Episode 171 Noise

Imagine giving birth in a peaceful sanctuary rather than a bustling, noisy ward. Join me, Florence, as  newly installed noise-monitoring devices in our maternity ward prompt me to think about noise levels in maternity.  Reflecting on my own experiences, including the challenges of keeping my voice down, we’ll navigate through the World Health Organization's guidelines on acceptable noise levels in hospitals. Discover the diverse sources of noise, from technological equipment to emergency buzzers, and understand how managing these sounds could create a more restful environment for laboring women and their newborns.

Engage more deeply with TheObsPod by exploring our programme notes packed with useful links. Connect with me on social media platforms like Twitter and Instagram, or send in your suggestions via email. Let's keep TheObsPod free and accessible for everyone, and if you enjoy our episodes, consider supporting us through the “buy me a coffee” link. Your contributions are appreciated but never expected. Thank you for being part of this journey, and I look forward to your continued support and engagement.

Want to know more?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935697/
https://soundear.com/soundear-ii-standard/
https://royalcornwallhospitals.nhs.uk/2024/04/26/digital-healthcare-transformation-project-aims-to-reduce-noise-levels-in-maternity-ward/

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Transcript

Speaker 1: 0:00

Hello, my name's Florence. Welcome to the OBSpod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife. Maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you.

Speaker 1: 0:55

Episode 171. Noise. You may have noticed I've had a little break since my last episode because I'm lucky enough to have been on holiday for a couple of weeks, and when I came back from holiday and returned to work, I noticed these new monitors on the wall. They look like a giant ear and I'm going to put a picture on my Instagram for you to take a look. These giant ears are pictorial representation of noise levels noise levels on the ward and they've been introduced apparently because of complaints from women and families about the levels of noise. What happens is, if you're having a normal conversation, the levels are green, but if something more noisy happens or you raise your voice a little bit, they go amber and red and you quickly realise that you need to quieten down.

Speaker 1: 2:14

My whole life I've had, I know, quite a loud voice. It's something that was commented on when I was in primary school and in fact they tested me to see if I might be slightly deaf. As a result, and just holding a enthusiastic conversation with a colleague, I quickly realised that I was triggering the noise level to go into an amber zone, something that I never would have thought about before, and whilst that does have benefits, it's been received with mixed results by staff. It's already a significantly hard job that we do, and the best of us try and keep our voices down and think about the environment we're in, but it's yet another thing to think about. But the introduction of them made me think about noise in general. I started to think okay, complaints noise. Obviously that's not a good thing. We want our environment to be a quiet, calm place for women and their new babies. But equally it made me think for women and their new babies. But equally it made me think well, what levels of noise are or aren't acceptable? What are we measuring against and what's realistic?

Speaker 1: 3:55

So I thought I'd take a little look into what I could find about noise levels in hospitals and in fact I came across the fact that there is some WHO World Health Organization noise level guidelines on what noise levels should or shouldn't be in a hospital environment because of the impact that this may have on sleep and rest and therefore long-term health of patients. These levels are not directly related to maternity, they are more general hospital levels, but they are as follows. They concluded that the proposed noise limits should be 35 to 45 decibels during the day and 20 to 35 decibels at night. Now, to me that doesn't mean anything at all, so I then had to look up well, what is what is 35 decibels? And a quick Google search illuminated me that 35 decibels is the level of a whisper. 35 to 45, is it realistic that we're going around in the daytime in hospital whispering? You know that's a hard one to think about. A more normal conversation level, apparently, is around 50 to 60 decibels, and I found a few papers that have looked at noise levels in hospital and they in fact do comment on an average daily sound of 50 to 60 decibels, but they relate that to being a crying baby or a vacuum cleaner, which is quite loud. The article I found showed that there's been a trend in increasing noise levels over the last 45 years. A 2021 systematic review of 33 studies found environmental noise in hospitals worldwide ranging from 37 to 88 decibels during the day and 38 to 68 decibels in the evening, with huge variations depending on the range and the setting. So how does that relate to maternity? Well, I think noise was one of the issues that I really noticed when I went out to a home birth, and I've talked about that in episode 10.

Speaker 1: 6:42

In your home, environment depends on your home. Of course it may or may not be noisy, but you've got control to a degree over the noise within your home, although you haven't got control of the noise outside In hospital. As a labouring woman, you have no control over the sound and noises. There may be other labouring women. We all know, working in maternity, that we can tell from the sound of a woman, particularly if she's not had an epidural, at what stage of labour she might be and how soon birth is imminent.

Speaker 1: 7:23

So a maternity unit can be a noisy place, undoubtedly, but the noise of the women is not the problem. It's all the other noises and I would say quite a lot of it is technological noises. So we have the noise of the baby's heartbeat monitor, which can be welcomed by some women but can be a distraction for other women. I've used it in my podcast Introduction and you can imagine hour after hour of that noise that could get on your nerves. It could be stressful, it could detract from focusing inward on yourself and keeping calm, particularly if the heart rate is varying, dropping or rising. It may make you anxious and I've previously had women comment to me about the point at which they realised they could ask the midwife to reduce the volume of that noise or even turn that noise off was a key moment in their labour. So that's a noise that we're introducing specific to maternity. But there's also patient call bells, there are emergency buzzers, there are the noises of the deliveries of equipment, scrubs, drugs, all the things that we need to keep the hospital going.

Speaker 1: 9:00

It's not uncommon when I'm doing a ward round, if someone trundles past with a trolley of equipment or the meal trolley, that I cannot hear the handover. I cannot hear what a midwife is saying about a woman. It's very distracting. We may have to pause. She will have to repeat the handover. She will have to repeat the handover. And even if I have heard what's been said. I find it very difficult to think clearly when there's a lot of external noise, so we may have to kind of gather ourselves and start again when we're thinking about the best care for that woman and the conversation we're about to have with her.

Speaker 1: 9:47

So there are many noises that the staff on a ward have no control over that happen randomly throughout the day, and more recently in my unit there's a new noise. We've recently gone to digital maternity notes. I know we're a bit behind. I know many units have done this before. I have noticed the increased noise of the incessant tapping away as everyone is typing up their notes, but we're also now starting to find Women commenting that the midwife is clicking away on a keyboard during their labour, and obviously this is intermittent, it's not non-stop, but I certainly hadn't even thought about the fact that writing with a pen and paper is silent.

Speaker 1: 10:55

Add in to these noises phones ringing, bleeps going off, the practice crash bleep that goes off and talks to you at least twice a day as a test call, as a minimum, doors banging, beds being delivered, and even off the ward downstairs in my office I frequently cannot hear what is being said in an online meeting or phone conversation as something goes past the window of my office. Maybe it's the rubbish collection system, sometimes it's a delivery van. It's all things that are important to the busy hospital site but make it pretty impossible to do any work. Hospital site but make it pretty impossible to do any work. And then we have the usual NHS noise problem of confidentiality. We are absolutely wonderful at assuming that people can't hear through a curtain. We have women behind curtained bays and we will go in and talk to them about all sorts of private things and everybody in that whole bay can hear every word. Yet we assume that the curtain acts as a wall access, a barrier. Even in clinic I'm sometimes conscious of this lack of privacy. Our clinic rooms have intercommunicating doors. That's fantastic for when someone needs to come and ask me some advice, but actually it means if I'm pausing to think in a conversation with a woman, or she's quiet while I'm writing some notes, we can hear the consultation in the next door room, unless it's happening at a very low level.

Speaker 1: 13:10

So then I thought well, is this noise really having a negative impact on people? And I couldn't find anything in the CQC maternity survey, but I could find it in the CQC national inpatient survey. This asked the question were you ever prevented from sleeping at night by any of the following, and listed noise from other patients, noise from staff. Noise from medical equipment. So in the most recent survey, 38 percent of respondents responded that they'd had their sleep disturbed by noise from other patients, 18 percent had had it disturbed by noise from staff and 18 percent had had it disturbed by noise from medical equipment. So that's around one in five of inpatients saying that noise from staff or medical equipment had impacted on their sleep. That's before they even think about other patients. That's before they even think about other patients.

Speaker 1: 14:31

Obviously, in maternity, noise from other patients is even more complex on the postnatal ward, where you may have the noise of crying babies, and I certainly remember when I had my second child being in a postnatal bay and walking up and down the corridor for much of the night because she was crying. I felt guilty that this was impacting on the other women and babies and a new postnatal mother shouldn't be having to do that because she's worried about disturbing other people. So do I have any answers to this? One great story I came across researching this episode was a little project that is going on currently in Cornwall, called the Silent Hospital Project, and this was particularly for the postnatal ward, as a pilot using software that, rather than having patient call bells, drives an audible alert to a mobile phone carried by a midwife or nurse. The idea of the pilot is to evaluate whether this can quieten the environment through use of a digital solution. Sounds like a great initiative and I look forward to seeing how they get on.

Speaker 1: 16:05

But in the meantime, what's my zesty bit? I think the idea of having a visual signal to remind you of the noise levels so that you can consciously try and keep them down is a good idea. It certainly worked for me this week. But I think we need to think about noise levels in general. What control do we have over some of these deliveries and routine things that happen on the ward every day? Would it be possible to concentrate those into a smaller time frame in the 24-hour period so that you could have a quieter time at a certain time of day? And then, aside from that, what can we recommend families might do, such as bringing in earplugs or noise cancelling headphones these days, or bringing in alternative noise such as music or something soothing that may help with that busy, distracting environment.

Speaker 1: 17:25

So I think for today, my zesty bit is simply to think about noise. Think about noise as a staff member. Try and notice the noises around you that wash over you and that you take for granted. The more you hear a noise, the more you don't recognise it as an issue. I know that from living under the Heathrow flight path. I often don't notice the aeroplanes as they come over in the way that visitors to my house do. And if you're a woman, also think about noise. Might it bother you in labour. Are there things that you could do, such as asking the midwife to turn down the foetal heart monitor? If you're having foetal heart monitoring, are there strategies that would help you keep a nice, quiet, calm environment? Thanks for listening.

Speaker 1: 18:29

I very much hope you found this episode of the OBS pod interesting. If you have, it'd be fantastic if you could subscribe, rate and review on whatever platform you find your podcasts. As well as recommending the OBS pod to anyone you think might find it interesting, the OBS pod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalogue from clinical topics, my career and journey as an obstetrician and life in the NHS more generally, I'd like to assure women I care for that. I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved, on that rare occasion when it's been absolutely necessary.

Speaker 1: 19:28

If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at TheObsPod, on Twitter and Instagram, and you can email me theobspod at gmailcom. Finally, it's very important to me to keep TheObsPod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and, by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free via my link to buy me a coffee. Keep it free via my link to buy me a coffee. Don't feel under any obligation, but if you'd like to contribute, you now can. Thank you for listening.