As we continue to advance in the fields of technology and design, specifically as it relates to the modern labour and delivery rooms, much has been said on how progressive and spacious they are now becoming. In our present culture where change is considered good, new is best and bigger is better that has been reflected in the designing and constructing of the labour and delivery room.

While certainly modern spacious designs have allowed for the integration and accommodation of medical equipment now being provided as standard of care, some would ask what the human cost of this. The large modern rooms are bright and airy with all the features one expects to find in a nice hotel room. Private bath rooms, with Jacuzzi tubs, comfortable chairs and fine

What the small labour room necessitates may be perhaps the most overlooked quality of all — intimacy

What the small labour room necessitates may be perhaps the most overlooked quality of all — intimacy"

While I am sure we can all agree that the small labour room has a great many detractions associated with it, lack of space, crowding, flexibility of use and utilitarian in décor. Perhaps we should take a good look at what we risk forfeiting in pursuing a new and improved space.

What the small labour room necessitates may be perhaps the most overlooked quality of all; intimacy. In a small room intimacy is imposed upon caregivers, support people and the labouring woman alike. Not much can be hidden in a small room, peoples faces are visible encouraging frequent eye contact, scents are intermingled and words sometimes all too audible. Movement in the small room when it has others in it, means being aware of where you are in relation to everyone else and adjusting your personal space accordingly.

In a small room encounters are often more than just proximity with each other. Individuals can become extensions of each other, such as when crowding dictates asking whoever is closest to something needed, to retrieve it. This constant and intense interaction fosters a feeling of togetherness that is further enhanced by the knowledge that everyone in attendance is there for a common purpose.

Caregivers working in smaller rooms may be unconsciously more attuned to their patients' circumstances, better able to intuit and respond to their patient's changing needs more swiftly as a result.

The experience of intimacy with a caregiver goes along way to build trust, experienced not only by the labouring woman, but amongst her support people and the various caregivers.

The client who is trusting of her supporters and her environment has a reduced need to solicit encouragement, or reassurances regarding her ability to cope. The recognition and acknowledgment of labouring woman's successful coping will be reflected in the behaviour of her supporters and the caregiving staff. The support staff's awareness of the labouring woman's state of coping, encourages them to believe in her abilities.

It is a win-win scenario for everyone involved.

This combination of trust and validation creates a heightened sense of empowerment. The labouring woman feels well supported and is therefore more relaxed and better able to cope, the support people see the labouring woman coping, and feel reassured that they are providing appropriate care, allowing them to relax, become more attuned to their environment and function at a higher level. It is a win-win scenario for everyone involved. For the labour doula working in a situation with a client who is the recipient of this level of support, facilitation of their client's birth wishes is much easier to achieve.

That is not to say that labour in a small room is a guarantee of success. In fact just the opposite can be true. Caregivers providing care in a small room who have a personal agenda or whose own feelings about labour and delivery are in conflict with the labouring woman's needs and wishes can create a power struggle situation. The intimacy of the situation, in this case, means that even subtle displays of dissent, such as smirking, eye rolling, or lack of eye contact which might be hidden in a larger room are exposed and magnified by proximity and observation.

The words spoken by the caregiver in this intimate setting carry significant influence as well. A tossed off "nobody gets extra points for being a martyr", or "an epidural can help you get some rest" spoken by a caregiver while providing hands on care for the labouring woman can have a devastating effect on her belief in her ability to continue coping. This spectre of doubt may affect the partners and support people. They may begin to question the validity of continuing on the path of support that they are currently on. Worse still they may begin to doubt the labouring woman's continued ability to cope.

So what can this new trend in room design mean for the future? As doulas we need to become aware of the environments we work in and an understanding of their associated pros and cons. We need to encourage the development of this observational skill as a powerful support tool to include in our kit. When we allow ourselves to stand back and just observe our environment we begin, to see the impact it has on behaviour, activity, interaction, creativity and care.

Recognizing this and keeping this understanding with us when in different environments may allow is too keep the vital lesson of the benefit of intimacy we risk throwing away in our haste to embrace the future.

- Virginia Collins