Dynamics of Social, Cultural, and Spatial Dimensions on Childbirth Experiences in Three Jeddah Hospitals: A Mixed Methods Study

Abstract

Over time childbirth practices evolve, and at the present time giving birth in hospital, rather than at home or in midwife led clinics, is the preferred option. While this shift has been beneficial for high-risk pregnancies, women with low-risk pregnancies frequently report low satisfaction levels. Research in Western contexts has revealed that spatial design impacts human behavior and social interaction during childbirth. However, there is a lack of research on how the physical environment affects the childbirth experiences of women in the Middle East. Thus, there is a need to provide data regarding the Middle East, as it has a unique culture. This study analyzes the impact of the birth environment, excluding sensory factors, on childbirth experiences in Saudi Arabia, integrating spatial analyses, women’s perceptions, and cultural considerations. This study utilized a Case Study-Mixed Methods Research (CS-MMR) design, incorporating both quantitative and qualitative methods (Quan + qual). The Quan aspect employed a Space Syntax (SS) analysis to examine the arrangements on Labor and Birth Wards (LBWs) at three hospitals. A satisfaction questionnaire was also administered to women who had given birth at these hospitals, requesting that they rate their experiences on a Likert scale. The qual aspect involved in-depth interviews with 31 Saudi women who had recently given birth at one of the three hospitals. The study identified noticeable connections between average spatial values and women’s satisfaction levels. For instance, Labor/Birth Rooms (LBRs) with higher mean integration values, indicating lower privacy, resulted in lower satisfaction levels overall (Tau (3) = -1, p≤.0001), as well as with the physical room (Tau (3) = -1, p≤.0001). Conversely, LBRs with lower mean step depth, indicated by more staff and entries, resulted in higher satisfaction with the services (Tau (3) = -1, p≤.0001) but had a negative association with privacy. Women’s satisfaction with staff communication was positively associated with the mean visibility of bed sight (Tau (3) = 1, p≤.0001) although this was not evident from the interview data. This study reveals that privacy concerns significantly correlate with how women report their childbirth experiences. The hierarchical power structure present in hospital institutions also informs the level of autonomy and control women feel during childbirth. The LBWs considered in this research each have different designs with varying levels of privacy and staff presence. Private LBRs offer greater privacy but are associated with issues surrounding unauthorized entry and staff presence. Integrated BRs result in a higher number of staff entries relatively, but provide improved privacy in the form of bed curtains. Women have varying preferences regarding staff movement during labor, depending on personal preference. This study’s results can potentially be drawn upon to improve the birth environments at hospitals in Jeddah and in similar locations. This could lead to women having childbirth experiences that are more positive, which is vital for their well-being. The methodology employed here could also be applied to analyze other hospitals, develop new designs to assess and anticipate potential improvements. Further examinations are necessary to understand EBR in birth spaces worldwide.