title: Messages from Space: An Exploration of the Relationship between Hospital Birth Environments and Midwifery Practice.
abstract: OBJECTIVE
  To explore the relationship between the birth environment and the practice of midwifery using the theoretical approach of critical realism.
  
  
  BACKGROUND
  The practice of midwifery has significant influence on the experiences and health outcomes of childbearing women. In the developed world most midwifery takes place in hospitals. The design and aesthetics of the hospital birth environment have an effect on midwives and inevitably play a role in shaping their practice. Despite this, knowledge about midwives' own thoughts and feelings regarding the design of hospital birth environments is limited.
  
  
  METHODS
  An exploratory descriptive methodology was used and 16 face-to-face photo-elicitation interviews were conducted with practicing midwives. Audio recordings were made of the interviews and they were transcribed verbatim. Thematic analysis, informed by the theoretical framework of critical realism, was undertaken.
  
  
  RESULTS
  Midwives identified cognitive and emotional responses to varied birth environments and were able to describe the way in which these responses influenced their practice. The overarching theme of "messages from space" was developed along with three sub-themes: messages, feelings, and behaviors. Midwives' responses aligned with the three domains of a critical realist world-view and indicated that a relationship existed between hospital birth environments and midwifery practice.
  
  
  CONCLUSIONS
  The design of hospital birth rooms may shape midwifery practice by generating cognitive and emotional responses, which influence the activities and behaviors of individual midwives.
  
  
  BACKGROUND
  Hospital, midwifery, quality care, staff, women's health, work environment.
authors.affiliation: CORRESPONDING AUTHOR: Athena Dee Hammond, The Centre for Midwifery, Child and Family Health, Faculty of Health, Level 7, Building 10, University of Technology, Sydney, Broadway, NSW 2007, Australia.
authors.forename: Athena D
authors.initials: AD
authors.lastname: Hammond
authors.forename: Caroline E S
authors.initials: CE
authors.lastname: Homer
authors.forename: Maralyn
authors.initials: M
authors.lastname: Foureur
mesh_terms: D001315:Australia; D036861:Delivery, Obstetric / Q000523:psychology*; D006272:Health Facility Environment / Q000458:organization & administration*; D006749:Hospital Design and Construction / Q000379:methods*; D006801:Humans; D008880:Midwifery; D036301:Qualitative Research; D017132:Workplace / Q000523:psychology*