The designers rethinking childbirth environments

Thinking back to the birth of her first child in 2016, architect and designer Stiliyana Minkovska describes the experience as “alien”.

Though she remembers the hospital care she was given as excellent, Minkovska says throughout the experience, she wanted to “escape” the of the maternity ward she was on.

“The hospital is an aggressive space in many ways – the lighting is harsh, the rooms are busy, and I felt pressure from constantly being under surveillance,” she says.

At the time, Minkovska was part way through a masters at the Royal College of Art and after giving birth to a daughter, she set about seeing how she could improve the childbirth experience through design.

For a point of reference, she began with her own birth. Recalling a moment in which she felt “the closest and yet furthest” from where she was in that second, Minkovska says this is when the idea for her project Ultima Thule was born.

More than aesthetic problems

Minkovska’s experience is not a rare one. In her research into the design problems of birth, she says she discovered that most of the systems and products used in birthing environments today haven’t been redesigned since the 1960s.

“It’s strange that we have to developed different rituals around giving birth – we have water births and hypno-births for example – but the actual spaces and services themselves haven’t been considered,” she says.

The effect of poorly-designed birthing spaces isn’t just aesthetic. Research conducted by health systems innovation centre Ariadne Labs and MASS Design Group suggests the shape and size of labour and delivery rooms has a significant impact on the rate of non-medically indicated caesarean-section births in the US.

The report, found that design elements relating to capacity of the space and those that affected the workload and motivation of the staff all had an impact on birthing experiences.

Meanwhile, a German study of the same issue found that in maternity rooms that had been redesigned away from “tradition”, the quality of maternal comfort and coping with pain were reported to be “significantly improved”.

Furniture to “give a parent time with themselves”

Armed with her own experience, Minkovska says in designing Ultima Thule she wanted to create something that felt as if it could “evolve with a person’s need birthing needs”. The result was a three-piece furniture suite.

The first piece in the collection Minkovska calls the Labour Silla. It is designed as an alternative to a hospital bed, and allows for “squatting, bending, squeezing and being,” she says. Upholstered in a soft, leather-like vinyl, the seat also permits the user to “lean and bury their nails” into it as they work to find their “spot”. The second, named the Parturition Stool, was created for a birthing partner to sit behind the woman to provide emotional and physical support.

The final piece in her collection was the Solace Chaise. Designed as a result of her own feelings of being watched, Minkovska intended it to be a “cocoon for parent and baby to bond in comfort and privacy”. It is also designed to be a space for postpartum recovery of the numerous other circumstance related to birth, such as miscarriage or abortion. She says it is designed “to give a parent time with themselves”.

Innovation in low-resource settings

Minkovska’s Ultima Thule is based on her own labour experience. Elsewhere in the world, other birthing environments require alternative methods of innovation – particularly those in low-resource settings.

In their Lab.our project, Finnish innovation lab Scope aimed to improve the birthing experience through spatial, service and product design.

“Significant strides have been made over the years to decrease maternal and infant mortality rates across the developing world,” says Mari Tikkanen, co-founder and co-CEO of Scope. “But it remains high in many areas and the labour and maternity wards are really some of the most neglected parts of this story.”

Bypassing the design of these spaces, she says, can be costly.

“There’s plenty of evidence that suggests that stress for the mother has negative outcomes for labour experiences,” she says. “Even just from that perspective, lowering the stress and allowing for a smoother, safer and frankly more pleasant experience is crucial.”

After conducting research into case studies and the World Health Organisation’s Quality of Care guidelines, the team was approached by the government of the Indian state of Odisha to overhaul its maternity hospitals.

“The key, we found, was to approach the issue holistically,” says Tikkanen. “The childbirth experience for these mothers is more than just the bed they lay on – it is everything else as well as that so you can’t just tinker around in the delivery room and expected everything to change.”

A systems-based approach

Scope’s innovations were co-created with hospital workers. Tikkanen says this was because “the project was about capturing solutions to problems people in the field were already aware of”.

A redesigned bed, for example, was created to better facilitate a stress-free delivery. It is “wider and more comfortable”, gives women more positions to chose from in labour and captures blood and fluid loss, an important thing to keep track of in the childbirth process.

Beyond the bed, Tikkanen says Scope realised that in treating the experience holistically, more attention needed to be paid to how both parents and support staff got around the hospital.

“With so many people in the hospital, it can be hard for all parties to find their way around,” Tikkanen says. “Parents need to know where they’re going, and support workers need to know who they’re talking to and what each person needs and expects.”

The new system takes pregnant women through five stages: arrival, admission, labour, delivery and postnatal, and was devised between UX designers and midwife support staff. Each section is colour coded and sign posted both in wayfinding and a wearable pass, given on arrival.

The pass for the woman contains her arrival time, preferences for her birth (such as choosing to save the placenta or allowing blood transfusion), as well as check-ups done during her visit.

The pass for companions contains information on how to provide support during the childbirth process and what their roles and expected tasks are during the stay. It is, after all, a “big responsibility on their part too”, according to Tikkanen.

Improving a “scary, stressful” experience worldwide

There are, according to Tikkanen, three main benefits from design innovation in childbirth, which can impact quality of care not only in low resource settings, but in all maternity environments.

“For the people working within the hospital, clearer patient journeys and more hygienic space are huge benefits,” she says. Additionally, it can’t be forgotten the impact these design features have on a mother herself.

“It’s clear from what our doctor colleagues have told us that so many women really do have nothing when they give birth – and this can really just be a scary, stressful experience,” Tikkanen adds.

Now with a tailored plan for one maternity hospital, Tikkanen says the idea is to work to implement these innovations across a whole area and eventually even further.

She says the roll out will focus on Scope’s systems-based approach, where communication and care are at the forefront of operations, as well as the people working in these environments.