I was fortunate enough to be able to work with a team of midwives in Sydney, Australia at the University of Technology, Sydney. Who had been looking at so many factors into what would create a quality birth experience for the woman, for the care providers, for the baby, and the family. And they realized that there was not enough information about the design of the space, so they developed what's called the Birth Unit Design Project, BUD, the BUD Project. And part of that process was developing an audit tool. So the intention was that anybody could walk into a birth environment, whether it be a resource rich or a low income setting without any special tools except for the ability to observe and to take note. So this this audit tool is called the BUDSET, Birth Unit Design Spatial Evaluation Tool. And this sort of led to them getting some grants, getting some grant funding. I live on the West coast of the United States, but I was fortunate enough to have relocated to Sydney before I even knew about this work, these very innovative midwives are working on. And I was welcomed on board as their project manager. And part of doing their research was taking video of of women in labor, getting the ethics approval for that process. And as I as I explored how to conduct the study, I realized that there was a lot more research that could be taken away from their work, so I preceded to work on my own PhD dissertation. So I looked specifically at how childbirth supporters experience this phase, but I also was able to help shape the project. Ao it has been an amazing journey that was almost five years ago now that I finished that. And since that time I've helped to co-convene the Global Birth Environment Design Network, and we have folks from all over the world. So far we're looking to expand who is involved with this, because we want to have diversity and inclusion for all types of people. And how they can better their built environment around where women are giving birth. It's a tricky process to do design research, right? Because if you think about the room you're sitting in watching this, or where you are, there are so many different design elements that could be affecting your experience. Some of them are physical and hard, such as the floor and the walls, but others are the soft ambience and so forth. So the process of doing design research takes a certain amount of multi-method work across many, many different people and different interdisciplinary approaches. So what I'm getting at is that the ability to to take one room, one family's experience, we use video ethnography, a quick ethnography process, to be able to really look at all of the rich data in that space and in that experience. We couple that with an interview process, where the supporters and the woman and her midwives were able to watch themselves on video, and notice things that they weren't able to notice at the time. And being able to interpret all of this data from video footage, which as you can imagine is teeming with data that you can interpret and make shape and sense of. To be able to put that into design recommendations, it takes a couple of steps to get there. And some of my publications show that audit trail and that process. So in the end of my experience gathering the data, I was able to articulate 28 design imperatives. Which I like to call it imperatives, because intervention requirements, these things people want something easy to just say, this is what we need to do. But what I always emphasize is, it's pretty important to understand your specific people. Who are your staff, who exactly are the types of people using the space that you're hoping to improve? But they are all along the lines that fit into the BUDSET, the Birth Unit Design Spatial Evaluation Tool that I mentioned previously. They tap into aspects of how the space might feel, have a sense of femininity. Is there a sense of control? A sense of control, the woman and her supporters don't need to have a lot of control over the space, but they need to feel like they have choices. That they can make, so that's something that can be considered in how the space is set up. We're not talking about needing to renovate an entire building. Yes, ideally my team and I we have ideas for re imagining how birth spaces should be. But we also understand you need to start with where you are and even the smallest intentional changes can help. For instance, there's quite a bit of excellent research about when a person first walks into a birth room they see the bed. If the bed is the first thing that they see, they immediately switch into the mindset of I am a patient they will tell me what to do. And this is counter to what is the most positive type of birth experience that we've found to be true, is that being mobile and upright, having the ability to choose how the body wants to move in order to have the birth process work most physiologically normally. Then the idea is well, perhaps you could shift the bed to somewhere not in eyesight, not in a central space. We're not saying let's not have a bed to the rest on, we're saying decentralize the visual focus of the bed. Same for the clock, I mean, that's a whole complicated ball of yarn, about the timing of how birth happens, of course, as you know. But having the feeling like you're being watched, this is also very counter to the normal birth process. Where a woman wants to feel that they have a sense of privacy, they aren't having people coming in and out of the door constantly. They aren't being watched whether it's by the machines in the room or by the clock on the wall. They want that sense of privacy. So to reiterate, the three sort of most rounded design interventions or imperatives that I would suggest are to do with the sense of privacy. Sense of perceived control of the space and the ability to personalize and to create the ambience in the space that can help the woman turn inward and to feel like this is a safe process for her. It takes some creative thinking on the part of the the staff, and the midwives, and the care providers, and the ability to implement the changes in a way that feels like it is supported for them. The physical environment alone is not going to change the shape of birth outcomes or experiences, it's the physical environment in tandem with the care that's provided. This creates the supportive, okay as a midwife I would like to be able to help the woman move around the room. How can my team support me in setting up the space? And of course design, there's a lot about that way finding which is navigating as your first entering, are you feeling welcomed? Or is the person feeling confused about where to go? If they start their initial approach to their birth experience feeling confused, this is going to start off that neurohormonal process of anxiety, it's not oxytocin. It's not that feel good hormone of, aah, I'm here. I can't wait to meet my little baby, so this even from the arrival point of view, the design of the space can really affect the outcomes. And of course there's, as with anything, there's a wide spectrum of what can be implemented starting, actually, it's interesting about making some low level design changes. Because in the 1970s people were very interested in this topic of how the design of birth environments might change the experience and they wanted to make it more homey. So the studies from that time period at showed that, well, putting a little night stand, with the tablecloths, and the lamp in the room really didn't end up having any change. Because it wasn't, I mean, it has to do with a more of a systemic shift, but I think we're ready to make that sort of a shift. It doesn't need to be A radical change, it can be implemented at the beginning phase, but as I mentioned previously, design research is very challenging because there are so many elements in a design environment. So along that line when you start to make design changes and design imperative start to happen, it might not necessarily be this radical improvement. But cumulatively there can be some really positive changes and that's what we're trying to gather a lot of more information about, what we know and what else do we want to know about. There has been more and more people interested in turning their research eye on this question, of how Designed environments affects childbirth experiences and outcomes. We formed a group called the Global Birth Environment Design Network, myself and a few other midwives. One is a midwife and designer. One is an architect. One is an artist and architect. So we have this balance of perspectives to help shape our work. And the intention of the Global Birth Environment Design Network is to gather all of the research has been done, and there's been a wide range. There's a random control trial happening in Germany currently. It's under way at the moment. We have many publications out that are at this point, the work I've done is been video ethnographic, qualitative, exploratory type work. It's very, it gets your question, what do we know? Well, we do know that the designed environment affects outcomes. When a person feels that they're in a overly medicalized place that doesn't personalize for their own experience. I think our overarching hypothesis maybe hasn't been articulated, but is that the need to have the medicalization is there. People want to have that available to them. They just don't want to see it. They don't want the space to be shaped to conform to the equipment in the medicalization of the process. We would like, the idea is that it's there as a support. Childbirth supporters are welcomed and supported. And there's that ability to allow the normal physiological process of childbirth to unfold in as well supported way for all involved. So that means the caregivers should be able to feel they can sit with the woman. Be with the woman. Make a cup of tea and not be under such pressures and so much stress that they feel that they can't attend to each person individually. When they're there and paying attention, they're able to notice when things are going sideways and having the design support. This understanding is something that we plan to work on for awhile to get a better sense of how this is connected.
