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Design & Health Scientific Reviewroom. An alcove at the entry can providea place to wash hands and a cupboardfor supplies before entry to the unit. Thewoman can see who is entering and hascontrol over her space. The room shouldhave an atmosphere of cleanliness and orderand contain feminine symbols of beauty,wholeness and harmony.Home comfortsMany women complain that rooms aredesigned around clinical procedures andthe simple things, which make the spacefamiliar and accessible, are missed 14 . Thereshould, therefore, be a cupboard to provideadequate space for the woman’s belongings.This should be designed for easy access, andfor quick unpacking and repacking as womenare not there for long.Birthing pools and large bathsIn the NCT study 14 , the second mostimportant feature of the labour roomidentifi ed by the women as helping tofacilitate their birth was access to a poolor large bath. Of those who felt this wasan important element, two-fi fths had nothad access to a pool during their last labour.Midwives who use birthing pools say womenprefer the bath not to be in the centre of aspace but drawn over to one side of theroom. The ability to lie in the water, hold onto a supporter, kneel, move about or sit up,all assist during labour and birth.There should therefore be a tub bath inone corner of the room, preferably designedso that only one side of the bath faces theroom and is not able to be approached fromall sides – thereby not placing the occupanton display. The approach side of the bathshould allow a support person or midwifeto sit and assist or to remain for some timewithout discomfort. There also needs to bea wide edge on the wall side of the bath sothe women can sit out of the bath or thepartner can lean in (as shown above).The bath must be deep enough for awoman to be on her hands and knees withher bottom submerged. Most commercialbaths are not deep enough and mean thata woman must recline (lie on her back) tolabour or give birth. A supine position hasbeen shown to be counterproductive to thephysiology of giving birth.The bath must have a showerhead witha pulsing feature and the fi xed rail for theThe birthing pool should be suffi ciently deep and provide comfortable access for birthing partners and midwivesshower head must be nogged into the wallif plasterboard, so the woman by pulling upcan use it for support. Keeping the bathwater hot is an issue and considerationmust be given to allowing higher levels oftemperature or faster fl ow rates than thenormal to quickly add hot water to the bath.Spa baths are not recommended due tocleaning and infection control issues.Convenient ensuite/bathroomIn addition to the bath, which becomesmore of a feature of the birth room, thereshould be a bathroom with toilet, hand basinand shower for normal ablution functions.The studies supported by the NCT surveyindicate that ready access to an ensuite toiletenables women to remain relaxed and canopen up their bodies without fear of soilingfl oor mats or the bed.Material support for birthingWomen will use other features in the roomat different times during labour and birth.Such items include a mantle piece for thewoman to lean on. Women often feel morecomfortable leaning on something whilestanding. The mantle piece should preferablybe of wood so that the texture and theappearance are domestic and have a naturalfeeling. Where possible, there should betiered soft-covered benches along a wall sothat the woman can lie or sit on them. Thesespaces are also important for the midwife orpartner to rest on as well.The woman can sit on the fl oor and leanagainst the benches, or use them to stabiliseherself while squatting. They need to becovered in soft material that can be easilycleaned. Material such as fl oor mattresses,bean bags, balls, pulling ropes and othersupports for labour and birth should beavailable but kept out of the room andbrought in as required.Lighting sets the moodLighting is critically important. In the fi rstinstance, natural light should be available andused. Natural light supports the biorhythmsof the body and knowing whether it is day ornight is an important orientation. Light affectsmood and stimulates people physiologicallyas well as psychologically.Colour builds the spiritCareful selection of colours is importantto support mood, by either stimulatingwith brighter colours or providing restfulpsychological responses with warm tonesthat are more subdued in colour. Smallamounts of strong colour will providestimulating vignettes but generally roomsmust have less white and cream in exchangefor stronger pastel colours.52 October 2008 | WORLD HEALTH DESIGN
Birthing Unit DesignTechnical supportThe need for medical gases and suctionare fundamental to delivery, even thoughthe focus of this guide is on low-riskuncomplicated births. Oxygen, suction andnitrous oxide should be stored behindcupboards and a service panel exposedby pulling open doors or dropping a tabledown. While women want the assurance ofthis technology, they don’t want to see it.Managing the bedThe bed in the birthing suite is importantand currently bed types vary dramaticallybetween units. Some have typical inpatientbeds incorporating electronic or manualadjustments while others have fi xed homestyledouble beds. An examination ofbeds leads to the following performancespecifi cation. The bed must not be the focusof the room. Too often the room has beensized with a bed in mind and little else. Thismeans that mobility and a capacity to remainupright becomes limited. Recently, largedouble beds have been used in birthingsuites and, while the intention is fi ne, thishas meant even less room is available foranything other than a bed. It is preferablethat the bed is pushed out of the way, forexample behind the door, and the balanceof the room left for multiple activities to suitthe woman during labour and birth.Most women do not use the bed whenalternatives are offered. This is especially trueif suffi cient space is available and womenare supported to remain off the bed. Somewomen will kneel or stand in front of thebed, some will squat using the side of thebed to hold onto, and many will give birth ontheir hands and knees on the fl oor leaningagainst the bed.The bed needs to be low. It needs tomove. It needs to be possible to lean againstthe bed when there is no other means todo so. If the woman has to use the bed,a birthing bar across the end of the bedcan be used to lean against. The bed is acritical element in setting the expressionand impression of the birthing room. If thebed ‘screams’ of technical clinical proceduresthen the whole birth experience will refl ectthis style of labour and birth.Controlling soundSoundproofi ng is required so that the roomis quiet on the inside and women feel theycan make noise during labour without beingoverheard. Soundproofi ng the room alsomeans that women in the waiting room arenot distracted or worried by the noise ofwomen in labour.Ancilliary spacesOther rooms in the unit should include thesupply room, a blanket warmer, clean linensupply and dirty linen hold, and a disposalroom. The equipment store should be ofa reasonable size. It needs to be locatedclose to the birth room to reduce clutterand to allow fl exibility in the use of differentbirthing support materials.Biophilia: connecting to natureAn important element of health facilitydesign is the connection with nature – toenable patients, family and the public tomove easily out into gardens and courtyards.This is recognised as an important stressreducingelement. Considerable research bybioscientists in the past 30 years suggeststhat humans gain enormous psychological,physiological and certain health responsesby engaging with living things.ConclusionThe development of the patterns whichled to the audit tool and the consequentreview of built facilities will help providedocumented evidence for use in the design ofbetter birthing units. The literature supportsthe notion that physical environmentsprovide both positive and negative effectson birthing outcomes. Women prefer quitespecifi c types of places in which to give birth.If we can ensure the essential elements ofthese designs are provided in every case, wewill have reduced anxiety, increased supportand might expect to see reductions in the‘fear cascade’ that creates the demand forinterventions that could have negativeconsequences for both mothers and babies.AuthorsIan Forbes is adjunct professor and directorof the Research Unit Group for HealthArchitecture and Planning at the Universityof Technology in Sydney, New South Wales.He is also a principal health planner andarchitect at GHD Architecture.Maralyn Foureur, Nicky Leap and CarolineHomer are professors of midwifery in theFaculty of Nursing, Midwifery and Healthat the University of Technology. CarolineHomer is also director of the Centre forMidwifery, Child and Family Health in theFaculty of Nursing, Midwifery and Health atthe University of Technology.References1. Buckley SJ. Gentle Birth, Gentle Mothering: the wisdomand science of gentle choices in pregnancy, birth andparenting. Brisbane: One Moon Press; 2005.2. Page L, McCandlish R. The New Midwifery;science and sensitivity in practice. 2nd edition. London:Elsevier; 2005.3. Dolan T. The Lure of Cesarean Sections. For TheRecord 2005; 17(18):34.4. Royal College of Midwives. Campaign for NormalBirth; 2007. Available http://www.rcmnormalbirth.net5. Maternity Center Association. What every pregnantwoman needs to know about caesarean section. New York:Maternity Centre Association; July 2004.6. Laws PJ, Grayson N, Sullivan E A. Australia’s Mothersand Babies 2004. Perinatal statistics series no. 18.AIHW cat. no. PER 34. Sydney: AIHW Perinatal StatisticsUnit; 2006.7. Walsh D, Downe SM. Outcomes of free-standing,midwife-led birth centres: A structured review. Birth2004; 31(3):222-229.8. Fahy K, Foureur M, Hastie C. Birth Territory andMidwifery Guardianship: Creating Birth Space. Oxford:Elsevier; 2008.9. Foureur M, Hunter M. The Place of Birth. in PairmanS, Pincombe J, Thorogood C, and Tracy S, Midwifery:preparation for practice. Elsevier, London; 2006.10. Lepori B, Foureur M, Hastie C.Mindbodyspirit architecture: Creating Birth Spacein Fahy, K; Foureur, M; Hastie, C. Birth Territory andMidwifery Guardianship: Creating Birth Space. Oxford:Elsevier; 2008.11. Day C. Places of the Soul: architecture andenvironmental design as a healing art, second edition.London: Elsevier; 2004.12. De Botton A. The Architecture of HappinessMelbourne: Penguin Group; 2006.13. Dilani A, A New Paradigm of Design andHealth. in Design & Health III: Health PromotionThrough Environmental Design edited by A. Dilani. (pp15-25) Stockholm: International Academy for Design &Health; 2004.14. Newburn M, Singh D. Creating a Better BirthEnvironment. London: National Childbirth Trust; 2003.15. Rubin H, Amanda J, Owens, J, Golden G. AnInvestigation To Determine Whether the Built EnvironmentAffects Patient’s Medical Outcomes Concord: The Centerfor Health Design; 1998.16. Alexander C, Ishikawa S, Silverstein M. A PatternLanguage: towns, buildings, construction. New York: OxfordUniversity Press; 1977.17. Olsen O, Jewell MD. Home birth versus hospitalbirth (Cochrane Review) (Issue 3 ed.). Oxford: UpdateSoftware; 2001.WORLD HEALTH DESIGN | October 2008 53
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Page 4 and 5: ContentsEditorial DirectorMarc Sans
Page 6 and 7: Briefi ngWorld experts come to Sing
Page 9 and 10: iefingExperts call for actionon des
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Page 14 and 15: Uniting the disciplines of architec
Page 16 and 17: DialogueCultural challengesPhil Ned
Page 19 and 20: Dialoguebecause they act as a blott
Page 21 and 22: The debate about single hospital ro
Page 23 and 24: Dongtan City: An eco-exemplarClient
Page 25: Shenzhen HospitalShenzhen Hospital,
Page 28 and 29: Market Report: Eastern EuropeIt has
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