In high- and moderate-income countries, labour wards have become the settings for childbirth for the majority of childbearing women. Routine medical interventions have also increased steadily over time, leading to many questions about benefits, safety, and risk for healthy childbearing women. The design of conventional hospital labour rooms is similar to the design of other hospital sick rooms, i.e. the hospital bed is a central feature of the room, and medical equipment is in plain view. In an effort to support normal labour and birth for healthy childbearing women, a variety of institutional maternity care settings have been constructed. Some are 'home-like' bedrooms within hospital labour wards. Others are 'home-like' birthing units adjacent to the labour wards. Others are freestanding birth centres. More recently, 'ambient' and Snoezelen rooms have been constructed within labour wards; these rooms are not home-like but contain a variety of sensory stimuli and furnishings designed to promote feelings of calmness, control, and freedom of movement.
The primary aim of this review is to evaluate the effects, on labour and birth outcomes, of care in an alternative institutional birth setting compared to care in a conventional hospital labour ward. We included nine trials involving 10,684 women. We found no trials of freestanding birth centres. When compared to conventional institutional settings, alternative settings were associated with reduced likelihood of medical interventions, increased likelihood of spontaneous vaginal birth, increased maternal satisfaction, and greater likelihood of continued breastfeeding at one to two months postpartum, with no apparent risks to mother or baby. Unfortunately in several trials, the design features of the alternative setting were confounded by differences in the organizational models of care (including separate staff and more continuity of caregiver in the alternative setting), and thus it is not possible to draw conclusions about the independent effects of the design of the birth environment. We conclude that women and policy makers should be informed about the benefits of institutional settings which focus on supporting normal labour and birth.