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...

Episode Transcript

Speaker 1 (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.

(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.

(00:55):
Episode 171.
Noise.
You may have noticed I've had alittle break since my last
episode because I'm lucky enoughto have been on holiday for a
couple of weeks, and when I cameback from holiday and returned
to work, I noticed these newmonitors on the wall.
They look like a giant ear andI'm going to put a picture on my

(01:23):
Instagram for you to take alook.
These giant ears are pictorialrepresentation of noise levels
noise levels on the ward andthey've been introduced
apparently because of complaintsfrom women and families about

(01:48):
the levels of noise.
What happens is, if you'rehaving a normal conversation,
the levels are green, but ifsomething more noisy happens or
you raise your voice a littlebit, they go amber and red and

(02:08):
you quickly realise that youneed to quieten down.
My whole life I've had, I know,quite a loud voice.
It's something that wascommented on when I was in
primary school and in fact theytested me to see if I might be
slightly deaf.
As a result, and just holding aenthusiastic conversation with

(02:36):
a colleague, I quickly realisedthat I was triggering the noise
level to go into an amber zone,something that I never would
have thought about before, andwhilst that does have benefits,
it's been received with mixedresults by staff.

(02:57):
It's already a significantlyhard job that we do, and the
best of us try and keep ourvoices down and think about the

(03:18):
environment we're in, but it'syet another thing to think about
.
But the introduction of themmade me think about noise in
general.
I started to think okay,complaints noise.
Obviously that's not a goodthing.

(03:38):
We want our environment to be aquiet, calm place for women and
their new babies.
But equally it made me thinkfor women and their new babies.
But equally it made me thinkwell, what levels of noise are
or aren't acceptable?
What are we measuring againstand what's realistic?
So I thought I'd take a littlelook into what I could find

(04:00):
about noise levels in hospitalsand in fact I came across the
fact that there is some WHOWorld Health Organization noise
level guidelines on what noiselevels should or shouldn't be in
a hospital environment becauseof the impact that this may have

(04:23):
on sleep and rest and thereforelong-term health of patients.
These levels are not directlyrelated to maternity, they are
more general hospital levels,but they are as follows.
They concluded that theproposed noise limits should be

(04:45):
35 to 45 decibels during the dayand 20 to 35 decibels at night.
Now, to me that doesn't meananything at all, so I then had
to look up well, what is what is35 decibels?
And a quick Google searchilluminated me that 35 decibels

(05:12):
is the level of a whisper.
35 to 45, is it realistic thatwe're going around in the
daytime in hospital whispering?
You know that's a hard one tothink about.
A more normal conversationlevel, apparently, is around 50

(05:33):
to 60 decibels, and I found afew papers that have looked at
noise levels in hospital andthey in fact do comment on an
average daily sound of 50 to 60decibels, but they relate that
to being a crying baby or avacuum cleaner, which is quite

(05:55):
loud.
The article I found showed thatthere's been a trend in
increasing noise levels over thelast 45 years.
A 2021 systematic review of 33studies found environmental
noise in hospitals worldwideranging from 37 to 88 decibels

(06:16):
during the day and 38 to 68decibels in the evening, with
huge variations depending on therange and the setting.
So how does that relate tomaternity?
Well, I think noise was one ofthe issues that I really noticed
when I went out to a home birth, and I've talked about that in

(06:40):
episode 10.
In your home, environmentdepends on your home.
Of course it may or may not benoisy, but you've got control to
a degree over the noise withinyour home, although you haven't
got control of the noise outsideIn hospital.
As a labouring woman, you haveno control over the sound and

(07:03):
noises.
There may be other labouringwomen.
We all know, working inmaternity, that we can tell from
the sound of a woman,particularly if she's not had an
epidural, at what stage oflabour she might be and how soon
birth is imminent.

(07:23):
So a maternity unit can be anoisy place, undoubtedly, but
the noise of the women is notthe problem.
It's all the other noises and Iwould say quite a lot of it is
technological noises.
So we have the noise of thebaby's heartbeat monitor, which
can be welcomed by some womenbut can be a distraction for

(07:47):
other women.
I've used it in my podcastIntroduction and you can imagine
hour after hour of that noisethat could get on your nerves.
It could be stressful, it coulddetract from focusing inward on
yourself and keeping calm,particularly if the heart rate

(08:08):
is varying, dropping or rising.
It may make you anxious andI've previously had women
comment to me about the point atwhich they realised they could
ask the midwife to reduce thevolume of that noise or even
turn that noise off was a keymoment in their labour.

(08:33):
So that's a noise that we'reintroducing specific to
maternity.
But there's also patient callbells, there are emergency
buzzers, there are the noises ofthe deliveries of equipment,
scrubs, drugs, all the thingsthat we need to keep the

(08:58):
hospital going.
It's not uncommon when I'm doinga ward round, if someone
trundles past with a trolley ofequipment or the meal trolley,
that I cannot hear the handover.
I cannot hear what a midwife issaying about a woman.
It's very distracting.
We may have to pause.

(09:18):
She will have to repeat thehandover.
She will have to repeat thehandover.
And even if I have heard what'sbeen said.
I find it very difficult tothink clearly when there's a lot
of external noise, so we mayhave to kind of gather ourselves

(09:40):
and start again when we'rethinking about the best care for
that woman and the conversationwe're about to have with her.
So there are many noises thatthe staff on a ward have no
control over that happenrandomly throughout the day, and
more recently in my unitthere's a new noise.

(10:01):
We've recently gone to digitalmaternity notes.
I know we're a bit behind.
I know many units have donethis before.
I have noticed the increasednoise of the incessant tapping
away as everyone is typing uptheir notes, but we're also now

(10:24):
starting to find Womencommenting that the midwife is
clicking away on a keyboardduring their labour, and
obviously this is intermittent,it's not non-stop, but I

(10:46):
certainly hadn't even thoughtabout the fact that writing with
a pen and paper is silent.
Add in to these noises phonesringing, bleeps going off, the
practice crash bleep that goesoff and talks to you at least
twice a day as a test call, as aminimum, doors banging, beds

(11:13):
being delivered, and even offthe ward downstairs in my office
I frequently cannot hear whatis being said in an online
meeting or phone conversation assomething goes past the window

(11:33):
of my office.
Maybe it's the rubbishcollection system, sometimes
it's a delivery van.
It's all things that areimportant to the busy hospital
site but make it prettyimpossible to do any work.
Hospital site but make itpretty impossible to do any work

(11:59):
.
And then we have the usual NHSnoise problem of confidentiality
.
We are absolutely wonderful atassuming that people can't hear
through a curtain.
We have women behind curtainedbays and we will go in and talk
to them about all sorts ofprivate things and everybody in

(12:22):
that whole bay can hear everyword.
Yet we assume that the curtainacts as a wall access, a barrier
.
Even in clinic I'm sometimesconscious of this lack of
privacy.
Our clinic rooms haveintercommunicating doors.
That's fantastic for whensomeone needs to come and ask me

(12:46):
some advice, but actually itmeans if I'm pausing to think in
a conversation with a woman, orshe's quiet while I'm writing
some notes, we can hear theconsultation in the next door
room, unless it's happening at avery low level.

(13:10):
So then I thought well, is thisnoise really having a negative
impact on people?
And I couldn't find anything inthe CQC maternity survey, but I
could find it in the CQCnational inpatient survey.
This asked the question wereyou ever prevented from sleeping

(13:34):
at night by any of thefollowing, and listed noise from
other patients, noise fromstaff.
Noise from medical equipment.
So in the most recent survey,38 percent of respondents

(13:56):
responded that they'd had theirsleep disturbed by noise from
other patients, 18 percent hadhad it disturbed by noise from
staff and 18 percent had had itdisturbed by noise from medical
equipment.
So that's around one in five ofinpatients saying that noise

(14:21):
from staff or medical equipmenthad impacted on their sleep.
That's before they even thinkabout other patients.
That's before they even thinkabout other patients.
Obviously, in maternity, noisefrom other patients is even more
complex on the postnatal ward,where you may have the noise of
crying babies, and I certainlyremember when I had my second

(14:44):
child being in a postnatal bayand walking up and down the
corridor for much of the nightbecause she was crying.
I felt guilty that this wasimpacting on the other women and
babies and a new postnatalmother shouldn't be having to do
that because she's worriedabout disturbing other people.

(15:10):
So do I have any answers tothis?
One great story I came acrossresearching this episode was a
little project that is going oncurrently in Cornwall, called
the Silent Hospital Project, andthis was particularly for the

(15:32):
postnatal ward, as a pilot usingsoftware that, rather than
having patient call bells,drives an audible alert to a
mobile phone carried by amidwife or nurse.
The idea of the pilot is toevaluate whether this can

(15:52):
quieten the environment throughuse of a digital solution.
Sounds like a great initiativeand I look forward to seeing how
they get on.
But in the meantime, what's myzesty bit?
I think the idea of having avisual signal to remind you of

(16:13):
the noise levels so that you canconsciously try and keep them
down is a good idea.
It certainly worked for me thisweek.
But I think we need to thinkabout noise levels in general.
What control do we have oversome of these deliveries and

(16:37):
routine things that happen onthe ward every day?
Would it be possible toconcentrate those into a smaller
time frame in the 24-hourperiod so that you could have a
quieter time at a certain timeof day?
And then, aside from that, whatcan we recommend families might

(17:04):
do, such as bringing inearplugs or noise cancelling
headphones these days, orbringing in alternative noise
such as music or somethingsoothing that may help with that
busy, distracting environment.

(17:25):
So I think for today, my zestybit is simply to think about
noise.
Think about noise as a staffmember.
Try and notice the noisesaround you that wash over you
and that you take for granted.
The more you hear a noise, themore you don't recognise it as

(17:49):
an issue.
I know that from living underthe Heathrow flight path.
I often don't notice theaeroplanes as they come over in
the way that visitors to myhouse do.
And if you're a woman, alsothink about noise.
Might it bother you in labour.
Are there things that you coulddo, such as asking the midwife

(18:13):
to turn down the foetal heartmonitor?
If you're having foetal heartmonitoring, are there strategies
that would help you keep a nice, quiet, calm environment?
Thanks for listening.
I very much hope you found thisepisode of the OBS pod
interesting.

(18:33):
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(18:54):
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There's also tons of episodesto explore in my back catalogue
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally, I'd like to assure
women I care for that.
I take confidentiality veryseriously and take great care
not to use any patientidentifiable information unless

(19:17):
I have expressly asked thepermission of the person
involved, on that rare occasionwhen it's been absolutely
necessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at

(19:38):
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(20:30):
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