The influence of the birth environment on childbirth experiences : a quantitative study of midwives’ perspectives

Abstract

Purpose: In recent decades, the institutionalisation of childbirth has led to increasingly medicalised maternity settings, with growing recognition of the impact this has on childbirth experiences. However, research has largely explored women’s perspectives and the physical aspects of the birth environment using qualitative methods. This study addresses these gaps by quantitatively investigating midwives’ perspectives on how various dimensions of the hospital birth environment shape the childbirth experience. Aim: To examine midwives’ views on the impact of the birth environment on the woman’s childbirth experience. Objectives: To identify midwives’ perceptions of physical factors in the birth environment that influence the woman’s childbirth experience; to assess midwives’ perceptions of psychological and emotional factors in the birth environment that influence the woman’s childbirth experience and to evaluate midwives’ reported practices in utilising the birth environment to enhance the woman’s childbirth experience. Methodology: A quantitative, non-experimental, cross-sectional design was employed using a self-designed online questionnaire distributed to midwives working in selected maternity settings within the main public hospital. Purposive sampling recruited 141 participants from a total population of 213 midwives, representing a 66.2% response rate. Quantitative findings were evaluated through descriptive and inferential statistical methods, whereas qualitative responses were examined using content analysis. The study was guided by the Birth Territory Theory (Fahy et al., 2008) and the Theory of Supportive Birth Settings (Maxwell et al., 2024), which provided the theoretical lens for interpreting findings. Results: Midwives highlighted key physical factors of the birth environment, including privacy, lighting and availability of birthing aids, while a calm and supportive atmosphere was recognised as crucial for psychological and emotional wellbeing. Novel findings included concerns about the delivery bed quality and functionality, the impact of swinging doors on privacy and soundproofing, and the anxiety-inducing presence of large wall clocks opposite delivery beds. Midwives identified various practices used to enhance the birth environment, however, institutional barriers were often reported to limit these efforts. Conclusion: This study contributes to the existing body of knowledge by providing quantitative evidence of midwives’ perspectives, a group previously underrepresented, and by extending focus beyond the physical to the psychological and emotional factors of the birth environment. Findings underscore the need for a balanced approach integrating environmental design, professional empowerment and institutional support to enhance childbirth experiences. The study provides a foundation for future research on broader dimensions of the birth environment and the factors that facilitate or hinder improvements in maternity care settings.