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Background An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/design Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and

BACKGROUND: Cesarean section is associated with delayed mother-infant interaction because neither the mother nor the father routinely maintains skin-to-skin contact with the infant after birth. The aim of the study was to explore and compare parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section. METHODS: A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin-to-skin contact either with fathers or mothers after an initial 5 minutes of skin-to-skin contact with the mothers after birth. The newborns' and parents' vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns' and parents' soliciting, newborns' crying and whining, and parental speech directed to the other parent and to the newborn. RESULTS: Newborns' soliciting increased over time (p=0.032). Both fathers and mothers in skin-to-skin contact communicated more vocally with the newborn than did fathers (p=0.003) and mothers (p=0.009) without skin-to-skin contact. Fathers in skin-to-skin contact also communicated more with the mother (p=0.046) and performed more soliciting responses than the control fathers (p=0.010). Infants in skin-to-skin contact with their fathers cried significantly less than those in skin-to-skin contact with their mothers (p=0.002) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers (p=0.029). CONCLUSIONS: Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin-to-skin contact and exposed to the parents' speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section, to support the early onset of the first voca