Birthing Games: Assistive Technology Lab Delivers Serious Perinatal Games

By Gordy Slack

UCSC graduate student Alexandra Holloway is passionate about creating games to help soon-to-be parents prepare for childbirth.

“Choose something that really matters to you, something you’ll stay passionate about,” was the advice given to Alexandra Holloway as she sought a research area for her doctoral thesis at UC Santa Cruz.

Holloway had recently given birth to her first child. To prepare, she and her husband had watched films, taken classes, and read numerous books. But nothing adequately prepared them for the startling realities of the delivery room. They had to experience it to believe it. And they found this to be true with many of their new-parent friends as well.

Teaching about the actual birth experience in digital games. Now that would be an interesting project. It could also be important. With good partner support, studies show birth outcomes improve significantly:  labor goes faster, medical interventions are less likely, and mortality drops. But pre-birth training is not available for many California couples—particularly those that are low-income, young, and minority. And as state and federal aid budgets fall, the situation worsens. The maternal mortality rate has tripled in California since 1996.

There is an acute need for inexpensive, accessible, and compelling alternative ways to train couples in effective childbirth support, says Holloway. Cell-phone- and PC-based games might provide one way to do that. In the past two years, Holloway and her colleagues in professor Sri Kurniawan’s Assistive Technology Lab have created several games that help expectant mothers and their partners better prepare for childbirth and infant care.

Holloway developed her first game, “The Prepared Partner,” to test the concept and see if allowing soon-to-be fathers and other partners play a simple game where they are the support in a simulated birth would make a measurable difference in the outcomes. The player assists a pregnant virtual woman, Amy, who has just begun the first stage of labor. The player is given several options to help Amy maintain her energy and remain cognitively and physically strong. As the labor progresses, the appropriateness and urgency of various actions change. The mother’s health level is tracked with a score, which must also be kept high. As her cervix dilates and labor progresses, she no longer wants to get up and walk around, for instance, or to be touched, but she does want a hot bath and to count her breaths. Her partner must monitor her needs and respond appropriately or the doctor is summoned to give her a Caesarean section. 

The game was evaluated with about 50 remote participants, who each took a pre-test about childbirth and labor support, played the game, and then took a post-test.  These participants scored with flying colors in the test after playing the game, despite dismal scores on the pre-test. In addition, participants stressed the need for supporting a mom through labor, showing that the idea really hit home for many people.

Another game, Digital Birth, in early stages of development, also simulates childbirth. Unlike The Prepared Partner, which lasts only a few minutes, Digital Birth unfolds over a period of days or weeks. When the game starts, the simulated pregnancy has just entered its third trimester. A player only knows that sometime between the 39th and 42nd week, his fictive partner will go into labor and he had better be prepared. The birth itself can take hours, or it can span several days, during which the players will face such challenges as increasingly painful contractions, mom’s falling energy level, and, if at the hospital, pressure to have the baby faster.  The partner can respond to the mom’s water breaking, to her needs, and to the suggestions given by the nurse, midwife, or doctor.

Another game under development in the lab is Latch Master, which aims to stress the difficulties that a newborn can have latching on for breastfeeding. The game employs a heavy, rice-filled, doll containing an iPhone. As the player goes through the motions of nursing it, the three accelerometers and the gyroscope built into the phone give feedback on the position and openness of the baby’s mouth, emphasizing the importance of the baby’s wide-open mouth in latching on.

Although the game targets nursing mothers, if it has its intended effect, it will also benefit newborns, struggling families, and the California economy, says Kurniawan. When mothers can successfully nurse their children, there are large and measurable health benefits for newborns and mothers, and those benefits are amplified over the entire lifetime of the child.

All of the game designers in Kurniawan’s program employ interviews, ethnographic observation, and statistical analysis techniques in developing their games.  Holloway, for example, used her experience as a birth doula (a woman in a role of emotional support for a woman in labor) together with suggestions from local midwives and obstetricians to inform the topics in The Prepared Partner.  For Digital Birth, Holloway and her research team are interviewing dozens of birth partners in hopes of finding the things that are really important to them as they support a mom through childbirth. The technique, known as participatory design, gives the targeted user population a lot of influence in the game’s design.

The Digital Birth team is currently interviewing birth partners to find out what is most important to them. “Specifically, with this game we hope to target lower-income expectant dads that typically do not have access to perinatal classes or other kinds of birth preparation,” says Holloway.  To participate in the interviews, write to Holloway or call 831-824-4723.

In addition to making Digital Birth available to expectant parents, Jenna Shaw-Battista, Assistant Clinical Professor and Assistant Director of Midwifery Education at UCSF’s General Hospital and a co-PI on the project, will distribute it to nursing students, incorporating the game into the curriculum on labor support. 

Driving the project is a desire to provide entertaining, inexpensive, and compelling ways to convey important information to expectant mothers and fathers—and to let them practice  what they learn. But, says Kurniawan—who has also worked on games and applications for blind people, for children with autism spectrum disorder, and overweight teenagers—her group is also motivated by a desire to boost old-fashioned fun. “We are working to make life more fun and colorful for people who could use a bit more help.”

“Games are very powerful,” says Kurniawan. “Even busy people spend late-night and weekend hours playing them. It is a very influential medium.”

Watch a recent talk by Prof. Kurniawan at CITRIS (Aug. 2011) on YouTube: