Effectiveness of a Snoezelen Room on fear, anxiety, and satisfaction of nulliparous women: A randomized controlled trial

Why does this study matter?
First, this study is about a non-Western culture, and from a research perspective, I thought this was interesting because this is generally an overlooked group in research. From a topic point of view, we actually have a number of studies looking at the influence of room design on birth and birthing outcomes, but we know that anxiety can contribute to fetal distress, the use of epidurals has increased, there is correlation between the fear of childbirth and postpartum depression, and the fear of childbirth is one of the main reasons to request a C-section. Understanding any implications of room design are important because it potentially influences the health of both the mom and baby.

How was the study done?
The researchers, based in Iran, conducted a 13-month randomized control trial with two arms – first time mothers giving birth in either a standard room (the control) or a multi-sensory room (the intervention). In this hospital, midwives are used. From a previous pilot study, the researchers knew 65 women were needed in each group. This was to get a study power of 80% with a 95% confidence level. They used convenience sampling, and random assignment was through an envelope distributed at admission. The study obviously couldn’t be blinded due to the nature of the intervention.

The multi-sensory room included an aquarium, a projector playing optical shapes, music, and essential aromas: sight, sound and smell. Data were collected with 3 surveys: the Harman’s Childbirth Attitude questionnaire, the Visual Analogue Scale to measure anxiety, and the Mackey Childbirth Satisfaction Rating Scale. Measures were taken at regular intervals before, during, and after birth. Fear was evaluated upon admission and at 4-8 cm dilatation; anxiety was measured hourly and at various dilations, and Satisfaction was evaluated at discharge.

So what do we learn from the study?
The difference in the mean score of fear at baseline between the control and intervention group wasn’t statistically significant. But the fear score went down with every subsequent measure in the intervention room while it went up in every phase in the control room. As a result, the postpartum fear score after birth in the control room was higher than before birthing started.
The mean score of anxiety was also measured before, during, and after childbirth. The results showed that the mean score of anxiety decreased across all phases in the intervention group, most notably after birth. The scores increased with each phase in the control room, again, resulting in more anxiety in the control room after birth than before birthing started. The differences between the two rooms were statistically significant both before and after birth. You might notice here, the intervention room had a higher anxiety score than the control room before, but it was significantly lower than the control room after the birth, so the difference is even greater.
Last, the total mean score of birth satisfaction was 163 in the intervention room and about 75 in the control room. All subsets in the satisfaction score were significantly higher in the intervention room, and in the end, almost 60% of mothers in the multi-sensory room were very pleased with the birthing experience, but more than two thirds (67.7%) were dissatisfied with their experience in the control room.

Can we say the results are definitive?
We don’t have any images or a plan of the intervention room included in the study, and we don’t know which features were used by the participants during the childbirth process. There were some clinical exclusion criteria, and authors report a comparison of groups relative to age, basic employment (employed or not), and prior hospitalization for labor, but there’s not a lot of other information about the mother’s health, prenatal care, or other confounders. There’s an implication that at least some of the mothers took part in childbirth classes, but we don’t know how this fits into each group.

What’s the takeaway?
At one level, we need to look at this in context. We have research on NICU design, and we even have a systematic literature review of birthing spaces. But the Australian-developed BUDSET has been widely published as a tool to evaluate birth unit design, and even this fell short of content validity for more diverse populations. While research matters, so does cultural context and sometimes, we may be a little too ready to dismiss studies from developing or third-world settings.
From an intervention point of view, we know about positive distractions and pain and we know about multi-sensory environments and the regulation of behavior, like we see for comfort rooms in behavioral health. This is taking what we know, and applying it to another setting. In the end, maybe we start thinking about multi-sensory environments as a weapon of mass distraction, but in this case, a positive one.

Momeni, M., Jamshidimanesh, M., & Ranjbar, H. (2020). Effectiveness of a Snoezelen Room on fear, anxiety, and satisfaction of nulliparous women: A randomized controlled trial. Iranian Journal of Psychiatry and Behavioral Sciences, 14(2), e89168. https://doi.org/10.5812/ijpbs.89168

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