Check out these BirthLink Resources:
Free Standing Birth
Center Project
Auction for Beautiful Design Concept Open Now
Thanks to architect, Sharmila Subramaniam, we are now offering the design of this wonderful facility to the highest bidder. This beautiful building incorporates a large water feature in the center and a lovely garden area. The bidding will begin at $1,000. Just e-mail us at BirthLink and let us know if you are interested in submitting a bid. Be sure to include your complete contact information with mailing address and phone. This project is a research based professional concept design. The plans would need to be developed for your specific site. All proceeds will be donated to BirthLink.
Birth Center
by Sharmila Subramaniam
"Gentle conscious Birth can lead the way to a better understanding of the true nature of our being and can bring us back to honoring how birth was meant to be."
- Barbara Harper, Gentle Birth Choices, Rochestor, Vermont: HealingArts Press, 1994, Pp. 113.
Human Birth is the most miraculous, transformational and mysterious event of our lives. It is also an experience that is shared by every single member of the human race. The birth experience indelibly imprints itself in the lives of both the mother who is giving birth and the baby who is born.In today's high-tech, industrialized world, our cultural perspective of birth depends greatly on who controls the birth experience. For centuries medicine has been trying to investigate, calculate and predict within a certain degree of probability the outcomes of birth. It has never been a priority of obstetrics to consider birth from the mother's perspective or to ask what could be done to make her birth more fulfilling.
This research aims to analyze the concept of 'natural childbirth', the physical and social 'birth center', and the benefits that these provide in the form of low technology care to birthing women. Its goals are to analyze a growing need for the design of a birth space that incorporates the needs of women adopting the natural childbirth model, to analyze existing birthing spaces both in a hospital and in an independent facility, and to learn from their positive and negative features in designing a new facility.
This research and design aims at using the Social Model of childbirth as against the Medical Model. The Social model emphasizes on natural childbirth with minimum intervention aided by midwives/doulas, at home or in a freestanding birth center or in a hospital birth center.
The research has been conducted in three phases:
PHASE I
Through a historical analysis to understand the transition of birthing spaces from 'Borning' rooms to birthing centers in the 21st century in the United States. The key references used for this phase of research were:
Primary Sources
- The Modern Hospital, American Journal of Public Health, Journal of American Medical Association (JAMA) between 1910 -1970
U.S Department of Health, Education and Welfare, Public Health Service, Design and Construction of General Hospitals, (New York, Modern Hospital Publishing Co., Chicago, IL, 1953)
(Guidelines for the design of hospitals and maternity wards) - National Association of Childbearing Centers (NACC), Standards for Freestanding Birth Centers 1995, 3123 Gottschall Road, Perkiomenville, PA 18074.
(Guidelines for the design of freestanding birth centers in the United States)
Secondary Sources
- Judith W. Leavitt, Brought to Bed: Childbearing in America 1750 – 1950, (New York: Oxford University Press, 1986)
- Richard W. Wertz and Dorothy W. Wertz, Lying In: A History of Childbirth in America, (New Haven: Yale University Press, 1989)
PHASE II
By distributing questionnaires among a group of women in and around Illinois who have adopted or plan to adopt the natural method of childbirth and birth centers. The survey focused mainly on what a woman would want in the physical space of a birthing center. It also addressed issues such as how and where you would want your child delivered and reasons for these choices.
This survey was conducted by:
- Distribution of survey questionnaires among mothers, nurse- midwives, doulas and other women who favored natural childbirth and the midwife model at the monthly meeting of 'Birthlink', a natural childbirth education organization, and by uploading it on their website for online responses.
- Mailed surveys to midwives, doulas and mothers who were enrolled in birth center programs and organizations like 'Birthlink' and 'Options In Birth'. The survey was also mailed out to birth- related service organizations and support groups.
PHASE III
By studying existing birth centers- both hospital and freestanding, analyzing the space usage in each, and identifying their positive and negative attributes. This was conducted by visiting two hospital birth centers and one freestanding birth center and carrying out an informal post occupancy evaluation of the space.
A total of 35 responses to the survey were analyzed and these results, along with the analysis of the case studies and literature review, were used to formulate design guidelines for a freestanding birth center. The research shows how alternative birthing centers and birthing movements of recent decades in the United States reflect changes in social values towards childbirth just as the birth environments of the past years reflected past technological conditions and social attitudes.
The conclusions from the three phases of this research are as follows:
PHASE I CONCLUSIONS
More than the entrance of male physicians and their medical interventions, the location of childbirth uncompromisingly and directly altered women's birth experiences, replacing the traditional female-centered domestic childbirth with a physician-directed medical and surgical event. In earlier periods, with either midwife or physician attendants, women controlled the scene of birth, but by the 20th century, the physicians who ruled the scene of birth also controlled the birthing women. The space for birth also changed drastically over the 20th century according to the type of birth attendants who dictated the needs for the sizes and organization of the different rooms in a facility.
Earlier the guidelines for the design were set by the midwives and women and towards the end of the century the person in charge changes and so does the guidelines and space formations. Facilities for the birthing woman's comforts however did improve in the 20th century, but birth itself was no longer in her hands. There were either midwives or doctors who controlled it.
The design of the birthing spaces has evolved over the 20th century. Most interesting is the finding that doctors and educators guided the course of change rather than birthing women (Results Phase I). What was under the domain of a birthing woman in the earlier centuries and in many countries around the world has now in the United States shifted to physicians. In the earlier part of the century, the birth space was a large area usually at home and what we have today are small delivery and labor rooms in hospitals. What a woman wants in her birthing space, how she would shape this space are questions never asked of women. Instead it has been taken for granted that physicians and medical institutions should decide what the appropriate design of this space is. Indeed, the attendants of birth are the ones who design the birthing space rather than the most important person in the scene-the birthing woman! We can also see that the importance and the scale of the birthing space have changed over the century.
- For detailed survey results, click here.
PHASE II CONCLUSIONS
There is a need for a well-designed birth space for women who adopt the natural method of childbirth (Results Phase II). Some of the specifics of this space are suggested by the women interviewed and some have been understood by their answers to design related questions.
PHASE III CONCLUSIONS
Birth centers today are trying to meet the needs of the birthing women. They however lack important design elements like the space hierarchy, privacy factors, size and scale for the different uses and most importantly the ambiance that would support the concept of gentle childbirth (Results Phase III). Birth centers are trying to strike a balance between the hospital maternity model and the natural model which has generated spaces that are trying to incorporate the best of both the models. However, in doing this, they have lost the main focus of creating a birth environment that answers the primary question of how a birthing woman would want her space to be.
The results from the research led to the setting of design guidelines for such a birth center. Some of these guidelines are based on the case studies or on what was observed in the early and later designs of hospital maternity areas that did and did not work effectively for the birthing woman.
Since there are few established birth centers and most do not incorporate most recommended design elements, most of the guidelines are a product of observation and analysis of what is lacking and how it could be incorporated or made useful for the birthing woman.
1. Space Hierarchy
Clearly delineate public space (streets), congregation space (open/semi-open spaces/ courts), and private spaces (the birthing rooms, family space, recovery rooms, and so forth), administrative space (offices) and education space (classrooms).
2. Entry/ Access
Visible entry and access to the facility buffered from the main street.
3. Noise
Provide buffer zones to prevent outside noise due to traffic and other disturbances from entering the birthing space and the facility.
4. Pleasing Milieu/Ambiance
The total visual milieu of the birthing center and the interior ambiance created is an important factor for the comfort and satisfaction of the birthing woman. The architectural style should blend with the buildings in the neighborhood and at the same time identifying the use of this facility. The color scheme should be carefully selected to reflect the subtle nature of the facility.
5. Views/ Seating/ Landscape
Most of the women in this study based their level of comfort on how well they can relate to nature during birthing. Be aware of local microclimate in locating sitting areas within courtyards/backyards/porches. Choose trees, ground cover and shrubs that are maintenance free.
6. Space for Water Birth/ Birth Room
One of the most important features is the space designed to create the ambiance and support the water birthing facility.
- Integrate the water birth space with the other areas instead of it being a separate facility.
- Create focus points.
- Decide the total area required for supporting the different postures and movement.
- Orientation of the water birth facility so that it is secluded at the same time receives natural light.
7. Passive Solar
Incorporation of passive solar concepts by orienting the occupant rooms such that there is maximum daylight and the courtyards such that there is a comfortable daytime temperature is essential.
By this research, I realized that it is indeed important for both architects/designers and the medical profession to understand not only the medical needs of the birthing woman but also her psychological and emotional needs during this most tender phase of her life and cater to the same by providing the necessary physical ambiance.
Each and every phase of this research and design has been guided by the concept of 'gentle, natural birth' which is a non-clinical, social model that emphasizes on both the physical as well as the psychological well being of the mother.
All the birthing rooms are designed such that they have maximum views to the outside. The rooms on either side face the central water\cascade or the sloped landscape. Trees screen off the building from the main roads and form small groves which act as sit outs and congregation spaces. The main entrances to both the birthing rooms and the administrative/therapy area point to the central water cascade thereby forming two focal points.
Rooms for family have been provided below the birthing rooms at the lower level that provide a direct access and a direct connection with the family at all times. The birthing rooms itself are individual suites that have an inbuilt kitchen, toilet/bath facility and a patio. The layout of the different rooms follow the natural lines of the existing contours thereby blending the structure with the site. The concept of sustainable design which blends well with the concept of natural birth has been incorporated.
SUSTAINABLE DESIGN
Some of the methods by which sustainability is incorporated in the design is by:
Passive Solar
The building on the site is oriented such that all the birthing rooms face south therebymaking maximum use of the daylight. Additional sun scoops are provided for the lobby areas thereby deriving maximum daylight.
Structural System
The entire structural system is of Certified Wood.
'Living Machine": Water Recycling Plant
A Living Machine is a series of tanks with live plants, trees, grasses and algae and a diversity of microorganisms and bacteria. Each tank is a different mini-ecosystem designed to eat or break down waste.The process takes about four days to turn mucky water crystal clear. In comparison to conventional waste treatment, it costs less financially and ecologically.
Landscape
Clay paving, herb garden where natural herbs are cultivated which is used for thearomatherapy. Rose garden with sit outs and walking path along these that create a soothing view. Children's play area and family gathering space. The covered indoor corridor looking out into the central cascade acts as a gallery space for display of newborn pictures and also for daily walks for the birthing women.
The design and organization of birth settings have significance for the delivery itself, as well as the safety – perceived and actual of the mother and child, the mother's posture and freedom of movement, her confidence and psychological well being, medical intervention and architecture.
This research led to the design of a freestanding birth center at Davenport, Iowa. This design project satisfied the capstone requirement of the School of Architecture.
