ABOUT ME

I began my career training to be a midwife, but the sterile labor and delivery rooms, chaotic nursing stations and incessant beeping and chiming of the hospital environment left me deeply dissatisfied with the typical U.S. birth experience—that seemed to approach even low-risk birth like an acute myocardial infarction. In fact, the Labor & Delivery unit bore a striking resemblance to an ICU. I practiced as a registered nurse (RN) for many years in women’s health until I decided to tackle birth as a design problem instead, earning a Master’s of Architecture from the Rhode Island School of Design (RISD). At RISD, I was awarded a travel grant to research the design of birth spaces in England and The Netherlands.

In 2015, I joined social impact architecture firm MASS, where my work focused on the intersection of design and healthcare, especially around childbirth. MASS offered me the opportunity to work from their flagship East Africa office in Rwanda, so in 2016, I packed up my family and moved to Kigali. For two years, I worked on a diverse portfolio of healthcare and birth-specific architectural projects in East Africa, including innovative maternity units for two Ministry of Health District Hospitals and a Postnatal Unit for a community health center in Malawi. I have researched and designed healthcare in both the Global South and Global North and found that despite the enormous disparity in resources, there are important lessons to be learned from both.

There is considerable variation in the design of childbirth spaces—from panopticon floorplans that maximize visual surveillance (a design borrowed from prison architecture) to a boutique birth hotel to an outdoor labor labyrinth. Within the U.S., few guidelines exist for the design of these life-altering spaces and little research addresses what works and what does not. In conversations with clinical staff and administrators, I have heard many times that facilities rarely share design successes or failures and teams charged with leading renovations feel as though they are starting from scratch. The result is that design trends without proven efficacy are perpetuated in the built environment at great expense and potential harm to patients.

Too little is known about the impact that design decisions have on birth outcomes. We do know that some important outcomes vary wildly by facility. A 2013 study found that, even after adjusting for maternal socio-demographic and clinical factors, it appears that a woman’s greatest risk factor for cesarean delivery is actually the facility where she gives birth, with cesarean rates varying between 7 and 70% of births among U.S. hospitals.* Clearly, many factors are at play in the care that women receive during childbirth; the question is how design of the facility contributes to the policies, pressures and clinical decisions that are made in the course of her birth.

Deb Polzin-Rosenberg RN, MArch, RA, AIA