Course title

Designing Delivery

Faculty

Kim Holden, Emily Abruzzo

Semester offered

Fall 2023

This studio will examine the intersection between design and birth and explore the role that environment plays in family and maternal outcomes and disparities.

Childbirth is a universal experience. We are all born and we have all been impacted by the design of birth spaces, whether we realize it or not. However, birth continues to be seen as a niche, women’s topic, and birth spaces remain modeled on acute hospital care. This is not without consequences: according to a 2022 study (1), the United States had the highest rates of preventable maternal mortality rate of ten of the wealthiest nations: 23.8 deaths per 100,000 live births. The Black Maternal Mortality statistics in the US are even more alarming. In 2020, the rate for Black women was 55.3 deaths per 100,000, whereas the rate for White women was 19.1. In addition, according to the National Institutes of Health (2), up to 45% of new mothers experience birth trauma, the effects of which can continue long after the birth itself. How did we get here and how can architects be instrumental in improving birth experiences and outcomes?

Childbirth is one of the most physiological and healthy of all human experiences, albeit not without risk. Over time, childbirth has been medicalized by hospitals and viewed as a condition to be managed, rather than a normal life event. As such, the design of many contemporary labor and delivery spaces is often a mismatch for childbirth, the medicalized environment reducing one’s sense of agency and instilling fear instead of projecting a feeling of safety and providing privacy, the qualities associated with a positive birth experience. Why are we not designing with this in mind? Much of it has to do with a lack of awareness of the birth process and the roles that anatomy, physiology, and environment play. Other factors like policy, funding, and cultural norms affect what gets built where and how.

We will begin the semester with a basic introduction to the process of birth, the history of modern obstetrics, and how the pandemic highlighted the dearth of birth choice, particularly the lack of freestanding, midwifery-led birth centers in Connecticut (3). Through visits with practitioners and facilities in New Haven and New York, students will explore logistical, spatial, visual, auditory, and aesthetic choices in women’s health design, at the object, individual, and institutional scales. Via additional dialogue with thought partners including architects, curators and clinicians, we will seek to understand barriers to systemic improvement, including policy, economics, and the healthcare system in the US. Enhanced understanding of birth as a societal issue – not just a women’s issue – is critical to the conversation and leads to discussion of other related topics like paid family leave, postpartum depression, infertility, breastfeeding/pumping in the workplace, childcare, and more. Equally important will be an investigation of our knowledge and own experiences as individuals within the medical system.

During the first weeks of the studio, students will research these topics, preparing collaborative resources to be used in the design of a maternal health center that addresses these deficits. A maternal health center or birth center, is a facility and model of care that utilizes a holistic, dignified, equity-centered, and evidence-based approach. A wide range of resources is available, including prenatal and postpartum counseling, therapy, and education, as well as programs that connect patients to essential services, which are especially critical for those who may not otherwise have access. Students will select one of three sites in Connecticut, identified by the Critics; site research, along with developing an understanding of the communities served, will accompany the topical research phase.

The studio will travel to the Pacific Northwest during the travel week. Our first stop will be the Gates Foundation in Seattle where we will view the Designing Motherhood exhibition and meet with maternal health experts. This initial visit will lay the groundwork for the remainder of the week which will include visits to women’s health and freestanding birth centers as well as hospital labor/delivery spaces in the Seattle and Portland areas including OHSU (Oregon Health and State University hospital), Andaluz Center, Astoria Birth Center, and a community based program providing comprehensive perinatal services to indigenous families with low incomes. In addition, we will visit iconic buildings and sites in and around both cities, including work by OMA, Kengo Kuma, Frank Gehry, and Allied Works, and will tour architectural studios including LMN, Olson Kundig, Mutuus and LEVER.

Once we return to New Haven, we will focus on analyzing the data that we have collected, and process it at the scale of the individual, family, community, and society, while continuing to develop the program and projects. The design of a site-specific birth center, which seeks to address the needs of its immediate community, will continue through the remainder of the semester. The project’s sites will vary in terms of groups served, adjacencies, and potential partnerships.

To be champions of change requires questioning the role of design in some of our most entrenched systems. As designers, we have an obligation to understand how complex human needs like safety, dignity, respect, and culture intersect with the assumptions and norms governing our built world. Preventing death in childbirth is not enough; we need to do so much better. This studio seeks to advance awareness of the role that architects can play in improving both health experiences and outcomes for families.

Note: We typically use the term “birthing person” when discussing our work. For the purpose of this studio brief, we used female identifying terms.