Evidence-based design for childbirth environments: the impacts of window view and daylight exposure on the health of post-cesarean section women

Hospital caesarean rates in the U.S. have soared to a record high of over 32.9% in 2009, making Cesarean Section a significant issue for women’s health. Prior studies have shown that natural and physical environments have significant impacts on human health. However, few studies have been published examining impacts of natural and physical environments within healthcare facilities on patients’ health outcomes, both mental and physiological. This research explores the effects of the built environment for childbirth, specifically in terms of daylight exposure and window views, on women’s recovery from post-Cesarean Section. The researcher examined the impact of the built environment on recovery such as patient-controlled analgesic (PCA) usage, length of stay, perceived pain, and general wellbeing of women who have undergone Cesarean Sections. The researcher recruited a total of 296 women undergoing Cesarean Sections and use of PCA for pain control after their Cesarean Sections from 3 tertiary hospitals in Taiwan for this research; with assistance from 19 physicians and 38 registered nurses. The study took nearly 9 months to complete data collection and an additional 14 months for data cleaning and analysis. Data collection methods include self-administered questionnaires, reviews of medical charts, and observations. The researcher applied BPI-SF (Brief Pain Inventory Short Form) to measure perceived pain and used SF-36, a well-validated health-status questionnaire with 36 short questions, to measure general well-being of the participants. Information regarding PCA usage and length of stay were extracted from charts. Some confounding variables such as socioeconomic data were collected through self-administered questionnaires. The subjects were asked to evaluate the percentage of natural components from their window view and their satisfaction. Daylight exposure of each patient was measured by a Konica Minolta Illuminance Meter T-10 twice a day after their delivery and throughout their hospital stay according to a predetermined guideline. Results of a series of regression analyses have showed that amount of daylight exposure have statistically significant association with improvement of PF (physical function). Therefore, increasing daylight exposure could improve physical wellbeing. In addition, patients’ satisfaction with their window view has a statistically significant and positive impact on improving perceived pain (pain severity). Results of focus-group discussion also suggest that if window view with favorable natural contents is unavailable, artworks such as nature scene murals or landscape paintings or photos, may provide positive distractions for patients. Redesigning patient wards to maximize the amount of daylight exposure patients receive and to increase satisfaction of window views may decrease usage of analgesic and reduce patients’ perceived pain. The three different combinations of two window view-related variables rated by independent raters (“window view satisfaction” and “percentage of natural content in window view”) were adopted into a series of regression models. Results of these analyses also show that window view satisfaction significantly decreases analgesics usage, reduces perceived pain and improves some dimensions of wellbeing. To maximize patient benefit and well-being, health care architects should design patient rooms to receive maximum daylight exposure, create maximum patient satisfaction with visual impacts, and expand patients’ window views. Incorporating the above-mentioned design considerations should contribute to future best practices for patient room design which may decrease the use of medication (analgesic) and therefore substantially reduce healthcare costs