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Are maternity units too noisy?

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According to a recent article in the Boston Globe, hospital noise has become problematic and researchers, along with some hospital administrators, are starting to listen.

From The Boston Globe article:

In 2005, a team of researchers at Johns Hopkins University led by the engineers Ilene Busch-Vishniac (now the provost at McMaster University) and James West looked at the best available historical data and found that, since 1960, the average daytime noise level in hospitals had doubled. At night, it was four times louder.

So what’s the buzz all about? The numerous studies cited in this article repeatedly point to concerns and, in many cases, concrete evidence that hospitalized patients tend to fare much worse as decibel levels rise. Vitals signs (blood pressure, heart and breathing rates and body temperatures) are less stable. Perceived pain and therefore request for pain medication is higher. Newborns in intensive care nurseries stay longer and can potentially suffer hearing damage. Surgical patients take longer to heal.

For me, this suggests the obvious question about mothers who are supposedly resting up from childbirth—particularly the ~30% of US women who are recovering from cesarean section deliveries—and what type of true “recovery” they are garnering during their 48 – 72 hour stays.

Some cultures around the world take the postpartum recovery of a woman so seriously, they expect mom to do nothing but remain at home, sleeping, eating and nursing her baby for upwards of forty days. In the United States, our hustle and bustle, noise-filled culture accompanies a woman’s postpartum experience.

Typical doctor’s orders on a maternity ward dictate a woman’s nurse(s) to visit her room no less than once every four hours to perform basic nursing duties—and assuming baby is rooming in with mom, there is often times a completely separate schedule of nursing visits for the newborn. But, following each of my three hospital birth experiences, I seem to recall the door to my room swinging open and shut many more than six times in a twenty-four hour period. Between doctors performing medical rounds, someone from the nutrition department collecting food orders, lactation specialists making their daily visits, hospital photographers stopping in for a quick snapshot of each bundle of joy and occasional hospital volunteer drop-ins, there’s actually very little time for a woman to rest following the birth of her baby.

Sleep studies tell us that when a person’s sleep is frequently interrupted, they are less likely to slip into non-REM sleep—the mode of rest during which growth and healing is most likely to occur. With overhead pages echoing down the halls, sitcom canned laughter from the neighbors’ too-loud television, and, let’s face it, the sound of multiple babies crying in poorly insulated quarters, it’s no wonder most women leave the hospital more rather than less tired when they entered. (And, if you’ve recently been pregnant, you’ll likely recall how tired you felt by the end of your third trimester.)

But it’s not just the postpartum wing where noise is a problem. The L&D room can be a rather cacophonic place as well. With fetal monitors tapping out the baby’s twice-per-second heart rhythm, constantly spewing out reams of paper, and bing-bonging an alert every time the baby’s heart rate falls outside certain parameters…with patient controlled analgesia pumps pumping and beeping away…with alarms sounding every time an IV line gets kinked or the bag empties…with a infant warming table blaring when it reaches its preset temperature…with labor and delivery nurses, aides, technicians, nursery nurses, midwives, doctors, PAs and possibly residents and interns floating in and out, a hospital birth room can become as busy as the intensive care department.

We know from observing animals that from an instinctual basis, it’s pretty darned hard for childbirth to take place amidst noise and lack of privacy. And, surprise, surprise: human beings are no different. Could the ever-increasing rates of labor augmentations, epidural usage, suction-assisted deliveries, and cesareans for “failure to progress” be explained, in part, by hospital setting noise? Is it possible that with every “unnatural” sound we hear, our bodies shut down just a little more—whether during the process of birth, or during the healing, resting, and mother-baby bonding period that is supposed to occur afterward?

Recently, a dear friend of mine delivered her second baby. Having shared a room with another woman in the postpartum wing, my friend initially spoke favorably of her experience being so close to another puerperal woman. “That’s when I realized how much I needed to be with other women following my birth experience,” she confessed.

But our conversation quickly turned to the idea of a postpartum floor lounge—a place specifically designed for mothers and babies…a spa reception-like setting where women could sit in comfortable rocking chairs and heavenly couches, nurse their babies, share stories, exchange words of advice and encouragement amidst quiet music (or no music at all) and dim lighting, drink from the endless supply of healthy teas, water and juices, and languish in an uninterrupted setting for as long as they desired.

“It wasn’t exactly ideal sharing a [hospital] room with someone else,” she later told me of her two-day postpartum roommate. “I could hear all their conversations and she constantly had the TV on. But still, I learned a lot about myself and my needs following my second baby’s birth.”

In the United States and many, if not most other developed nations, women do not look forward to a 40-day lying in period following childbirth. So, that cultural practice being what it is, perhaps hospitals that are currently looking at their facility-wide noise levels and amelioration plans should also contemplate the overall setting of the labor, delivery and postpartum wing.

This is a guest post by Kimmelin Hull, PA, LCCE. Kimmelin is a Lamaze Certified Childbirth Educator, mother of three, and author of A Dozen Invisible Pieces and Other Confessions of Motherhood. You can visit Kimmelin at her blog site: http://kimmelin.wordpress.com.

Photo by debsilver, used under a Creative Commons license.

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  1. June 11th, 2010 at 09:27 | #1

    Yes. Yes they are. Shared postpartum recovery rooms make for nothing but unnecessary interruptions to parents and baby (or babies).

  2. avatar
    Carolyn
    June 11th, 2010 at 13:20 | #2

    I’ve had three babies, only one in a hospital. I transferred during labor from an attempted homebirth. My daughter was born around 8 pm. My midwife suggested I go home after a few hours since my birth was pretty uncomplicated (the labor was complicated, not the birth), but since I left in a hurry and we didn’t have a car or carseat at the hospital, I decided to stay and “get some sleep” and leave the following morning. What a joke that was! That was the most horrible experience, trying to sleep to sleep in a hospital. Since I had only given birth at home before, I assumed that I would get several hours of uninterrupted sleep, and that any required tests would be done quietly with dim lighting. HA! Third baby was NOT born in a hospital, and my immediate postpartum period was so much easier than my 2nd birth.

  3. avatar
    Krista
    June 11th, 2010 at 14:45 | #3

    I have two children, both born in an independent birth center, not hospitals. I was at home in my nice quiet bed in under 10 hours for both births. It was great! No one bothering me during the night, cozy bed, good food…can’t beat it for anything.

  4. avatar
    sara
    June 11th, 2010 at 18:49 | #4

    And what’s worse is that for all of the noise and disruptions the hospital that I birthed in charged almost 900$ per night! For that amount of money I should be in a spa somewhere!

  5. avatar
    Juliette
    June 11th, 2010 at 21:09 | #5

    And let’s not forget the roomates with the portable DVD player and no headphones…

    Yes. My first birth I was at the hospital for 2 days post-partum – apparently to “get some rest”. And I had the nurses coming in every 4 hours to check the baby had nursed, give me conflicting advice, and then check my blood pressure, which went up and up I’m sure with all the hustle and bustle … I got no rest.

    My second birth, we went to a much smaller hospital with a different philosophy, and our midwife discharged us 3 hours after the birth and visited us that evening. Much better, so much more peaceful.

  6. June 11th, 2010 at 22:32 | #6

    I’m afraid they’ll have strict rules about noises the maternity patients make. Mandatory epidurals and narcotics will keep those noisy women under control.

  7. June 12th, 2010 at 05:28 | #7

    Great article, putting this in Sunday Surf!
    I wrote about post natal care in Ivory Coast a while back. Quite the difference. I would have much preferred the african way to lying in abed alone feeling sad because nobody came to visit, not sleeping and getting bad food
    http://mamapoekie.blogspot.com/2010/03/post-natal-care-in-ivory-coast.html

  8. June 12th, 2010 at 09:16 | #8

    @sara
    Amen to that! And don’t forget about the five star meals that ought to go with a $900/night price tag! “Nutrition Department” issued meals wouldn’t exactly garner rave revues from food critics!

  9. June 12th, 2010 at 09:18 | #9

    Thanks to Amy Romano for the opportunity to write for Science and Sensibility!

  10. avatar
    Esther Shire
    June 12th, 2010 at 11:51 | #10

    My stays in an English hospital after each of my two caesarean births were hideously noisy. Especially at night when doors crashed open, and noisy metal bins clashed open and shut. I woke each time with my heart pounding, and cried the first time when it was suggested that as nobody was available to sign me out, I might have to stay in for another night! I was hugely relieved when, five years after the first birth, I was told that it was now considered necessary for post caesarean mothers only to stay in for two nights rather than the three we endured first time round. Each time I was woken at night to be told off for keeping the baby in bed with me, and nurses seemed astonished when they took temperatures and realised that the baby wasn’t over heating when laid skin to skin with me. Horribly experience, except for the fact that I had my baby, but I couldn’t wait to be back home as a proper family.

  11. June 13th, 2010 at 19:05 | #11

    Thank you, Kimmelin! This is such an excellent point. I was relieved to go home from the hospital after my birth so I could finally get some sleep.

    The whole time we were there, the nursing shifts kept changing (there were multiple last-minute switches), and each new nurse would come in, wake me up, and ask me questions. I couldn’t believe anyone would wake up an exhausted new mother and baby like that!

    In addition to the noise was the light. Everyone kept turning bright lights on as they walked into the room, or rolling up our window blinds to “give the baby sunlight.” Um, he’s not jaundiced and he is (was) sleeping peacefully; back off.

    The experience really did make me think it was a wonder if anyone ill ever recovered during a hospital stay, for all the lack of sleep!

  12. June 14th, 2010 at 08:55 | #12

    Hospital noise is actually one of the main reasons we’re planning on a homebirth for our next child. We stayed at the hospital for two days after my daughter was born, and we hardly got ANY sleep! Thee were tons of people coming in and out of our room with no notice: doctors, nurses, lactation consultants, people from nutrition, photographers, and let’s not forget family. It was exhausting! None of us slept well at all (except maybe the baby–but she slept much better once we were home). It was awful!

    Ironically, the nurses shushed me for making noise when I was actually birthing my daughter. Go figure.

  13. June 14th, 2010 at 19:40 | #13

    As a doc I can say that L and D units are way to noisy. Sometimes at night I feel like the unit is just a wall of sound, even to the point of me raising my voice to get everyone’s attention to tell them all to be a little quieter. A times it is just crazy. At one hospital I worked at the central monitoring system had a piercing alarm for abnormal tracings that could only be turned off at the bedside. Given that the ability of a computer to accurately tell when a strip is bad is total crap, this led to a near constant stream of terrible noises in the nursing station. It sucks.

  14. June 15th, 2010 at 08:25 | #14

    @ Nicholas: Your input is awesome….and I think it’s great to see that even health care providers recognize this as a problem (sometimes!) and that it can be just as disturbing for them/us as for the patients. (I’ve known docs who always demanded classical music to be played in the OR, others…Van Morrison and still others…absolute silence.)

    @ Cate: Yes, it is ironic how many women are urged to “shush” during the birthing process. So much so that while teaching my classes, I would often have a segment where we, as a group, practiced MAKING NOISE to override that message…to remind women that MAKING NOISE IS PART OF THE BIRTH PROCESS and is NORMAL…not animalistic…not undignified…not scary…just NORMAL.

  1. November 15th, 2010 at 16:25 | #1