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BIRTH 27:4 December 2000

Single Room Maternity Care and Client Satisfaction
Patricia A. Janssen, MPH, PhC, Michael C. Klein, MD, CCFP, FCPS, Susan J. Harris, MD, CCFP,
Jetty Soolsma, MA, CNM and Laurie C. Seymour, BSN
ABSTRACT: Background: Single room maternity care is the provision of intrapartum
and postpartum care in a single room. It promotes a philosophy of family centered care
in which one nurse cares for the family consistently throughout the intrapartum and
postpartum periods. At B.C. Women’s Hospital, a tertiary level obstetric teaching hospital
in Vancouver, British Columbia, a seven-bed, single room maternity care unit was developed
and opened as a demonstration project. As part of the evaluation of this unit, client
satisfaction was compared between women enrolled in single room maternity care and
those in a traditional setting. Method: The study group included 205 women who were
admitted to the single room maternity care unit after meeting the low-risk criteria. Their
responses on a satisfaction survey were compared with those of a historical comparison
group of 221 women meeting the same eligibility criteria who were identified through chart
audits 3 months before the single room maternity care unit was opened. A second, concurrent
comparison group comprised 104 women who also met eligibility criteria. Results: Study
group women were more satisfied than comparison groups in all areas evaluated, including
provision of information and support, physical environment, nursing care, patient education,
assistance with infant feeding, respect for privacy, and preparation for discharge. Conclusions: Single room maternity care was associated with a significant improvement in client
satisfaction because of many factors, including the physical setting itself, avoidance of
transfers, and improved continuity of nursing care. (BIRTH 27:4 December 2000)
The continued evolution of maternity care toward a
philosophy that is both client centered and acknowledges birth as a normal physiologic and developmental
process has given rise to many changes in the last two
decades. The traditional practice of admitting women
to labor rooms, moving them to delivery rooms, and
then transferring them to postpartum wards was based
on a partitioning of resources, space, equipment, and
nursing staff that was intended to provide an economy
of scale for the institution. This movement of the
childbearing woman to the location of a variety of

Patricia Janssen, Michael Klein, and Susan Harris are from the
Department of Family Practice, University of British Columbia
and B.C. Women’s Hospital; Jetty Soolsma and Laurie Seymour
are from B.C. Women’s Hospital; and Patricia Janssen is also from
the B.C. Research Institute for Children’s and Women’s Health,
Vancouver, British Columbia, Canada.
Address correspondence Patricia Janssen, BC Women’s, 4500 Oak
St, Room E414A, Vancouver, British Columbia, Canada, V6H-3N1.
q 2000 Blackwell Science, Inc.

caregivers can result in her experiencing feelings of
disorientation, anxiety about being in the right place
at the right time, a lack of space in any one area, and
a need to meet and adjust to multiple caregivers.
In a system with single room maternity care, when
the parturient woman is in established labor, families
are admitted to one room and stay there throughout
the intrapartum and postpartum periods. The newborn
remains with the family at all times. This type of
care promotes a philosophy of family centered care,
characterized by continuity, a team approach to decision making, respect for privacy and individual choice,
and appreciation of childbirth as a natural and normal
process. The purpose of the study was to compare
women’s satisfaction with single room maternity care
with that of clients cared for in the traditional labor
and delivery unit and the postpartum unit.
Background
The concept of single room maternity care was first
introduced in South Africa in 1970 as the ‘‘Single-

women were transferred to a postpartum room 2 hours after delivery. and social aspects of childbirth. first-served basis. emotional. The Single Room Maternity Care Unit Our single room maternity care unit consists of seven spacious rooms. Three perinatal nurses. attractively decorated. making it the largest such facility in Canada. The low-risk delivery suite comprises eight delivery rooms built within the inner structure of the building. Elements that these two systems had in common were an emphasis on the humanistic. continuity of care through use of midwives. The literature to date. which are available at no extra charge and filled on a first-come. a family centered birth. It must be pointed out that in the 1990s. This system allowed for the family to room in together during the entire hospital stay (2). low-touch’’ appearance. A seven-bed demonstration single room maternity care unit was constructed in 1997. Soundproofing was installed in the walls throughout the unit. and postpartum rooms at Clarkson Hospital in Nebraska (5). therefore. The Birthplace at St. and a positive environment conducive to a more physiologic labor and delivery and sense of well-being (2). and make telephone calls or watch the family television channel. in which home births were considered to be the only way to have ‘‘natural deliveries’’ and the hospital was the only way to ensure ‘‘safe’’ deliveries. however. Women’s Hospital. which will be the topics of future publications. Advantages for clients included an increased opportunity to establish rapport with their nursing caregivers.C. The postpartum modules each consist of 14 small rooms designed for mothers only. the rooms have a ‘‘high-tech. Satisfaction with single room maternity care among nurses has been measured but not compared with that of nurses working in other areas (unpublished data. The results were reported anecdotally. and a nursing education program. Before 1997 all care was provided in 12 labor and delivery rooms and 52 postpartum rooms. Mary’s Hospital in Minneapolis with 18 single maternity care rooms evaluated patient satisfaction by means of questionnaires completed after discharge (6). Before implementing single room maternity care on a wide scale. supported by a patient services clerk and a patient services aide. with encouragement for the participation of fathers and family members during childbirth. no separation of parents from the newborn.C. including water therapy and natural daylight.236 Unit Delivery System’’ or ‘‘SUDS’’ (1). Winnipeg. Recent literature continues to report client satisfaction as a major benefit of single room maternity care. families can prepare their own meals.’’ Unlike today’s single room maternity care. and have bathrooms complete with bathtubs. British Columbia. 1992). where more than 7000 BIRTH 27:4 December 2000 births per year occur. B. all others are single occupancy. The rooms. and positive comments about the facility itself. and an outside window to provide natural lighting (3). even though at their inception they represented a dramatic improvement over the ‘‘operating room’’ style that was the standard at that time. Two of the rooms are doubles. Staffing Single room maternity care nursing staff consists of a core group of 20 nurses who have completed perinatal nursing training. an obstetric tertiary level teaching hospital in Vancouver. The nurse-to- . The Cybele Cluster System evolved from the single unit delivery system in the United States in the early 1980s. staff the unit around the clock. primary care nurses. A sofa chair converts to a comfortable bed for a labor support person. In general. She refers to a postcare evaluation indicating that the 12-bed single room maternity care unit was an ‘‘overwhelming success with families. Berkland described the conversion in 1990 of labor. we wished to evaluate its impact on client satisfaction in a large cohort study that compared low-risk women receiving the new program with similar women receiving care in the traditional setting within the same institution. delivery. In the family lounge. or both. One respondent noted that the ‘‘many amenities made one feel at home. The units are decorated with maple furniture. airy. and allowed for free movement. are dark with small bathrooms that only have toilets and showers. Victoria General Hospital. with patients complimenting the nursing staff on their helpfulness and understanding.’’ A caring supportive staff was the first item mentioned by most families. These SUDS rooms were designed to be able to cope with every obstetric contingency other than cesarean delivery. has generally been descriptive in nature (4). They were designed to instill an atmosphere of ‘‘positiveness and cheerfulness. sit at a table or in comfortable chairs. utilization and cost issues. Rooms were bright. Supplementary staff comprise eight ‘‘casuals’’ who have had comparable perinatal training. these rooms are overcrowded. pregnancy outcomes. each with outside windows. This system was developed to address a polarization of attitudes toward childbirth care. attractive and functional furnishings including an adjustable bed to promote physiologic birth. followed by attention given to family. Women’s Hospital was built in the early 1980s when the importance of natural childbirth. and delivery rooms to labor.’’ The current study was conducted at B. This evaluation also examined caregiver satisfaction. was not understood as it is today.

These eligible women were in active labor. oligohydramnios (amniotic fluid index < 5%). These women were admitted to the delivery suite in active labor and stayed there until 2 hours postpartum.C. In collaboration with our Department of Health Promotion. comprising all women who had received their care in the single room maternity care unit during the first 6 months after the unit opened. normal fetal health assessment). Women’s Hospital had initiated a maternity satisfaction survey. Organization of the delivery suite is centralized and coordinated by the team leader. and women are transferred to the postpartum unit as soon as their condition allows. The women were identified through a review of patient Kardex files in postpartum nursing stations. We reviewed women’s comments about their hospital stay that had been gathered as part of a community health care evaluation. thereby masking the true influence of the intervention on patient satisfaction. Data from this comparison group were collected concurrently with data from single room maternity care women. Some physicians did not want to care for women on the single room maternity care module because they were often concurrently caring for others in the delivery suite. Additional revision focused on ensuring that wording was culturally appropriate and in context. newborn. Approval for the final version was given by the University of British Columbia Behavioral Re- search Ethics Board and the B. or insulin-dependent diabetes. as defined by the presence of regular contractions and cervical dilation of at least 3 cm and less than 0. They were experiencing a normal pregnancy (37–42 weeks’ gestational age. and the birth itself. B. It was translated into Chinese and Punjabi script and then back-translated into English to check for accuracy. located on a different floor. This is the traditional labor and delivery/postpartum approach. nurses provide primary nursing care to the childbearing families in collaboration with physicians and other health caregivers. cephalic presentation.C. we designed a questionnaire that was reviewed by hospital patients and revised. but who did not go there because no room was available at the time or because their physician did not want them to use that type of care.5 cm in length. we held focus groups with approximately 40 mothers and their babies who attended well baby drop-in clinics in community health units. We also reviewed the literature on measurement of satisfaction related to maternity care. exclusions included any indications for intensive monitoring in . Nurses and support staff communicate by way of an in-house wireless companion telephone system. Exclusion factors included anticipated imminent delivery on admission (within 15 min). Women’s Research Review Committee. Responses from these two comparison groups were compared with the study group. intrauterine growth restriction (estimated to be < 10th percentile for gestational age and gender). The evaluation team addressed the task of designing such a tool. and no tools have been rigorously designed and tested for evaluating patient satisfaction in single room maternity care. and these data provided insight into important issues for our clients. A second comparison group was composed of all women who were eligible for single room maternity care according to its triage form. Six months before the development of single room maternity care. In the delivery suite. then piloted and revised further. In addition. This often includes the repetition of a lot of information about the mother. Our initial challenge was to determine from our clients the important components of satisfaction. elevated blood pressure (> 140/90 or evidence of pregnancy-induced hypertension). The activity level in the delivery suite is high. when they were transferred to a postpartum ward. single fetus. presence of thick meconium. planned cesarean section. who have to develop a new set of relationships. This group was chosen for comparison in case the introduction of the intervention of single room maternity care created changes in philosophy related to patient care that would be reflected throughout the institution. that is 1 to 1 in labor and 1 to 4 in postpartum. Sample The first group to be surveyed was composed of all women who met eligibility requirements for single room maternity care during the 3 months before the opening of the new unit.237 BIRTH 27:4 December 2000 patient ratio is the same in the single room maternity care group and in the comparison groups. On the postpartum unit a new care team that has not participated in the birth receives the family. Methods Survey Instrument Satisfaction is a difficult concept to measure (7). After identifying several key areas related to satisfaction. All women who would have been eligible for single room maternity care during the 3-month period were handed surveys with an explanation by a postpartum nurse clinician. Members of the evaluation team also attended patient focus groups at a recently renovated suburban hospital attended by multiparas who had given birth in both a traditional setting and in their new single room maternity care setting.

3) 0. The research nurse gave women in the two comparison groups the surveys. SRMC 4 Single room maternity care. and 50 percent from the concurrent comparison group. Those who were randomized to a care model different from what they had asked for might be disappointed. The envelopes were then placed in a basket in the nursing station for the research nurse to pick up.8) 45 (43. if their opinions were sought and choices valued. stating that completing the form would help us to provide better care for our clients. Results Survey return rates were 99 percent from the single room maternity care group. which could be reflected in their responses. respectively. that is. The comparison group represented in Tables 2 to 9 is the concurrent comparison group. To avoid selection bias. the study group responded significantly more positively on all items in this category ( p < 0. to be completed after delivery and before discharge. Women were asked about their preference at the time they presented at the hospital admitting/triage desk.21 0.2) (4. and 193 subjects were in the three groups. Our research team chose not to assign women to groups randomly. No adjustment was made for multiple comparisons. since it was thought to be the group most relevant for comparison. Participants were asked about information and support they received: specifically.5) 96 (46. Nurses used prenatal records to assist them in the triage process. More women in the study group thought that they Table 1.4) (2. (%) SRMC Group (n 4 205) No. and participants returned them to their nurse in sealed envelopes.6) (4.9) (17.8) (6. Surveys were given on the day of delivery. Comments from open-ended questions in the caregiver surveys were categorized and summarized. Characteristics of Participants and Comparison of Groups Characteristic Parity Nulliparas Language spoken English Cantonese Mandarin Punjabi Comparison Group Pre-SRMC (n 4 221) No. or who stated before triage that they preferred the traditional care.20 0. In total. they had asked for single room maternity care. if they were given adequate information for decision making. Data Analysis Categorical variables were analyzed using the chisquare statistic. 221. or who had no preference. Women were evaluated for eligibility when they presented to the admission/triage desk at the entrance to the delivery suite.1) (3.06 0. This nurse tracked the numbers of surveys handed out each day on each module.7) 150 34 4 6 (76. Data for the historical comparison group are available on request. 205. and returned 2 or 3 times to encourage women to complete the surveys if they had not yet done so. We believed that such a comparison would be confounded by women’s preferences. where 1 4 very dissatisfied and 5 4 very satisfied).238 BIRTH 27:4 December 2000 labor or postpartum or prolonged postpartum stay (> 48 hr).33 165 29 9 10 (77. together with an explanation of how to complete them in a value-neutral fashion. The study group women were similar to comparison groups in both language spoken at home (a measure of acculturation) and in parity (Table 1).15 71 22 8 7 0. and if they were satisfied with comfort measures. that is. Although both groups scored their care very positively (> 4 on a scale of 1–5. When women who had not obtained their preferred place of care were eliminated from the concurrent comparison group. Data from 5-point Likert scales were analyzed using a nonparametric statistic. Time spent with family and friends was evaluated. Surveys were anonymous. 55 percent from the historical comparison group.001) (Table 2).8) * Data refer only to those women who preferred either the traditional labor-delivery-recovery and postpartum service. (%) Comparison Group Concurrent* (n 4 104) No. In contrast. All women who went to single room maternity care either wanted to go there or had no preference. 40. The type I (alpha) error was set at 0. because the responses on surveys were not normally distributed.4) (7.5) (13. the MannWhitney U test. (%) p 105 (47.9) (21. the data presented for the comparison group represent only those women who either had no preference for either single room maternity care or traditional labor and delivery/postpartum care.1) (68. .05. 104 participants remained.2 percent of women receiving care in the postpartum modules did not receive their preference.

001 4.001 <0.005) and their baby ( p 4 0.001 4.001 Caregivers helped you view birth as a natural process Caregivers asked for your feelings/opinions in planning care Caregivers gave information needed to make informed choices Caregivers supported your choices Assistance given to support person Comfort measures to deal with pain of labor Comfort measures to deal with pain after the baby was born SRMC 4 Single room maternity care. Table 3. and lighting (Table 5) (1 4 strongly disagree.001 <0.001 (Table 5).27 4.001 <0. Being with Your Family and Friends Question Amount of time spent with your support person was: Not enough Just right Too much The amount of time spent with your baby was: Not enough Just right Too much The amount of rest you had was: Not enough Just right Too much Comparison No. and postpartum stay Number of different doctors (including students.24 4.5) 197 (96.001) (Table 4).001 <0.60 4.3) 141 (71.3) 6 (5. 5 4 strongly agree).39 SRMC 4 Single room maternity care.19 4.66 <0.4) 0.8) 0 202 (98.7) 1 (0.71 4. Noise was an issue for both groups. (%) p 3 (2. Study women experienced less exposure to multiple caregivers and thought that more respect was shown for their privacy ( p < 0. Although most mean scores Table 2. Table 4.239 BIRTH 27:4 December 2000 spent the right amount of time with their support person ( p 4 0.5) 0.71 4. The physical layout of the single room maternity care room was found to be superior by the study group with respect to spaciousness. in fact.1) 7 (3. Information and Support Question Comparison (n 4 104) Mean SRMC (n 4 205) Mean p 4. residents) who looked after you during labor.57 <0. but less so for the study group.1) 66 (66.6) 1 (0. Comparison Mean SRMC Mean p 4.62 0.15 4. availability of supplies. and spiritual needs during both labor and the postpartum period.61 4.29 4.4) 11 (10. Privacy Needs Question Respect shown by caregivers for your privacy Number of different nurses who cared for you during your labor. (%) SRMC No.71 <0.001 <0.007 33 (37.001 .15 4. in which 14. delivery. delivery. The amount of rest that each group received was insufficient for approximately one-third of each group. Perceptions of the time that nurses could spend with families were assessed in relation to physical.33 4.5) 0. Ratings of quantity and quality of food were not different and.5) 3 (1.46 4.66 4.73 4.9 percent of women were bothered by noise compared with 34 percent in the comparison group ( p < 0.007) (Table 3).7) 0 58 (28.9) 95 (91. emotional. and postpartum stay Number of hospital staff who came into your room during labor period Number of hospital staff who came into your room during postpartum stay SRMC 4 Single room maternity care. comfort of the support person. the same dietary department served all areas.58 4.005 3 (2.001 <0.9) 89 (86.001 <0.26 4. Sources of noise that were less troublesome to the study group were hospital neighbors and crying babies.32 4.07 4.61 4.001 <0.25 4.

25 3.5) (9.0 or higher for both groups.68 4.001 <0. 5 4 strongly agree).7) (21.001). Physical Environment Question Bothered by noise at any time Talking/visiting by hospital staff Talking/visiting by hospital neighbors Staff talking at the nursing station Crying babies Women in labor Room was spacious and adequate for my needs I was able to find the supplies I needed My support person was comfortable Lighting was adequate Food was acceptable in quantity Food was acceptable in quality Housekeeping staff respected my privacy Comparison No. Discharge instructions and review of written information were more consistently carried out in single room maternity care (Table 9). Comparison Mean SRMC Mean p 4. and receiving the opportunity to rest by nurses who cared for their baby.001 .80 4. Some women in comparison groups expressed a wish to have stayed in a single room.29 3.001 <0.54 4. 5 4 ample).88 4.5) Mean Mean 4.28 <0.75 <0. (%) 35 8 17 10 22 3 (34. bathing.65 p <0.240 were 4.001 0. (%) 30 9 8 9 13 13 (14.4) (2.27 4. Families were invited to write comments in relation to each of the areas assessed by the questions.5) (6. and finding sources of help in the community.5) (6.62 4. Study group mothers thought that caregivers spent more time assisting with feeding ( p < 0. 48.09 <0. Similarly.28 4.001 <0. Some women in the study group felt pressure to go home before they felt comfortable leaving.95 3.002 4.001 SRMC 4 Single room maternity care.8) (16. Specific areas of knowl- BIRTH 27:4 December 2000 edge in relation to baby care were assessed and found to be similar between the groups.001) (Table 7) (1 4 strongly disagree.0) (4.53 <0. All groups provided positive feedback on the quality Table 5.44 4.26 4.5) (4. time spent teaching the family about care of the mother and baby was perceived to be greater and information given to be more consistent by the study group ( p < 0.001 0.001 <0. the single room maternity care women consistently scored their nursing care significantly higher ( p < 0. with the exception of positioning the baby for feeding and sleeping.001) (Table 6) (1 4 not enough.9) SRMC No. enjoying the experience of rooming-in.001 0.001).001 0. No differences were found in proportions of women putting the baby to breast immediately after birth. Single room maternity care mothers made most of the comments about staff support.78 4. Significantly fewer babies in single room maternity care received supplementation with formula (18.17 3.94 4.50 4.001 0. which were items that study group parents felt better able to cope with than comparison group parents.64 <0. p < 0.4%.65 <0.41 4.41 4.08 <0.4% vs.001 <0.05 4.001 0.001 4. caring for the umbilical cord.71 4.10 4.06 0.66 4.30 <0.38 4.9) (4.87 4.57 4. Breastfeeding practice differed between the two groups (Table 8).0) (7. Table 6. Both study and comparison women viewed nursing staff as being very supportive to them.001 3. Nursing Care Question Amount of time nurse was able to spend with you was adequate to take care of your physical needs Labor Postpartum Amount of time—emotional needs Labor Postpartum Amount of time—spiritual needs Labor Postpartum Nurse responded to your needs in a timely manner Labor Postpartum SRMC 4 Single room maternity care.

30 0.5) 172 (97.2) 34 (18.95 4.009 0. you will be able to cope with: Knowing when the baby is hungry/full Knowing that the baby is getting enough milk Positioning your baby to feed Positioning your baby to sleep Knowing when your baby is ill Knowing what to do if your baby gags or chokes Giving your baby a bath Caring for your baby’s cord Knowing some ways to cope with your crying baby Finding sources of help in the community SRMC 4 Single room maternity care.2) 149 (83.17 4.001 .0) 44 (48.241 BIRTH 27:4 December 2000 Table 7. baby received supplementation with water How are you feeding your baby Breast Formula Both Comparison No.2) <0. Discharge Planning Question Before going home.47 4.10 3.31 3. Table 9.1) 15 (7. (%) p 71 (85. fed baby within 1–2 hr after birth If breastfeeding.05 76 (90.7) <0.5) 159 (90.39 4.30 4.51 <0.29 4.001 Comparison No.7) 0. 5 4 ample) If breastfeeding.7) 143 (87.00 4. baby received supplementation with formula If breastfeeding.5) 66 (81.06 0.25 SRMC 4 Single room maternity care.044 <0.40 <0.7) 14 (7.21 4.001 <0.57 4.001 0.13 4. (%) SRMC No.07 0.4) 0.04 0.25 0.80 3.001 Mean Mean 4.7) 166 (85. Feeding Your Baby Question Amount of time caregivers spent helping you to feed your baby (1 4 not enough.52 3.001 4. (%) p 4.92 3.81 4.05 3.47 <0.6) 8 (7.25 0.10 63 (60.25 4.001 10 (13.001 <0.1) 0.42 <0.69 4.001 79 (79.001 Amount of time your caregivers were able to spend with you to teach you to care for yourself Care for your baby Spend with your support person to teach them about caring for you and your baby Information you received from different caregivers was 1 4 very inconsistent 5 4 consistent SRMC 4 Single room maternity care.008 0. Teaching Question Comparison Mean SRMC Mean p 4. 4. (%) SRMC No.3) 155 (90.001 3.4) 160 (84.01 57 (68.7) 33 (31.53 4.7) 55 (64.15 4.19 0.33 0.14 4. Table 8.3) 12 (6.9) 0. did your nurse give clear instructions about: When to call the doctor When to make an appointment for your doctor to see the baby When to expect a call from the community health nurse How to use a car seat Did the nurse review handouts in your information package When you get home.98 4.82 4.

5-minute Apgar scores. and availability of nursing care and teaching.02). Rather. Most respondents addressing the quality issue were from the study group. including information and support.04) compared with the concurrent comparison group. privacy and noise levels. In a larger study at B. Nurses in the historical comparison group were perceived to spend less time providing emotional support ( p 4 0. Few women. Another concern related to a lack of rest and time to assimilate information because of too many visitors.02) and teaching baby care ( p 4 0. or admissions to a secondary or tertiary nursery among newborns. and family.C. In addition. use of episiotomy. Fewer women in the historical group (76. use of epidural or narcotic analgesia. that is.9%). Therefore it is unlikely that outcomes negatively influenced satisfaction in the comparison group. which may be because single room maternity care nurses may have had more time and more enthusiasm to encourage their clients to complete the survey forms. the changes observed reflect a true difference in levels of satisfaction. Women’s Hospital conducted at the same time as this study and extending an additional 3 months. with the exception that differences between the groups became nonsignificant with respect to knowing when to call the doctor. rates of cesarean section or forceps use. therefore. The historical group was more often bothered by noise (49.242 BIRTH 27:4 December 2000 of nursing care. respondents observed that the nurses were too busy and too few—an observation that also extended to the postpartum period in the single room maternity care unit. This expectation was met in every study category. chose not to go to single room maternity care at the time of triage. findings showed no differences in augmentation of labor. and comparison group families may have been less motivated to do so because they were not in a new setting. study participants continued to be significantly more satisfied with their care in relation to the same aspects as in the first analysis. The comparison group contained a large proportion of women (40%) who indicated on their survey form an initial preference for single room maternity care. Comments with respect to availability of nurses varied among the comparison groups. time spent with baby. One objective in undertaking a cohort study. Discussion Improved overall client satisfaction appeared to be the most likely outcome resulting from the implementation of single room maternity care. We can conclude therefore that the investigation was not simply measuring two groups who were cared for in the units of their choice. Impediments to teaching and learning were a lack of sufficient nurses in the comparison groups and too short a stay in the single room maternity care unit. This study is limited because response rates among comparison group participants differed from those among study group participants. In this longer study. Women praised nurses in all areas for their knowledge and willingness to teach. incidence of postpartum hemorrhage or fever.3%) versus the concurrent group (86. allowing women to choose their birth setting as opposed to randomly assigning it. was to measure preference. When the study group was compared with the entire comparison group. In the delivery suite and postpartum areas. Disappointment related to not receiving the setting of their choice could have biased satisfaction results in favor of single room maternity care. This analysis was. limited to comparing responses of women in single room maternity care only with those women in the comparison group who either preferred the traditional labor and delivery/postpartum model or had no preference. The pre-single room maternity care comparison group did not have the choice to be cared for in single room maternity care. The two comparison groups differed little from each other in their responses to the questions. New mothers in single room maternity care indicated that they felt more competent in some aspects of baby care. Again. doubtless because traditional postpartum rooms used centrally located carts for supplies whereas in single room maternity care all supplies were kept in individual rooms in cupboards. Supplies were easier to find in their rooms. friends. indicating that the noise level in the institution may have been decreasing over time. The study is also limited because of the lack of outcome data linked to individuals who completed the satisfaction forms. only 16 among 548 eligible women. participants in the comparison groups did not differ with respect to age or marital status. and they were more likely to be exclusively breastfeeding. We did not restrict the analysis of comparison participants in the postpartum wards to women who were . Responses among the concurrent comparison group and the historical comparison group did not differ substantively. which examined 583 women in the single room maternity care group and 393 in the comparison group.8%) than the concurrent group (35.7%) knew when to call their doctor ( p 4 0. since disappointment with the management or outcome of labor and birth might have influenced their survey responses. Reduced participation from comparison groups may not have biased the study if families who felt strongly either positively or negatively took the time to complete the survey forms. most such comments came from study group women. families who felt very positively about their care may have been more strongly motivated to complete the surveys. with a few exceptions.

However. The single-unit delivery system—A safe alternative to home deliveries. 1981. Reed G. 1991:60–65. The participants in this study were selected because of their low-risk status. The consistency of findings in favor of the single room maternity care group in almost all of the parameters measured raises the question of systematic bias. Bramadat IJ.12:22–24. It is important to recognize that. Although such a restriction may have reduced differences between groups. J Obstet Gynecol Neonat Nurs 1986. Dearing R. 1982: 315–328. part of the reason for introducing single room maternity care was to ensure that families were in private rooms throughout their hospital stay. In: Young D. Comparison group nurses may have had other women assigned to them who had more complex nursing care needs than those assigned to study group nurses. which may have decreased their opportunity for as much personal contact with the comparison group women as study group nurses. Williams J. and whether or not the comparison group was surveyed concurrently with or before the initiation of the single room maternity care unit. McKay S. Phillips C. and bathtubs are available—options not available in traditional delivery suite rooms. 1984. It is impossible to know from this evaluation exactly what contributed to the increase in client satisfaction in single room maternity care. remained small. It is known that the workload for individual nurses in the single room maternity care unit at times may have been less than that for nurses in other areas because the unit was not running at full occupancy during the time of the evaluation. Many families responded that the amount of contact they had with single room maternity care nurses was reassuring. Small. women in all groups were highly satisfied with their care. 4. Our consistent findings in favor of single room maternity care are supported by the comments of clients in response to the open-ended questions in the survey. Rochester. Improvement in satisfaction was sustained despite a shorter hospital stay.9 percent in the comparison groups were bothered by the noise of other women in labor. Differences.132: 889–894. indications are that the improvement was multifactorial. Nursing implementation of single-room maternity care. References 1. Experience in other settings has shown that mothers receive more education and support in newborn care. 28–31. Mervis R. This finding speaks to the continuity-of-care issue.21:22–29. Most differences between means scores were in the order of 0. Rockville. We have no reason to suspect that these results would not be generalizable to other settings that care for women of variable-risk status. Driedger M. NY: Childbirth Graphics Ltd. Omaha. Am J Obstet Gynecol 1978. 7. 2. An obstetric program in a Florida teaching hospital reported a 126-percent increase in private maternity patients after the introduction of this type of care. Notelovitz M. such as patient teaching and preparation for discharge. 162:23–24. Report of the Fifth Ross Planning Associates Symposium. and may not represent a difference that is truly important to families. Birth 1993. leads to improved confidence in parenting skills (9). Fenwick L. . Schmid M. Certainly it is not surprising to find that families are happier in new rooms where the windows open. Four of the 16 beds in postpartum rooms have double occupancy. Young D. These findings supported the hypothesis that single room maternity care for eligible low-risk patients significantly improved client satisfaction. Berkland C. ed. 9. which in turn. but the author did not comment on specifically which factors attracted the new clients (8). Family-Centered Maternity Care: Implementation Strategies. differences in the two settings within the institution may have been more pronounced. Although soundproofing was installed in the walls of the single room maternity care units.and high-risk families. 5. Increased satisfaction related to the privacy of a single room is part of the experience the study wished to measure. Phillips C. Single-room care for low. and increased access to nursing time for education and direct care. It is possible that some of the issues perceived by women to be better addressed in the single room maternity care setting might be even more important to women of higher risk status. The Cybele Cluster: A Single Room Maternity Care System for High. The one aspect of client care that did not differ between the groups was with respect to the food service. Use of the labor-delivery-recovery room in an urban tertiary care hospital. OH: Ross Laboratories. Spokane: Cybele Society. Perinatol Neonatol 1988.243 BIRTH 27:4 December 2000 in single rooms. 6.5 percent of women in the single room maternity care unit versus 2.to Medium-Birth Hospitals: Bishop Clarkson Memorial Hospital. 3.and Low-Risk Families. Components of this improvement included satisfaction with the physical environment. 8. since the rooms were adjacent. whether or not the comparison group consisted of women who had received their first choice of setting (labor and delivery/postpartum). Columbus. in general. lighting is natural. 6.15: 386–389. although statistically significant. MD: Aspen Systems. A concern raised by staff in single room maternity care units visited before the construction of our unit was the increased ability to hear other women in labor. Satisfaction with childbirth: Theories and methods of measurement. In an institution where the overall satisfaction was lower. Changing Childbirth. Clients in our setting talked about the ease of having family members stay together and learn together in this environment. emphasis on family centered care. Single-room maternity care for maximum costefficiency.5 on a scale of 1 to 10. Am J Obstet Gynecol 1990.