As caesarean section (CS) continues to increase in many parts of the world, concern has arisen about the consequences for maternal and neonatal morbidity. Many strategies have been explored to address CS, but few are informed by theoretical understandings of women’s emotional experience of the ebb and flow of labour within institutional based care. Evolving neuroscience knowledge provides insights into why the labouring woman’s perception of safety and privacy, or her feelings of insecurity, through being under close surveillance, may be a key to normal birth.

We have two aims: To extend current understandings of the theory of Birth Territory, in particular, two very different types of spaces: the sanctum and the surveillance environment (Fahy et al 2008). To do this, we draw on Binding, a theoretical tool (Stenglin 2004) concerned with understanding the ways different spaces make us feel: whether protected and secure, overwhelmed, oppressed or unencumbered and free.

Secondly, we explore how the ‘Design’ and use of existing birth spaces can be maximized to create safe, sanctum-like environments that meet the changing needs of women as labour unfolds. ‘Design’ can involve materially organizing new spaces that are custom built, or utilising existing spaces in such a way that they create a sanctum like environment.

The implications are, if we can identify the types of birth spaces that help women feel safe and secure, we may improve birth outcomes (Foureur et al 2010) by ‘Designing out’ the fear cascade.