in the ninth month of pregnancy if they do not have health problems or chronic illnesses that impact childbirth and commences the childbirth journey with a natural cervical dilatation without incident or postpartum bleeding.\u0026rdquo; \u003cem\u003e(P1, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Instinctive natural birth occurs spontaneously with no complications.\u0026rdquo; \u003cem\u003e(P2, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The mother must have good psychological and physical health to have a natural, instinctive childbirth, without medications or unnecessary medical procedures and with a companion present in the birthing room to support the natural birth.\u0026rdquo; \u003cem\u003e(P8, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious Birth Room Design\u003c/strong\u003e. Natural, instinctive childbirth is not promoted by the design of the previous birth room design, which often has multiple mothers in the same room, which has a negative impact on the presence of a companion and disrupts the comfort of the mother. This was noted by several participants. For example:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A number of practices can promote natural instinctive birth. However, the previous design does not. This is because the previous design was a small room with a bed that only enables the mother to sleep in the lithotomy position throughout the delivery process.\u0026rdquo; \u003cem\u003e(P11, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;In the previous hospital rooms, multiple women were placed in the same room. In turn, this adversely impacts the presence of a companion in the room and disrupts the comfort of the mother.\u0026rdquo; \u003cem\u003e(P15, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Wellbeing of the Mother.\u003c/strong\u003e The birthing room design influences the psychological state of mothers throughout the birthing process. Example comments are provided as follow:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The design of the birthing room impacts the mothers\u0026apos; psychological state during childbirth. For instance, the mother\u0026apos;s thoughts and feelings are influenced by the room\u0026apos;s decoration, which can lessen the pain of childbirth\u0026rdquo; (P10, Midwife)\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The color and brightness of the delivery room can also impact the mother\u0026apos;s mental state during labor and delivery because they enable her to cope with the pain of birth. Windows that allow daylight to shine through during the day are crucial since they impact the mother\u0026apos;s mental health.\u0026rdquo; \u003cem\u003e(P1, physician)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 2. Creating Privacy Through the New Design\u003c/h2\u003e\n \u003cp\u003eThe second theme was established after examining the opinions of healthcare providers, who felt that a birthing room should feel comfortable and safe for women. A hospital-style room is not homely at all but is rather created from a business and care perspective, taking into account the risks and dangers of childbirth. A hospital room can never be truly homelike, but there are some features that can help to make the space more comfortable, such as adding natural features, light, and personal belongings. Light plays a key role here in establishing a cozy atmosphere. Dimmable lights produce a comfortable, serene, and enveloping atmosphere. A homely feeling can also be facilitated through bright colors on the walls, nice posters, or even green plants. Three sub-themes were identified alongside this main theme, namely \u003cem\u003eSuggested new birth room design\u003c/em\u003e, \u003cem\u003eControlling Labor, Companion Involvement, and Positive Distraction.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSuggested new birth room design.\u003c/strong\u003e All of the healthcare providers believed that the cozy features of the newly designed space facilitated a homely setting that would be advantageous for expectant mothers. In turn, this generated a feeling of solitude, and the transfer from home to the hospital went well. Moreover, the mothers would likely have more confidence in the professional conclusions if they were made to feel at home in a familiar setting. Furthermore, sufficient space in the delivery room encourages the mother to move around and decide on the positions that she feels most comfortable in during childbirth. For example, the placement of yoga mats, rope, and a bathtub in the room can be particularly effective. As mentioned by most of the participants, placing pictures and wall speakers in the room, ensuring that there is effective lighting, and taking into consideration the presence of green plants also play a critical role here.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;It is important that the space reminds her of her home environment, facilitating total privacy. The mother\u0026rsquo;s birth hormones are impacted by her psychological comfort throughout the labor process, which stimulates her natural birth hormones. Thus, the birth must take place in a safe setting so that the mother can have a positive experience.\u0026rdquo; \u003cem\u003e(P13, midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;It is important that we promote the use of birthing balls and a rope that enable mothers to perform exercises and squats. The presence of a bathtub with warm water should also be considered during the childbirth process.\u0026rdquo; \u003cem\u003e(P1, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;As gravity facilitates the fetus\u0026apos; descent into the pelvis and helps the mother give birth naturally, the layout of the room also helps the mother to move when exercising and walking around. Placing photos of the sea or other relaxing scenes in the delivery room can help the mother feel at ease. It is also beneficial to think about installing wall speakers and using green designs to allow the mother to listen to music or the Qur\u0026apos;an whenever she wants.\u0026rdquo; \u003cem\u003e(P3, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;We must redesign birthing rooms so that they support natural and instinctive childbirth. Medical devices must be hidden behind walls and the mother must have full control of the lighting in the room. It is also important that the walls are brightly colored to represent the happiness of childbirth.\u0026rdquo; \u003cem\u003e(P14, Midwife).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eControlling the Labor.\u003c/strong\u003e It is important that mothers have the capacity to control the labor and select the position that they find the most comfortable. This was mentioned by several participants. For example:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Once the birth rooms had been redesigned, mothers were given a separate room to use throughout labor and delivery. The new rooms also enable mothers to exercise throughout labor and give birth in the same room, which has helped many women to have a pleasant delivery experience and promoted natural birth practices as mothers have progressed to managing the labor stage.\u0026rdquo; \u003cem\u003e(P6, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A birthing chair should be provided in the new rooms to afford mothers the freedom to take control of the labor by selecting the most comfortable birthing positions.\u0026rdquo; \u003cem\u003e(P4, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCompanion Involvement.\u003c/strong\u003e Some of the participants mentioned a recommended delivery room design, which included a coffee machine, soft bed, and chair to encourage mothers and their companions to participate in an instinctual and natural childbirth.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Hospital rooms with a comfortable bed and chair support the presence of a companion during the birthing process.\u0026rdquo; \u003cem\u003e(P1, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;It is important to have more space in the delivery room so that mothers can move around and walk with their companions. It also gives the companion an opportunity to rest inside the room.\u0026rdquo; \u003cem\u003e(P2, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A companion can help the mother by massaging their back and offering words of support, which will help her get through the agony and exhaustion of giving birth. Thus, ensuring that the birthing room is designed to accommodate the mother and a companion is paramount. In turn, this will increase the chances that the mother will give birth naturally in a supportive and comfortable environment.\u0026rdquo; \u003cem\u003e(P3, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Rooms must be designed to be spacious and contain snacks and coffee machines for the companion, which will help them to support the mother throughout the labor process. The companion can help the mother by massaging her and applying warm compresses.\u0026rdquo; \u003cem\u003e(P14, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Television screens should also be installed, as well as spaces for tea and coffee provisions, mobile chargers and free internet for the companions to use.\u0026rdquo; \u003cem\u003e(P5, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Distraction.\u003c/strong\u003e Some participants stated that the new design of the birthing rooms should offer privacy to expectant mothers and should be painted in bright colors that promote happiness and joy.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The renovated rooms must include pictures that diver the mother\u0026apos;s attention away from her pain and suffering during labor and render it a more pleasant experience. It is also important to provide headphones or speakers so that the mother can listen to music while giving birth. The provision of exercise balls and a bathtub in the rooms can also help to alleviate the pain of the mother.\u0026rdquo; \u003cem\u003e(P8, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Images should also be displayed that explain the story of pregnancy, from conception to birth, which distracts the mother away from her pain and promotes the arrival of the baby.\u0026rdquo; \u003cem\u003e(P10, Midwife)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 3: Influence of the Delivery Room Design on Midwives\u0026rsquo; Roles\u003c/h2\u003e\n \u003cp\u003eThe participants referred to the influence that the delivery room design has on the role of the midwives. Two sub-themes have been identified for this primary theme, namely \u003cem\u003ethe midwife\u0026rsquo;s role and responsibility, and the Midwife Shortage.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eThe Midwife\u0026rsquo;s Roles and Responsibilities.\u003c/strong\u003e This key component refers to how the birthing room and its surroundings help the midwife to perform their role and undertake their responsibilities whilst promoting natural and instinctive birth.\u003c/p\u003e\n \u003cp\u003e\u0026quot;Midwives are skilled and trained to promote spontaneous, instinctive delivery through non-pharmacological approaches including massage, warm baths, breathing exercises, and the use of natural aromatic scents such as lavender. The ideal delivery room layout will help midwives to promote and facilitate spontaneous, instinctual childbirth.\u0026rdquo; \u003cem\u003e(P11, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A key role of the midwife is to offer words of encouragement to the mother. For example, they may tell her that she is a hero or that she is very strong. The midwife must also remind the mother to breathe during the labor and provide her with water, fruit, and other sources of energy. Thus, the design of the room ultimately helps them to perform their roles.\u0026rdquo; \u003cem\u003e(P13, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;After the hospital was redesigned, balls were placed in the delivery room, and this significantly reduced the pain and discomfort felt by mothers during childbirth. Moreover, the presence of midwives supporting and promoting natural birth positively transformed the experiences of expectant mothers throughout the birthing process.\u0026rdquo; \u003cem\u003e(P8, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMidwife Shortage.\u003c/strong\u003e A number of physicians stated that more midwives were needed to support normal and natural childbirth:\u003c/p\u003e\n \u003cp\u003e\u0026quot;We need more midwives to support each low-risk mother and encourage them to undertake an instinctive and natural childbirth.\u0026rdquo; \u003cem\u003e(P5, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;It is imperative to employ more midwives so that we can establish a one-to-one ratio between midwife and mother.\u0026rdquo; \u003cem\u003e(P2, Physician)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eTheme 4: Suggestions and Recommendations\u003c/h2\u003e\n \u003cp\u003eThis last theme examines the recommendations made by healthcare providers. Four sub-themes were identified for this primary theme, namely \u003cem\u003eBirth Room Visits, Community Awareness, Massage to Decision Makers and Authority, and the Training of Healthcare Providers.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBirth Room Visits.\u003c/strong\u003e The physicians recommended that childbirth education classes involve real-life visits to birth rooms in order to reduce the anxiety and stress of expectant mothers:\u003c/p\u003e\n \u003cp\u003e\u0026quot;I also propose adding a visit to the birth rooms to the curriculum of education classes for natural childbirth, as this will help to reduce the stress and anxiety felt by mothers on the day of delivery.\u0026quot; \u003cem\u003e(P2, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Without a doubt, we need to provide childbirth education courses that include birth room visits, as this helps to promote natural, instinctive childbirth. In other words, childbirth will be easier if the mother is more knowledgeable about the birthing process.\u0026rdquo; \u003cem\u003e(P5, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity Awareness.\u003c/strong\u003e The theme of promoting community awareness about the significance of birthing room design emerged during the interviews and was highlighted by healthcare providers:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;To ensure that pregnant mothers\u0026apos; are cooperative during labor, we need to raise awareness in our community about the significance of delivery room design and how it affects natural, instinctive childbirth. I also propose opening a dedicated channel to teach expectant mothers about these concepts.\u0026rdquo; \u003cem\u003e(P5, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;It is critical to spread awareness about the importance of designing delivery rooms and how this influences the psychological states of mothers during childbirth.\u0026rdquo; \u003cem\u003e(P15, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMassage to Decision Makers and Authority.\u003c/strong\u003e The healthcare providers involved in the study provided recommendations relating to decision-makers and responsible authorities. For example, some healthcare providers stated that:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The design of delivery rooms should be presented in a proposed form to the responsible parties at the Ministry of Health so that they understand the importance of the issue. We must raise awareness of the issue with the Ministry of Health.\u0026rdquo; \u003cem\u003e(P6, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Midwives must ensure that hospital decision-makers hear their opinions regarding the significance of the birthing room design and the positive influence that it has on birthing experiences.\u0026rdquo; \u003cem\u003e(P10, Midwife)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTraining Healthcare Providers.\u003c/strong\u003e Once the delivery rooms have been redesigned, we must train healthcare providers. The importance of this has been highlighted by healthcare providers in the study:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;In order for everyone to understand their roles, responsibilities, and duties in supporting natural birth, training sessions for healthcare providers and pregnant mothers with companions are required after the delivery rooms are redesigned. Additionally, it is imperative that all healthcare providers understand clear policies and guidelines.\u0026rdquo; \u003cem\u003e(P3, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Following the redesign, all healthcare providers must be trained so that they can effectively support natural childbirth.\u0026rdquo; \u003cem\u003e(P5, Physician)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Educating healthcare providers (including physicians, nurses, and midwives) is critical in ensuring that they support new practices and help the mother to eat, drink, and move during labor. It is also important that they understand the importance of allowing the mother to choose different birth positions, which is still a new concept to us.\u0026rdquo; \u003cem\u003e(P15, Midwife)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study used an interpretative phenomenology research design to understand healthcare providers' perspectives on the new birthing room design and its influence on mothers' natural instinctive childbirth. The findings included a core category of supportive birth environment for natural childbirth with four themes: supporting natural birth through room design, providing private space through the new design, the influence of birthing room design on midwives' roles, and suggestions and recommendations. The analysis yielded themes that provide insight into the importance of listening to the voices of healthcare providers who participated in a new birthing room design in Saudi Arabia. The findings show that the participants discussed natural childbirth and its meaning, as well as how birth rooms are designed and how these factors affect mothers' psychological well-being. Other studies have highlighted similar findings. A study showed that a calm, private, and safe environment can reduce stress and enhance the release of endogenous oxytocin, potentially leading to more comfortable and efficient labor, which leads to natural childbirth [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Similarly, specially designed hospital birthing rooms, which offer a sense of such as bolstering lighting, comfortable furniture, and calming sounds, can reduce women's requirements for epidural analgesia during labor [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and lower cesarean birth rates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, women's experiences of birth environment influence their mental health and well-being [20].\u003c/p\u003e \u003cp\u003eIn most countries, homelike environment/family-centered care units are designed for uncomplicated deliveries. The evidence shows that despite the global efforts toward the development of physiologic delivery in the maternity unit, which refers to a birth process that is not interfered with unless necessary, the design of the delivery environment still needs reforms. A study in Nigeria showed that the staff's clamor to control the situation transferred the staff's stress to the parturient women [21]. Additionally, our findings indicated that the presence of a hospital-style room is not homely at all but is rather created from a business and care perspective, taking into account the risks and dangers of childbirth. A hospital room can never be truly homelike, but some features can help make the space more comfortable, such as adding natural features, light, and personal belongings. Light plays a key role here in establishing a cozy atmosphere. Dimmable lights produce a comfortable, serene, and enveloping atmosphere. Some participants commented that a homely feeling can also be facilitated through bright colors on the walls, nice posters, or even green plants. Similarly, a previous study opened up new avenues for understanding and designing birthing rooms and concluded that a homelike childbirth room was characterized by warm colors, warm lighting, and comfortable furniture; the bed and medical equipment were not placed in the center of the room [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Goldkuhl et al., [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] also found that specially designed hospital birthing rooms with comfortable furniture can reduce women's requirements for epidural analgesia during labor. Moreover, in the birthing environment, the birth spaces' psychological and sensory features can influence health outcomes and affect physiological birth by limiting interventions [22,23]. Additionally, the authors demonstrated that some participants mentioned a recommended delivery room design, which included a coffee machine, soft bed, and chair to encourage mothers and their companions to participate in instinctual and natural childbirth. Similarly, a study conducted by AlKhunaizi et al., [24] showed that the active participation of birth attendants and providing adequate support and resources can help enhance mothers' well-being and contribute to a positive experience during their hospital stay.\u003c/p\u003e \u003cp\u003eThe concept of the influence of birthing room design on midwives' roles emerged as a key theme in our study. Midwives spend a large proportion of their working hours in the birthing room, which thus represents an important component of their physical working environment [25]. The participants referred to the influence that the delivery room design has on the role of the midwives such as the midwife's role and responsibility, and the midwife shortage. According to a study conducted by Townsend and colleagues, the birth environment can influence women's experiences of labor and birth and midwifery practice [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, a study showed that insufficient numbers of midwives in the workplace increased the effort necessary to complete their work, the general workload, and the time required to fulfill their responsibilities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, these findings contradict another study that showed that midwives were less likely to agree that they had everything they needed in case of an emergency and were also less likely to react appropriately in an emergency [27]. Goldkuhl et al. [20] also noted uncertainties in addition to the positive effects of redesigning birthing spaces. The uncertainties related to task performance may have a negative impact on midwives' job satisfaction, while the positive effects could include improved patient outcomes and a more comfortable working environment.\u003c/p\u003e \u003cp\u003eFurthermore, our research identified several suggestions and recommendations. These suggestions encompassed issues such as birth room visits, community awareness, massage to decision makers and authority, and the training of healthcare providers. The participants stressed the importance of community awareness in promoting the benefits of the new birthing room design, making the audience feel responsible and engaged in this crucial aspect of maternal well being. They recommended that childbirth education classes involve real-life visits to birth rooms in order to reduce the anxiety and stress of expectant mothers. Similarly, a study conducted by Rashed et al., [26] recognized that the participation in childbirth classes has the potential to increase women's knowledge about childbirth while also reducing anxiety and fear.\u003c/p\u003e \u003cp\u003eSimilarly, a literature review on the influence of birthing room design on maternal and neonate outcomes revealed a crucial role of healthcare professionals, architects, and researchers in shaping birthing room design to promote health in birthing women and their babies, particularly in hospital-based labor wards. This research underscores the vital role of healthcare providers in this process, highlighting their value and importance in the design and implementation of birthing room changes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on our research, hospital decision-makers must hear their opinions regarding the birthing room design's significance and its positive influence on birthing experiences. To ensure a comfortable and homelike environment for mothers, redesigning birthing rooms must be made and unified in the Ministry of Health maternity hospitals. This may involve the placement of yoga mats, rope, a bathtub in the room, pictures, and wall speakers in the room, ensuring adequate lighting, and considering the presence of green plants, which also play a critical role here. Ultimately, hospital policymakers must train healthcare providers to understand their roles, responsibilities, and duties in supporting natural birth; training sessions for healthcare providers and pregnant mothers with companions are required after the delivery rooms are redesigned.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths. It addresses the question of information needs regarding the perspective of healthcare providers on the new birthing room design and its influence on mothers\u0026rsquo; natural instinctive childbirth. The participants had exclusive experience with the previous and the new birthing room designs. The qualitative approach, which allowed for a deep and thorough understanding of the perceptions of healthcare providers as they provided during the interviews, is a reassuring aspect of this study. Qualitative research relies on participants\u0026rsquo; experiences and opinions and researchers\u0026rsquo; interpretations and subjective judgments, so some subjectivity and interpretation challenges may be introduced as the limitations of this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eWhat this study adds\u003c/h2\u003e \u003cp\u003eThe findings have added to the evidence on the positive influence of the new birthing room design on mothers' psychological well-being. Our study also highlights the potential positive impact on natural childbirth. Furthermore, we offer new insights into the importance of proposing the new birthing room design to the decision-makers and responsible authorities at the Ministry of Health. We emphasize the significance of the new birthing room design on the mothers\u0026rsquo; experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eOur findings support the redesign of birthing rooms in all hospitals to support low-risk mothers in having a natural, instinctive childbirth. This redesign should ensure space for the mothers\u0026rsquo; companion and provide facilities that enhance relaxation and physical comfort, such as home-like furniture, light, space, bathtub, yoga mat, rope, and green plants. However, amidst all these changes, one thing remains crucial-the one-to-one care of the midwives. It's not just important, it's a key factor in the mothers' birth experience, and it's something that should be ensured and maintained.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative study explored the perceptions of healthcare providers regarding the new birthing room design. All participants demonstrated awareness of the advantages of the new birth room design for the mothers' psychological well-being and normal, natural childbirth, which can help contribute to a positive experience during their hospital stay. However, additional efforts are required to deliver massage to the decision-makers and responsible authorities at the Ministry of Health about the significance of the new birthing room design on the mothers\u0026rsquo; experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their appreciation to the Deanship of Scientific Research through the Research Center at College of Nursing, King Saud University, for logistically supporting this study. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board Alahsa Health Cluster IRB MCH No. (H-05-HS-137) and King Saud University (Reference # KSU-HE-24-570). The participants were fully informed about the study procedure and were given the opportunity to participate voluntarily, with the reminder of their right to withdraw at any time without any consequence. They were assured that their responses would be kept confidential and only accessible to the members of the research team. To maintain confidentiality, participants were assigned codes to use instead of their names. Finally, all participants agreed to be audio recorded, and they were assured that all responses and transcripts would be securely destroyed. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, A.N.A and A.G.A.-O and; methodology, A.N.A and A.G.A.-O; validation, A.G.A.-O; formal analysis, A.N.A and A.G.A.-O; investigation, A.N.A.; data curation, A.N.A and A.G.A.-O; writing\u0026mdash;original draft preparation, A.N.A and A.G.A.-O.; writing\u0026mdash;review and editing, A.N.A and A.G.A.-O. Both authors guarantee the integrity of the content and the study. Authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to considerations on privacy of participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants gave their informed written consent for their data to be coded for analysis, and for certain anonymous citations to be included in the publication, while respecting their confidentiality. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/sup\u003eMaternal and Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 11421, Saudi Arabia; [email protected] (A.N.A); \u003csup\u003e2\u003c/sup\u003eFundamental of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal Uviversity, Dammam 34212, Saudi Arabia; [email protected] (A.G.A.-O). \u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOlza I, Uvnas-Moberg K, Ekstr\u0026ouml;m-Bergstr\u0026ouml;m A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. Plos one. 2020 Jul 28;15(7):e0230992.\u003c/li\u003e\n\u003cli\u003eUvn\u0026auml;s-Moberg K, Ekstr\u0026ouml;m-Bergstr\u0026ouml;m A, Berg M, Buckley S, Pajalic Z, Hadjigeorgiou E, Kotłowska A, Lengler L, Kielbratowska B, Leon-Larios F, Magistretti CM. Maternal plasma levels of oxytocin during physiological childbirth\u0026ndash;a systematic review with implications for uterine contractions and central actions of oxytocin. BMC pregnancy and childbirth. 2019 Dec;19:1-7.\u003c/li\u003e\n\u003cli\u003eTownsend B, Fenwick J, Thomson V, Foureur M. The birth bed: A qualitative study on the views of midwives regarding the use of the bed in the birth space. Women and Birth. 2016 Feb 1;29(1):80-4.\u003c/li\u003e\n\u003cli\u003eNielsen JH, Overgaard C. Healing architecture and Snoezelen in delivery room design: a qualitative study of women\u0026rsquo;s birth experiences and patient-centeredness of care. BMC pregnancy and childbirth. 2020 Dec;20:1-1.\u003c/li\u003e\n\u003cli\u003eGoldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvn\u0026auml;s-Moberg K, Berg M. Room4Birth\u0026ndash;the effect of giving birth in a hospital birthing room designed with person-centred considerations: a swedish randomised controlled trial. Sexual \u0026amp; Reproductive Healthcare. 2022 Jun 1;32:100731.\u003c/li\u003e\n\u003cli\u003eWronding T, Argyraki A, Petersen JF, Tops\u0026oslash;e MF, Petersen PM, Lokkegaard EC. The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions\u0026ndash;an observational retrospective cohort study. Scientific reports. 2019 Jan 22;9(1):303.\u003c/li\u003e\n\u003cli\u003eAndr\u0026eacute;n A, Begley C, Dahlberg H, Berg M. The birthing room and its influence on the promotion of a normal physiological childbirth-a qualitative interview study with midwives in Sweden. International journal of qualitative studies on health and well-being. 2021 Jan 1;16(1):1939937.\u003c/li\u003e\n\u003cli\u003eHodnett ED, Stremler R, Weston JA, McKeever P. Re‐conceptualizing the hospital labor room: the PLACE (pregnant and laboring in an ambient clinical environment) pilot trial. Birth. 2009 Jun;36(2):159-66.\u003c/li\u003e\n\u003cli\u003eBowden C, Sheehan A, Foureur M. Birth room images: What they tell us about childbirth. A discourse analysis of birth rooms in developed countries. Midwifery. 2016 Apr 1;35:71-7.\u003c/li\u003e\n\u003cli\u003eLorentzen IP, Andersen CS, Jensen HS, Fogsgaard A, Foureur M, Lauszus FF, Nohr EA. Does giving birth in a \u0026ldquo;birth environment room\u0026rdquo; versus a standard birth room lower augmentation of labor?\u0026ndash;Results from a randomized controlled trial. European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology: X. 2021 Apr 1;10:100125.\u003c/li\u003e\n\u003cli\u003eNilsson C, Wijk H, H\u0026ouml;glund L, Sj\u0026ouml;blom H, Hessman E, Berg M. Effects of birthing room design on maternal and neonate outcomes: A systematic review. HERD: Health Environments Research \u0026amp; Design Journal. 2020 Jul;13(3):198-214.\u003c/li\u003e\n\u003cli\u003eSetola N, Naldi E, Cocina GG, Eide LB, Iannuzzi L, Daly D. The impact of the physical environment on intrapartum maternity care: identification of eight crucial building spaces. HERD: Health Environments Research \u0026amp; Design Journal. 2019 Oct;12(4):67-98.\u003c/li\u003e\n\u003cli\u003eSmith JA, Nizza IE. Essentials of interpretative phenomenological analysis. American Psychological Association; 2022.\u003c/li\u003e\n\u003cli\u003eTakrouni EO, Al Dawlah RA, Khalifah S, Ali GY, Al-Aithan FM. Impact of Hospital Breast Feeding Awareness Among Lactating Mothers in Maternal and Children Hospital, AL-Hassa, Kingdom of Saudi Arabia. Global Journal of Health Science. 2019 Mar 11;11(4):32.\u003c/li\u003e\n\u003cli\u003ePalinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and policy in mental health and mental health services research. 2015 Sep;42:533-44.\u003c/li\u003e\n\u003cli\u003eAl-Otaibi AG, Alyousef SM, Alhamidi SA, Almoammar DN, Alanazi NH. Exploring Nurse perceptions of structural empowerment in midwifery practice in Saudi Arabia: A qualitative study. Health Care for Women International. 2024 Jan 31:1-5.\u003c/li\u003e\n\u003cli\u003eLincoln YS, Guba EG. Naturalistic inquiry. sage; 1985.; Available online: https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842\u003cu\u003e.\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eJang MS, Kim S. Person-centered relational care experienced by critical care nurses: an interpretative phenomenological analysis study. Journal of Korean Academy of Nursing. 2019 Aug 1;49(4):423-36.\u003c/li\u003e\n\u003cli\u003ePeck B, Mummery J. Recovering the\u0026quot; individual\u0026quot; for qualitative research: an idiographic approach. InForum Qualitative Sozialforschung/Forum: Qualitative Social Research 2019 Sep 26 (Vol. 20, No. 3).\u003c/li\u003e\n\u003cli\u003eKazemi A, Beigi M, Najafabadi HE. Environmental factors influencing women\u0026rsquo;s childbirth experiences in labor\u0026ndash;delivery\u0026ndash;recovery\u0026ndash;postpartum unit: a qualitative cross-sectional study. BMC Pregnancy and Childbirth. 2023 Mar 13;23(1):169.\u003c/li\u003e\n\u003cli\u003eBohren MA, Vogel JP, Tun\u0026ccedil;alp \u0026Ouml;, Fawole B, Titiloye MA, Olutayo AO, Ogunlade M, Oyeniran AA, Osunsan OR, Metiboba L, Idris HA. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reproductive health. 2017 Dec;14:1-3.\u003c/li\u003e\n\u003cli\u003eAburas R, Pati D, Casanova R, Adams NG. The influence of nature stimulus in enhancing the birth experience. HERD: Health Environments Research \u0026amp; Design Journal. 2017 Jan;10(2):81-100.\u003c/li\u003e\n\u003cli\u003eNicoletta S, Eletta N, Cardinali P, Migliorini L. A broad study to develop maternity units design knowledge combining spatial analysis and mothers\u0026rsquo; and midwives\u0026rsquo; perception of the Birth Environment. HERD: Health Environments Research \u0026amp; Design Journal. 2022 Oct;15(4):204-32.\u003c/li\u003e\n\u003cli\u003eAlKhunaizi AN, Al-Otaibi AG, Alharbi MF, Bahari G. Exploring Healthcare Providers\u0026rsquo; and Women\u0026rsquo;s Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study. InHealthcare 2024 Apr 23 (Vol. 12, No. 9, p. 869). MDPI.\u003c/li\u003e\n\u003cli\u003eWangler S, Simon A, Meyer G, Ayerle GM. Influence of the birthing room design on midwives\u0026apos; job satisfaction\u0026ndash;A cross-sectional online survey embedded in the \u0026lsquo;Be-Up\u0026rsquo;study. Sexual \u0026amp; Reproductive Healthcare. 2023 Sep 1;37:100867.\u003c/li\u003e\n\u003cli\u003eRashed MS, Nour SA, Mohamed HS, Ragab AR, Salama NS, Nasr EH. Effectiveness of childbirth education on primigravida womens\u0026rsquo; knowledge about childbirth preparation. Port Said Scientific Journal of Nursing. 2023 Jun 30;10(2):95-113.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Birth room design, Interpretative phenomenological analysis, Natural birth, Psychological wellbeing, Midwives’ roles, Semi-structured interviews","lastPublishedDoi":"10.21203/rs.3.rs-4714570/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4714570/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBirth is a process which encompasses neurohormonal, physiological and psychological elements, but is mainly controlled by oxytocinergic mechanisms. Neurohormonal processes can be impacted negatively by the external environment, since an unknown and stressful environment can trigger the sympathetic nervous system, and thus repress the amount of endogenous oxytocin being released. This, in turn, can weaken or even stop labor contractions. Alternative birth environments can not only reduce the effects of negative healthcare, but can also result in women having a positive perception of patient-centered care and its capacity to meet the health and social care needs of future generations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn interpretative phenomenological qualitative approach was conducted in a government hospital in the Eastern Province of Saudi Arabia. Data collection involved conducting semi-structured interviews with 15 participants. The sample consisted of physicians, and midwives, ensuring a diverse range of perspectives.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAn interpretative phenomenological analysis was conducted for data analysis. One core category Supportive Birth Environment for Natural Childbirth with four emerged from the data analysis. The four themes are: supporting natural birth through room design; providing private space through the new design; the influence of birthing room design on midwives\u0026rsquo; roles; and suggestions and recommendations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAll participants demonstrated awareness of the advantages of the new birth room design for the mothers' psychological well-being and normal, natural childbirth, which can help contribute to a positive experience during their hospital stay. However, additional efforts are required to deliver massage to the decision-makers and responsible authorities at the Ministry of Health about the significance of the new birthing room design on the mothers\u0026rsquo; experience, aiming to foster their understanding of the importance of redesigning the birthing room at the national and international level.\u003c/p\u003e","manuscriptTitle":"Listening to the Voices of Healthcare Providers Who Involved in a New Birthing Room Design: An Interpretative Phenomenological Analysis Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-28 12:03:36","doi":"10.21203/rs.3.rs-4714570/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-23T06:03:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-19T07:23:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T16:50:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80356380676735536237396348307961751431","date":"2025-06-12T07:04:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-11T05:23:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119834741537004757561716219577113707653","date":"2025-06-10T12:33:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312862367296831758772284067275336904148","date":"2025-06-10T10:47:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123939140649860022211307705233604761842","date":"2024-09-07T07:44:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-03T11:15:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19835703367071089804752128214828846403","date":"2024-08-31T09:38:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255046861676061979119881237578319219561","date":"2024-08-31T06:45:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43634797871220095846037752144298324135","date":"2024-08-24T13:04:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-22T08:47:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-06T16:24:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-17T15:51:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-17T09:44:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-07-17T09:43:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccdbe64d-ec6b-4311-9ceb-7c3e66e7a659","owner":[],"postedDate":"April 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:00:23+00:00","versionOfRecord":{"articleIdentity":"rs-4714570","link":"https://doi.org/10.1186/s12913-025-13950-9","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-12-26 15:57:06","publishedOnDateReadable":"December 26th, 2025"},"versionCreatedAt":"2025-04-28 12:03:36","video":"","vorDoi":"10.1186/s12913-025-13950-9","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13950-9","workflowStages":[]},"version":"v1","identity":"rs-4714570","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4714570","identity":"rs-4714570","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}