NATURAL
BIRTH
CENTER
ANDREA LEANO • IND 5626 PROJECT PROGRAMMING • PROF. PHILIP ABBOTT
INDEX
Review of Literature………………………………………………1
Typology…………………………………………………………30
Client Owner…………………………………………………….66
Location and Site……………………………………………….76
Client User………………………………………………………92
Goals and Objectives…………………………………………124
Quantitative…………………………………………………….127
Site documentation, building selection………………….….130
Mentor Session……………………………………………….133
Design Guidelines……………………………………………..135
References…………………………………………………….141
REVIEW OF LITERATURE
LITERATURE REVIEW
INTRODUCTION
Background
Maternal mortality rates are increasing, not decreasing,
in the United States, according to several recent
reports. Deadly Delivery, a 2010 report by Amnesty
International
(http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.
pdf), notes that the likelihood of a woman dying in
childbirth in the U.S. is five times greater than in
Greece, four times greater than in Germany, and three
times greater than in Spain. In the article “Letter from
Europe: Home birth reborn,” Sheila Kitzinger (2008)
raises the question of “how in a culture that regulates
child birth with prompt intervention, and sophisticated
technology we have got into this mess”. (p.77) John
Davis, Emeritus Professor of Child Health at Cambridge
University, observes: “It is so often the unnerving
atmosphere of a busy obstetric unit for a woman in
labor that brings about the very problems that it is
equipped to deal with” (Kitzinger, 2008, p. 77). Based
on these studies, there appears to be an increased
awareness on how the physical characteristics of birth
centers and their tendency to resemble homelike
environment
designs,
promote
physical
and
psychologicalthat
comfort
consequently result in the relaxation
of the mother during the delivery process.
Centuries ago, childbearing was a
woman’s activity. Having a baby was part
of the natural process of a woman and
even part
of a regular day of work. Women valued teachings and
experiences from previous generations as important
knowledge to have their babies. Labor and delivery of
the baby took place in the home environment
surrounded by family and a midwife. “The laboring
woman was comforted, encouraged, and supported
throughout labor and for days and weeks after their
infant was born” (Lothian 2001, p. 13). Natural birth
was viewed as a journey that required patience, trust
and confidence. (Lothian, 2001).
The social changes of the twentieth century as well as
scientific advances in medicine coupled with
recognition of obstetrics as part of the medical
profession led childbirth from the home setting to the
institutional setting. (Lothian, 2001). As technology and
management of childbirth increased, obstetrics
became part of hospital care where physicians had all
the modern tools needed to manage labor as well as
the advantage of convenience, with all patients in one
location. Judith Lothian in the article Back to the
Future: Trusting Birth reaches to the conclusion that:
“… the restriction of the hospital environment and
obstetric care practices limited women’s ability to find
comfort without the use of medication….as birth
technology increased, interventions once reserved for
complicated labors, such as intravenous lines,
restrictions on eating and drinking, and confinement to
bed, became routine for all women” (Lothian, 2001, p.
14)
1
LITERATURE REVIEW
Purpose of this study
Since 1970 there has been a movement to change
hospital environments from a sterile atmosphere to a
more humanized environment. (Jimenez, 2010, p.
160)The tendency has been to recreate a home like
environment. Even though steps have been taking to
accomplish this, there is still a long way to go to
improve the satisfaction level on women and the quality
of the process of giving birth. Women have been taken
into account as costumers of the healthcare
environment. They are the ones that aside from
selecting the place where to give birth also make
decisions for the rest of the family to visit different
doctors. (Eshelman, 2004, p. 2)
The purpose of this study is to determine the features of
the interior environment that contribute to the perception
of hominess in a birth room setting. The idea is to be
able to recognize the physical qualities of the space that
support the relaxation of the mother and improve the
birth experience. “Successful design in hospital birthing
settings can contribute to women’s feeling of hominess
by providing personal control over visual access, patient
exposure, family visitation and the
immediate environment” (Eshelman, 2004,
p. 2)
It is important for us as interior designers
to understand the needs of the users and
find the connection between the physical
and psychological needs to the physical
environment. According to Mary Lay
Schuster, “…a client’s perception of the experience
they wish for and seemingly get in giving birth at the
center is the consequence of mind, body, and place”.
(p. 5)
Research Questions
Central question:
•What interior design characteristics contribute to the
physical and psychological relaxation of mothers and
babies for a better birth experience as well as the
support of birth as a natural process?
Sub-questions:
1. What is natural birth?
2. What effects does the physical environment have
on pregnant women?
3. What are the psychological effects of pregnancy in
women?
4. What kind of relaxation methods help pregnant
women relax during labor?
5. How is the homelike environment translated into a
birth environment?
6. How does the physical environment of the birth
center support family and friends participation in
the birth process?
2
LITERATURE REVIEW
Significance of this Study
Women are exposed to physical and psychological
changes during pregnancy and given the severity of the
effects of depression; there are different ways in which
the physical environment can support a healthier
pregnancy, delivery and post delivery process by
promoting higher levels of relaxation. (Jimenez, 2010)
Pregnancy is a difficult time in which many women face
problems of anxiety, stress, and depression. Women
who present this kind of health problems are more likely
to have premature births and low weigh births. (MeiYueh Chang, 2008, p. 2580). According to Dr. Janice H.
Goodman, depression problems during the pregnancy
or a shocking delivery experience can damage the
bonding between mother and child, interfere with the
development of a child, and cause chronic implications
of a reoccurring depression in a woman’s life.
(Goodman, 2009, p. 61)
This study provides a view of how the health care
design has been revolutionized to shift directions from a
sterile environment to a more family centered
atmosphere. According to Judith A. Lothian, “Of all
medical specialties it is in the obstetrics and
gynecology in which clinical practice is
least likely to be supported by scientific
evidence”(p.17).Based on this lack of
evidence, it is important to have a deep
understanding of women’s needs during
pregnancy and delivery of the baby where the
environment
promotes
family
participation.
“Pregnancy, birth, and the postpartum period are
milestone events in the continuum of life. These
experiences profoundly affect women, babies, fathers,
and families, and have important and long-lasting
effects on society” (Lothian, 2001, p. 20)
LITERATURE REVIEW
Natural Birth
Despite technological advances, there is many people
who want to bring back the old practices of birth in
which women are encouraged to experience birth as a
normal, natural and healthy process. (Lothian, 2001).
Unfortunately as the process of giving birth has gotten
more technological, giving birth naturally is rather seen
as a diagnosis of a medical condition. Today giving
birth to a baby is seen more of a risky procedure in
which the presence of medicine has become a must
without allowing the mother to really experience her
body and embrace pregnancy as a natural cycle and
process of life. The introduction of medicines such as
picotin and epidural prevent women to respond to the
needs of their bodies and to embrace the natural
process of labor. Lothian explains in her article “Back
to The Future: Trusting Birth” the importance of the
different stages of labor and how feelings of pain
3
LITERATURE REVIEW
indicate women how to deliver their babies. “The active
participation of the mother is an important, if not
essential, part of natural birth. Anatomically, the
mother’s movements in response to contractions
facilitate rotation and descend of the fetus and protect
the cervix and the birth canal” (Lothian 2001, p. 16).
Lothian also makes emphasis on the baby’s
participation at the moment of labor, how the physical
closeness of the mother and child right after birth can
help the mother, not only the newborn’s sucking but
also the child’s touch and massage of the mother’s
breast promote the oxytocin release necessary for
breastfeeding and potentially crucial for preventing
postpartum hemorrhage (Lothian 2001,). There is
extensive evidence that supports the idea, that the way
in which the physical environment is arranged supports
natural delivery. According to Ronald L. Cole, M.D. in
his book “The Gentle Greeting” the most important
factor is a calm, loving, and joyful atmosphere in the
birthing room. “ My experience shows that the most
crucial factor contributing to a successful, non-traumatic
birth is the environment that promotes a nice emotional
atmosphere surrounding all the participants in the
pregnancy and birth experience: parents, family, friends,
physicians, and nurses” (Cole, 1998, p.
116)
According to Diony Young in his article
What is Normal Childbirth and Do We
Need More Statements About It? Each
country has a different concept of what
natural
stands for and how much medical intervention is
involved. He makes emphasis on the fact that the term
is in an ever evolving change and that providers and
consumers have to fight for the reformation of the
concept in order to make natural a real natural
process. (Young, 2009) A vast range of practices have
been introduced to start, accelerate, monitor, and
numb the physiological process of labor, thereby
making the concept of practice of normal child birth an
ever changing and ever expanding process (Young,
2009). Young concludes his article by stating “Now, as
cesarean delivery rates escalate alarmingly all over the
world, perhaps it really is the time for a rebirth of
natural childbirth” (Young, 2009, p. 2)
It is easy to describe the components of those natural
and normal births - physiological labor and delivery, no
drugs or medical interventions, a spontaneous
delivery, no episiotomy, minimal mother-baby
separation, and early and exclusive breastfeeding. But
today in most Western countries, having this type of
natural birth is an unusual event in a hospital, and
most likely to occur with a midwife at home or in a
free-standing birth center (Young, 2009)
“The midwifery model of birth defines birth as a lowtech natural process and most laboring women as well
prepared to succeed if they are allowed to listen to
their own bodies and articulate their own needs”.
(Schuster, 2006, p. 14). For the most part, midwifes
4
LITERATURE REVIEW
let the mother design their own experience of giving
birth. Birth is considered a family event, and the
participation of the family is encouraged depending on
the preferences of the mother. Midwifes follow the
mother’s plan of giving birth, unless they see any risks
that would require the mother to be transferred to a
medical facility. “Midwifes call this philosophy the whole
woman
approach,
offering
clients
emotional,
psychological, and physical support and considering the
mother and baby a unit: what is good for the mother will
benefit the baby and vice versa” (Schuster, 2006, p. 15)
The great advantage of having a midwife throughout the
process of pregnancy is the bonding between the
mother and the midwife. Prenatal appointments are not
limited to keeping record of the physical changes of the
mother and baby; it is also time to talk about any
emotional changes in the mother or any other
pregnancy related issue. Women get to ask any
questions to the midwife or talk about any of their
concerns. The importance of this relationship is the
bonding that it creates between women. Such bonding
creates a feeling of familiarity to the mother in respect
with the staff members and the actual place of birth.
Psychological effects of pregnancy
and the environment
Men and women have a tendency to
suffer from depression from time to time.
Women have a greater chance to suffer
from depression because of
the
childbearing
experience. The rates of women suffering from
depression are really high and studies show how the
effects of the depression can damage the bonding
between mother and child, interfere with the
development of a child, and chronic implications of a
reoccurring depression in a woman’s life. (Janice H.
Goodman P. , 2009). The is a tendency in women to
avoid any kind of treatment when they suffer from
depression. According to studies, there are many
reasons that explain why women have such reactions.
Some women feel ashamed to admit their depression
during such happy moments of their lives. Others fear
what their families will think of them. There is also a
tendency to avoid treatment due to lack of
transportation or help with the care for their others
kids. Having a better understanding of what prevents
women from getting treatment will help find solutions
for those problems and create a program that supports
their different conditions, improve treatments and
improve the overall health of childbearing women.
(Goodman , 2009) “A traumatic or unsatisfactory birth
can lead to postpartum depression or post-traumatic
stress disorder, in which women relieve their labor in
dreams and flashbacks that trigger extreme distress”
(Jimenez, 2010, p. 160)
Pain during Labor and the environment
In an attempt to define the ways in which women can
have a more relaxed and friendly delivery of the baby,
5
LITERATURE REVIEW
it is important to also analyze how the procedures use
during delivery affect a woman. The different
procedures used during delivery can be enhanced and
supported by the design of the birth room. Judith A.
Lothian make emphasis on going back to old
techniques of giving birth naturally, perhaps the
environment should represent a more natural
environment that can shape women’s perception of the
delivery of babies. There is also emphasis on the
emotional support that family and friends can offer to
mothers during delivery and the positive outcomes this
has to a better delivery. Such participation of family and
friends can be reinforced and reflected in the built
environment by making their participation as
comfortable as possible. (Lothian, 2001). “…when
clients [mothers] realize the physical and psychological
consequences of structures and objects, they reconnect
with their physical bodies, associate mental attitudes
with physical sensation, and sustain a counter
disclosure about birth” (Schuster, 2006, p. 1)
Baby Haven is a free standing birth center designed by
Sarah Stanton. Stanton designed Baby Haven to
support the midwifery model where medical instruments
are hidden and only used in case of emergency.
Stanton
expresses her intent in the design of a
birth center that supports a natural
process, but it is important to see how the
design affects client’s minds and bodies.
(Schuster, 2006, p. 17)” Baby
Haven clients perceive the effect of the low lighting,
the quite, and the smells from the kitchen on their
minds and bodies. They attribute their ability to relax
during labor to the center’s homelike décor and the
sensations it provokes”. (Schuster, 2006, p. 17)
Clients in this birth center suggest that the ability of
their bodies to relax within the space helps them deal
with pain during labor. According to Stanton, “avoiding
the psychological sensation of fear makes the physical
sensation of pain manageable,….and the most
effective way to avoid fear is to birth in a place similar
to home, where one feels safe and in control”
(Schuster, 2006, p. 18) Baby Haven is a perfect
example in which the process used to give birth along
with the support of the physical environment improved
women’s experience of birth by relaxing them and
encouraging them to embrace the natural labor
process. Stanton intended for her clients to be able to
relax psychologically enough to manage pain
physically when she designed Baby Haven (Schuster,
2006)
As interior designers we have the opportunity to shape
the process of giving birth, by the way we arrange the
environment. According to Mary Lay Schustape
people’s mentality of birth being a medical procedure
reflects both cultural and material arrangements and
thus is a physical representation of relationships and
ideas. (Schuster, 2006, p. 1) Mary quotes Roxane
Mountford and her extension on Henri Lefebvres’s
6
LITERATURE REVIEW
theory of social space to argue that “particular spaces
can move people both by suggesting symbolic
associations and by causing us to form relationships
with each other and the space through its structure”
(Schuster, 2006, p. 5) Mary proceeds to explain that
“….spaces, therefore, have “heuristic power over their
inhabitants and spectators by forcing them to change
both their behavior and sometimes, their view of
themselves” (Schuster, 2006, p. 5)
Hospital environment vs. Homelike environment
Mother’s Perception of Hominess
Despite the continued claim by health care
professionals that the hospital is the safest place for all
women to give birth, with most citing the need for
continuous surveillance in case of emergencies, there
has been no evidence that the hospital is safer than
other birthing alternatives for the low-risk , childbearing
woman. Other health care professionals argue that
childbearing is not a sickness but a life event in the life
of a woman in which the hospital setting designed to
treat the ill does not support the needs of women to
embrace labor as a family event. Veitch and Arkkelin
suggested that the mere mention of the words hospital
brings thoughts of long sterile hallways, stainless steel
utensils, banks
of
life-monitoring
equipment, people in white
uniforms rushing to and fro, specialized
rooms
for
specialized
functions,
wheelchairs lined up at elevators, and the
smell of rubbing alcohol and disinfectant
(Leather, 2003). The cold environment of the hospital
might create negative feelings of fear as a result of
being in an environment associated with death and
suffering. These negative feelings can in turn raise
levels of stress for the users of the space. (Leather,
2003)
Throughout the years, there has been an intention to
change the healthcare environment to one that not
only supports the functionality of the space but also
one that utilizes the interior design to improve the
experience of the user. This approach has been taken
into account directly into the maternity care unit. The
tendency has been to recreate a home like
environment. As women have been taken into account
as costumers of the healthcare environment, they are
the ones that aside from selecting the place where to
give birth also make decisions for the rest of the family
to visit the different doctors. (Eshelman, 2004)
“Successful design in hospital birthing settings can
contribute to women’s feelings of hominess by
providing personal control over visual access, patient
exposure,
family
visitation,
and
immediate
environment” (Eshelman, 2004, p. 1)
“Complex psychological and social outcomes result
from giving birth and a woman’s satisfaction with her
child birth experience may have immediate and longterm effects on her health and her relationship with her
infant” (Vania Jimenez, 2010, p. 160) In general,
7
LITERATURE REVIEW
there seems to be a discontent across the board on
how women perceive the birth environment. In many
cases women end up choosing a place to have their
babies, not based on what they like but on what they
believe is the most safe environment for their babies.
(Jimenez, 2010). The involvement of interior design
should be more present in the redesign of birth rooms.
Different hospitals have use different techniques at
making the birth room a more home like environment,
but for the most part the modifications are limited to the
use of wall covering and drapery. (Eshelman, 2004).
The contradiction between what mothers to be want and
what they choose, clearly suggests an opportunity for
interior design intervention
In order to evaluate the tendency of interior designers to
recreate the birthing room as a homelike environment,
it’s important to define what home represents and how
it influences mother’s psychology. According to John
Ruskin:
“[home] is the place of peace; the shelter not only from
injury, but from all terror, doubt, and division. In so far as
it is not this, it is not home… it is then only part of the
outer world which you have roofed over…” (Gifford,
2007, p. 254)
Another definition states that home is “the
rich set of evolving cultural, demographic,
and psychological meaning people attach
to that physical structure” (Gifford, 2007,
p. 255). Home has great personal
and social meaning for us, and we likely also
experience belongingness, happiness, self-expression,
and good relationships within it. According to Robert
Gifford there are six dimensions that enable us to
experience such feelings: haven, order, identity,
connectedness, warmth, and physically suitable. This
definitions of home bring thoughts to my mind as to
how mothers to be, relate to this feeling of shelter and
protection at the moment of delivering their baby.
According to Bordo in her study of bodily integrity, the
essence of the pregnant woman is “her biological,
purely mechanical role in preserving the life of another”
(Schuster, 2006, p. 8). It is important for interior
designers to understand mother’s perceptions as they
move through the space and their expectations of
safety that supports their role as mothers.
Re-conceptualization of the Labor Room:
A homelike environment is very important for the way
the space is perceived from the mother and family as a
whole. The idea of a birth room resembling a home
environment promotes birth as a family event instead
of an illness. According to Jung-Hye Shin, Lorraine E.
Maxwell and Paul Eshelman; “The birthing experience
has been described as a normal, healthy process
which occurs during the lives of most women”
(Eshelman, 2004, p. 1). Shin, Maxwell and Eshelman
also state in their study, that the design of birth rooms
should be viewed as the ability of the built environment
to
8
LITERATURE REVIEW
support family events. (Eshelman, 2004). When
analyzing the six dimensions of home, we can see how
these concepts take form in the physical environment
and can be perceived as we move through the space.
Six dimensions of home:
Home is a haven that surrounds us with privacy,
security, refuge, and protection from the slings and
arrows of life outside it.
Order: Home helps us to know our place in the world.
This ordering is not only spatial, but temporal; home is
strongly related to our sense of continuity.
Home is central to our identity. As social creatures,
home includes for us a sense of family kinship, ethnic
belonging, and socioeconomic status. Home is thus an
important part of who we are. Through self expression
and personalization, the home comes to resemble or
represent our selves.
Through
order
and
identity
home
means
connectedness, the patterns of spatial and temporal
order help us feel connected to certain people, to the
place, to the past, and to the future. We feel part of a
family or group, and part of a culture.
Home is warmth. This grows out of the
preceding qualities, but goes beyond
them. This warmth is like that of the
hearth, but is symbolic and interpersonal.
Home is physically suitable. Obviously,
this
means more than the material physical aspects of the
house. It means the physical form and structure of the
house matches our psychological needs.
Spatial meaning and aesthetic quality are tools of
Interior Design that help improve the experience of the
space and at the same time support the function. In
the case of hospitals a lot of emphasis has been put
into a functionally successful design. When creating a
space that gives a feeling of haven and order , it s
important to take into account spatial continuity that
provides the right privacy levels, transitional spaces
that can be controlled by the users as well as
openness to the outside and inside of the
architectural structure. (Eshelman, 2004). Too much or
too little privacy can cause stress to the mother by
creating feelings of isolation or a sense of crowding.
One way to achieve the right connection between
spaces is with the use of special continuity and
transitional spaces. In a study on Mothers perception
of Hominess, suggested that doorways without
transitional spaces are less homelike than those with
more transitional space. Additionally, rooms with
physical barriers tend to be more homelike than those
in which the space is more exposed. (Eshelman,
2004).
Exposure to daylight has a tremendous positive effect
on people. Research indicates that openness to the
outside through widows can give patients something
to do, help orient them through the time of the day,
9
LITERATURE REVIEW
season and weather, and even give them pleasure. In
the case of expectant mothers, daylight and fresh air
can help mothers to relax, and control their circadian
cycle. In the other hand, lack of daylight can result in
lethargy, depression, increased rate of suicide, and
seasonally affected disorder. (Eshelman, 2004). It is
important to keep in mind the right size and location of
widows. According to Eshelman, “The number and size
of windows in a hospital setting can affect the user’s
feeling of boundary and involvement” (Eshelman, 2004,
p. 2)Studies suggest to stay away from floor to ceiling
windows in order to avoid a feeling of exposure. This
supports Ching’s theory on space that can be too open.
“In interior environments, when the space looses a
sense of enclosure, it becomes too diffuse and begins
to merge with adjacent spaces. (Eshelman, 2004)
Consequently, people might tend to lose their sense of
security.
A home only becomes a home when we recognize a
series of items that represent personal belongings that
create a set of meanings and reinforce our identity.
There is a need in health care facilities to provide space
for people to customize their spaces so they feel a
connection to the space and avoid feelings of isolation.
Personalizing the space can also raise
the levels of privacy even for temporary
stays. (Gifford, 2007). According to a
study on the comparison of standard
hospital labor rooms versus a more
residential birthing
means more than the material physical aspects of the
house. It means the physical form and structure of the
house matches our psychological needs.
Spatial meaning and aesthetic quality are tools of
Interior Design that help improve the experience of the
space and at the same time support the function. In
the case of hospitals a lot of emphasis has been put
into a functionally successful design. When creating a
space that gives a feeling of haven and order , it s
important to take into account spatial continuity that
provides the right privacy levels, transitional spaces
that can be controlled by the users as well as
openness to the outside and inside of the
architectural structure. (Eshelman, 2004). Too much or
too little privacy can cause stress to the mother by
creating feelings of isolation or a sense of crowding.
One way to achieve the right connection between
spaces is with the use of special continuity and
transitional spaces. In a study on Mothers perception
of Hominess, suggested that doorways without
transitional spaces are less homelike than those with
more transitional space. Additionally, rooms with
physical barriers tend to be more homelike than those
in which the space is more exposed. (Eshelman,
2004).
Exposure to daylight has a tremendous positive effect
on people. Research indicates that openness to the
outside through widows can give patients something
to do, help orient them through the time of the day,
10
LITERATURE REVIEW
person who gives her care, and by the environment in
which she gives birth” (Lothian, 2001, p. 20). The
moment of having a baby is a memory that stays with a
mother for the rest of her life. Creating a nice memory is
a combination of the experience of the mother during
labor, the interaction with each of the participants of the
birth process and the experience of the environment.
Home is directly related with the feeling of family
warmth. It is in the home where we built unforgettable
memories that stay for the rest our lives and make us
who we are. Creating a home warmth feeling in the
birthing room, depends on the mothers opportunity to
give birth as she wishes in an environment in which she
feels nurtured and secure, and her emotional well
being, privacy, and personal preferences are respected.
The physical suitable aspects of the home environment
can be translated into the birthing room as a toll that
can increase the relaxation of the mother if those match
her psychological needs. Birthing rooms that are
associated with the home environment are those that
offer privacy, promote social support, allow freedom,
and control, are calming, and include scenes of nature
and other visual and auditory stimuli that create
positive
emotional responses (Hodnett, 2009).
Research suggest that exposure to natural
settings may reduce stress, engenders
feelings of peace, hope, upliftment, joy,
reflection, relaxation, enrichment, and
spiritual connection. (Whitehouse, 2001). Operable
windows are an important mechanism to improve
control over ventilation, temperature and exposure to
the outside. Studies suggest that sliding doors and
French doors tend to be perceived as homier when
compared to fixed windows and small awning
windows. (Eshelman, 2004). Lighting plays a very
important role in setting the mood of the room.
Mothers perceive the effect of the low lighting as their
ability to relax and cope with pain. (Schuster, 2006). It
is also important to have different sources of lighting
such as task lighting for family member’s activities (i.e.
reading) and good amount of natural light as well s full
spectrum artificial light.
Relaxation Methods during Pregnancy and Labor
Knowledge
Dissatisfaction in women starts with the lack of
information they received when deciding where to
have a baby and pregnancy in general. How much
knowledge a mother has, influences the outcome of
delivery. Studies show that the majority of women don’t
know how to proceed when deciding where to have a
baby. Most of them go to a hospital based on their
notion of safety and risk, even though they don’t like
the environment. Fort the most part women think the
epidural is the only pain relieve method there is.
Informed women feel they have more options to decide
11
LITERATURE REVIEW
where to have their babies and what methods for pain
relieve they want to choose. In general women find it
very confusing on how to proceed during and after the
pregnancy. (Jimenez, 2010) Consistently with other
research findings, the more control women feel over the
situation, the more confident they feel on their
performance during delivery.
Water
Different studies indicate that giving birth in water has
many positive effects not only on the mother, but also
on the fetus and on the family in general. Water birth
improves comfort and mobility. The mother has much
greater ease and freedom to move spontaneously and
to change position to assist the descent of the baby.
(Jessiman, 2009)It also promotes deeper relaxation. As
a woman relaxes deeply in water, her hormones kick in
and she starts progressing faster and with more rhythm;
labor becomes more efficient. (Jessiman, 2009)One of
the most important effects of water during the delivery
of the baby is the fact that it water minimizes pain
effectively that for most women other pain control
methods are no longer needed. As mentioned before
the control of the mother over pain relieve anxiety and
promotes relaxation. As the mother
feels more relaxed, it is possible to
promote family relationships. When the
mother's pain is dramatically reduced,
many fathers eagerly take a more active
role in the delivery, resulting in a greater
family bond. (Jessiman, 2009).Miller argues that if
Midwifes are really committed to restoring normality in
birth then every women without major complications
should be offered the opportunity to labor and give
birth in water. (Jessiman, 2009, p. 586)
Music
“…non-pharmacological preventive intervention for
antenatal stress, anxiety and depression should be
considered of significant importance [to avoid risk of
the fetus and mother]” (Chang, 2008, p. 2581). There
is a need to understand how to address the problem of
depression and offer adequate support to pregnant
women. The fact that pregnant women cannot take
any medication during pregnancy or during lactation
gives a lot of power to alternative solutions. Studies
indicated that women who listened to music rated
substantially lower level of stress, anxiety and
depression. Music does not only influence pregnant
women to be more stable emotionally but also any
depression patient in general. Music’s healing
properties are based on neutralizing negative emotions
and
elevating
harmony
and
inner
peace.
“…advantages for music therapy applied in pregnancy
and childbirth on anxiety reduction and stress, as well
as providing pain management during childbirth”
(Chang, 2008, p. 2581)
Acupuncture
Studies indicate that acupuncture helps relieve the
pain
12
LITERATURE REVIEW
but not the intensity, regardless of the method use;
women experience the same amount of pain. The
difference lies in the way women perceived the process
of birth. Women who use acupuncture as pain relieve
feel in more control of the situation than women who
use other pharmacological methods. According to Lisa
Borup,” [women] feeling of control contributes to a good
birth experience” (p. 11). In other words if the mother is
more relaxed, she is likely to have more control and
consequently be more able to cope with the pain. Based
on Borup’s studies, women who use acupuncture have
a faster recovery than women who use conventional
techniques. The lacks of side effects make the recovery
a lot easier. (Borup, 2009)
Conclusion
Interior design impacts, influences and affects our world
in many ways and in many different aspects. With the
intention of improving the quality of life, increasing
productivity, and protecting health, safety, and welfare
of the public, the professional Interior Designer uses
evidence based design to create a set of design rules
that support users needs in different settings. When
designing the ideal place for mothers to deliver babies,
it is of extreme importance for designers to recognize
those qualities of the space that create a
comfortable setting for a successful
delivery of the baby. The physical
characteristics of the space have such
influence on pregnant women that a
successful design can potentially reduce or avoid
medical intervention and help women embrace birth as
a natural process by encouraging the capability of their
bodies’ natural design to give birth.
The birth room is our first experience in the world and
therefore it should afford a nice transition from the
womb of the mother into the physical environment. It is
in the design of the room that the birthing experience
becomes a family event and allows for the participation
of family members during the entire process by
creating comfortable spaces that meet their needs.
The Literature review suggests the great importance of
having control in order to provide relaxation to the
women. Mother’s control over the environment as well
as decision making seems to provide comfort and to
relax woman during the process of giving birth. This
relaxation in turn creates less of a need for women to
seek pain relieve in medical procedures and instead
rely with confidence on their ability to give birth
naturally. The literature showed women’s preferences
for the different space qualities that recreate a home
like environment. The studies’ results show that one of
the most important elements for women is those in
which they have control to satisfy their needs such as,
operable windows. Women feel a sense of control over
the environment; they feel like they have been given
an option. Control over social contact thru the use of
different environments is also important. The idea of a
13
LITERATURE REVIEW
but not the intensity, regardless of the method use;
women experience the same amount of pain. The
difference lies in the way women perceived the process
of birth. Women who use acupuncture as pain relieve
feel in more control of the situation than women who
use other pharmacological methods. According to Lisa
Borup,” [women] feeling of control contributes to a good
birth experience” (p. 11). In other words if the mother is
more relaxed, she is likely to have more control and
consequently be more able to cope with the pain. Based
on Borup’s studies, women who use acupuncture have
a faster recovery than women who use conventional
techniques. The lacks of side effects make the recovery
a lot easier. (Borup, 2009)
Conclusion
Interior design impacts, influences and affects our world
in many ways and in many different aspects. With the
intention of improving the quality of life, increasing
productivity, and protecting health, safety, and welfare
of the public, the professional Interior Designer uses
evidence based design to create a set of design rules
that support users needs in different settings. When
designing the ideal place for mothers to deliver babies,
it is of extreme importance for designers to recognize
those qualities of the space that create a
comfortable setting for a successful
delivery of the baby. The physical
characteristics of the space have such
influence on pregnant women that a
successful design can potentially reduce or avoid
medical intervention and help women embrace birth as
a natural process by encouraging the capability of their
bodies’ natural design to give birth.
The birth room is our first experience in the world and
therefore it should afford a nice transition from the
womb of the mother into the physical environment. It is
in the design of the room that the birthing experience
becomes a family event and allows for the participation
of family members during the entire process by
creating comfortable spaces that meet their needs.
The Literature review suggests the great importance of
having control in order to provide relaxation to the
women. Mother’s control over the environment as well
as decision making seems to provide comfort and to
relax woman during the process of giving birth. This
relaxation in turn creates less of a need for women to
seek pain relieve in medical procedures and instead
rely with confidence on their ability to give birth
naturally. The literature showed women’s preferences
for the different space qualities that recreate a home
like environment. The studies’ results show that one of
the most important elements for women is those in
which they have control to satisfy their needs such as,
operable windows. Women feel a sense of control over
the environment; they feel like they have been given
an option. Control over social contact thru the use of
different environments is also important. The idea of a
14
LITERATURE REVIEW
but not the intensity, regardless of the method use;
women experience the same amount of pain. The
difference lies in the way women perceived the process
of birth. Women who use acupuncture as pain relieve
feel in more control of the situation than women who
use other pharmacological methods. According to Lisa
Borup,” [women] feeling of control contributes to a good
birth experience” (p. 11). In other words if the mother is
more relaxed, she is likely to have more control and
consequently be more able to cope with the pain. Based
on Borup’s studies, women who use acupuncture have
a faster recovery than women who use conventional
techniques. The lacks of side effects make the recovery
a lot easier. (Borup, 2009)
Conclusion
Interior design impacts, influences and affects our world
in many ways and in many different aspects. With the
intention of improving the quality of life, increasing
productivity, and protecting health, safety, and welfare
of the public, the professional Interior Designer uses
evidence based design to create a set of design rules
that support users needs in different settings. When
designing the ideal place for mothers to deliver babies,
it is of extreme importance for designers to recognize
those qualities of the space that create a
comfortable setting for a successful
delivery of the baby. The physical
characteristics of the space have such
influence on pregnant women that a
successful design can potentially reduce or avoid
medical intervention and help women embrace birth as
a natural process by encouraging the capability of their
bodies’ natural design to give birth.
The birth room is our first experience in the world and
therefore it should afford a nice transition from the
womb of the mother into the physical environment. It is
in the design of the room that the birthing experience
becomes a family event and allows for the participation
of family members during the entire process by
creating comfortable spaces that meet their needs.
The Literature review suggests the great importance of
having control in order to provide relaxation to the
women. Mother’s control over the environment as well
as decision making seems to provide comfort and to
relax woman during the process of giving birth. This
relaxation in turn creates less of a need for women to
seek pain relieve in medical procedures and instead
rely with confidence on their ability to give birth
naturally. The literature showed women’s preferences
for the different space qualities that recreate a home
like environment. The studies’ results show that one of
the most important elements for women is those in
which they have control to satisfy their needs such as,
operable windows. Women feel a sense of control over
the environment; they feel like they have been given
an option. Control over social contact thru the use of
different environments is also important. The idea of a
15
LITERATURE REVIEW
women been able to control when she is able to see her
family and friends, increases her sense if privacy.
Transitional spaces at the entrances play an important
role as well. Having a transition in between the door and
the bed lets mothers know when someone is in the
room without having to be exposed right way.
It is also important to have an understanding of the
different techniques and methods in which women can
achieve higher levels of relaxation during pregnancy
and labor, in order to shape the environment in a way
that supports and promotes such techniques. The
literature suggest different methods such as music,
water, nature, and acupuncture as ways to provide
comfort, relieve pain and improve relaxation. Perhaps
the introduction of a good sound system in the design of
birthing rooms would be of great importance as well as
the introduction of a comfortable pool. The presence of
nature seems to a key element to increase relaxation
levels not only for the mother and baby but also for the
family and even staff members.
Further research is needed to test the previous findings.
The next step will be to develop a grounded theory
through the qualitative research of birth centers
dedicated to promote birth as a natural
process. Semi structured interviews will be
conducted in both cases, followed by
visual assessments of the environments.
Design characteristics related to home like
environments in the birthing room:
•Spatial Continuity: right privacy level vs. isolation
•Entrance transition Space: transition spaces using
semi- transparent wall allowing
occupants to see
and hear visitors approach before they enter the room
to avoid exposure.
•Openness towards the outside (degree of
enclosure, operable windows): access to natural
views and daylight as well as adequate window
treatments for light and privacy control. Operable
windows are an important mechanism to improve
control over ventilation, temperature and exposure to
the outside.
•Personalization of the Space: display surfaces for
personal mementos
•Family Alcoves: Alcoves to provide comfort and
privacy to family members
•Outdoor spaces: private patios to provide patients
access to natural light and outdoor spaces.
•Materials: that are both residential and durable.
•Lighting: Mood low lighting in the birthing room. Task
lighting for family member’s activities, (i.e. reading).
Good amount of natural light as well as full spectrum
artificial light.
16
LITERATURE REVIEW
Ada Nierop, Petra H. Wirtz, Aliki Bratsikas, Roland
Zimmermann, Ulrike Ehlert. (2008). Stressbuffering effects of psychosocial resources on
physiological and. Elsevier , 261-268.
Journal: Elsevier Journal
A global company headquartered in Amsterdam,
employing more than 7,000 people in 24 countries.
They are a founding publisher of global programs that
provide free or low-cost access to science and health
information in the developing world. Elsevier's roots
are in journal and book publishing, where they have
fostered the peer-review process for more than 125
years. Today they are driving innovation by delivering
authoritative content with cutting-edge technology.
Title: Stress-buffering effects of psychosocial
resources on physiological and psychological stress
response in pregnant women
Author(s): Ada Nierop, Petra H. Wirtz, Aliki
Bratsikas, Roland Zimmermann, Ulrike Ehlert
All authors are from the Department of Clinical
Psychology and Psychotherapy, University of Zurich,
Binzmu¨hlestrasse
Summary:
The main objective of this study was to
identify
the
potential
effects
of
psychosocial resources on physiological
stress response in pregnant women.
The study was able to determine a buffering effect of
self-efficacy. Self-efficacy is a term that the authors
used to refer to people’s beliefs about their
capabilities to produce effects. The idea was to find
out how social contact influences pregnant women
and helps them reduce their levels of stress and
anxiety that lead to depression
Stress was induced by the Trier Social Stress Test,
TSST, which is known for its naturalistic exposure to
a socio-evaluative stressful situation. According to
references in this article this standardized stress test
induces a significant activation of physiological and
psychological responses to stress in healthy females
and patients. Their results revealed that higher selfefficacy is related to lower perceived stress.
The authors used to different terms to compare the
different social influences on women: daily uplifts and
daily hassles. Daily uplifts are positive and favorable
experiences, and reflect small, pleasant daily
occurrences, whereas daily hassles can be defined
as daily annoyances that provoke stress and anxiety.
The analysis revealed a significant interaction of daily
uplifts and stress levels, higher daily uplifts were
associated with lower perceived stress during
pregnancy
To sum up, these results indicate that psychosocial
resources seem to act as a buffer on HPA and ANS
stress responses, thereby protecting pregnant women
under stress conditions and helping them to avoid
maladaptive physiological responses.
17
LITERATURE REVIEW
Relation to the present study:
This article is of great value to my project. Part of the
programming of the birth center I intent to design
includes a series of different activities such as yoga,
aerobics, swimming, and prenatal classes that will
help women to create those daily uplifts to reduce
levels of anxiety and depression. In previous literature
I found information on how one of the causes for
depression during and after pregnancy is the change
of life style women face and difficulties coping with
such changes. Having the opportunity to meet with
other pregnant women to share similar experiences
will also emphasize the uplift moments. Such
socialization will potentially increase the self-efficacy
mentioned in this article, on pregnant women.
Quotes:
“There is clear evidence that high levels of perceived
stress and anxiety during pregnancy are associated
with several negative health consequences, like
gestational complications, spontaneous abortion,
preterm labor, low infant birth weight, postpartum
depression and negative developmental outcome in
infancy” p.261
“…there appears to be a demand for
studies taking into consideration factors
such as psychosocial resources which
might play an important role in protecting
the pregnant woman and her unborn
child
against harmful consequences of heightened stress
levels” p.261
“Self-efficacy can be defined as people’s beliefs about
their capabilities to produce effects” p.261
“In addition, studies indicate that high self-efficacy is
significantly related to lower intensity of perceived
pain during childbirth” p.262
“Women with high childbirth fears seem to have a
significantly lower perceived self-efficacy, and low
perceived self-efficacy was found to be a predictor of
psychological trauma of childbirth ...higher selfefficacy resulted in higher birth weight” p.262
“Daily uplifts represent the second potential stressbuffering resource of interest in this study. Daily
uplifts are positive and favorable experiences, and
reflect small, pleasant daily occurrences, whereas
daily hassles can be defined as daily annoyances”
p.262
“Daily hassles belong to the stress provoking factors,
whereas daily uplifts seem to be more of a stressmoderating factor” p.262
18
LITERATURE REVIEW
Lisa Borup, R. W. (2009). Acupuncture as Pain
Relief During Delivery: A Randomized Controlled
Trial. Blackwell Publising Ltd. , 5-12.
Journal: Birth
Birth: Issues in Perinatal Care is a multidisciplinary,
refereed journal devoted to issues and practices in
the care of childbearing women, infants, and families.
It is written by and for professionals in maternal and
neonatal health, nurses, midwives, physicians, public
health workers, doulas, psychologists, social
scientists, childbirth educators, lactation counselors,
epidemiologists, and other health caregivers and
policymakers in perinatal care.
Title: Acupuncture as Pin Relief During Delivery: A
Randomized Controlled Trial
Publisher: Blackwell Publishing Ltd.
Author(s): Lisa Borup, RM, Winnie Wurlitzer, RM,
Morten Hedegaard, MD, PhD, Ulrik S. Kesmodel,
MD, PhD, and Lone Hvidman, MD, PhD
Summary:
A study was done with 620 Danish women for
alternatives of pharmacological and
invasive methods for pain relive. The idea
was to measure the effects of
acupuncture during the delivery and
postpartum recovery. They also wanted to
prove whether the use
of acupuncture helped women to have a more
relaxed birth experience. The results indicate that
acupuncture helped relieve the pain but not the
intensity, regardless of the method used women
experienced the same amount of pain. The
differenced laid in the way women perceived the
process of birth. Women who used acupuncture as a
pain reliever felt in more control of the situation than
women who used other pharmacological methods.
The fact that women had more control over the
situation with the used of acupuncture created a more
relaxed delivery. Another important observation was
the post partum process in which women who has
used acupuncture had a faster recovery than women
who used conventional techniques. The lack of side
effects of acupuncture made the recovery easier.
Relation to the present study:
Being the purpose of this study to analyze natural
process of having a baby and embracing natural
procedures to avoid the use of intrusive methods, the
information in this article is very valuable. It is
important to know the different ways of how to reduce
the pain during delivery. This article also reinforces on
the idea that having control over the delivery process
increases relaxation of women during birth. In
previous articles read, also agree on the fact that
having control over the environment provides
relaxation and reduces anxiety in women.
19
LITERATURE REVIEW
Quotes:
“Acupuncture during labor reduced the need for
pharmacological and invasive methods, mainly
nitrous oxide, ephedrine, and sterile water papules,
without affecting the birth outcome” (10)
“The women in the acupuncture group tended to
report a lower score [of pain] 2 hours postpartum”
(11)
Women in the acupuncture group tended to report a
higher degree of relaxation and control…” (11)
” [women]…..feeling of control contributes to a good
birth experience” (11)
20
INTRODUCTION • PROJECT OVERVIEW
INTRODUCTION • PROJECT OVERVIEW
NATURAL BIRTH CENTER
Based on different studies on the way birth is
being handled in different countries, there is a
need for a redefinition of birth; a new definition in
which the natural design of the female body is
taken into account as capable of delivering
babies without medical intervention. Research
suggests that the physical environment has a
direct connection in the way women perceive
birth and their ability to relax. In other words, the
feature elements of the birthing room have the
ability to shape women’s perception on birth by
embracing the delivery of the baby as a natural
process. Such perception is achieved by the
effects of the physical environment on higher
levels of relaxation for the mother and baby. A
relaxed mother helps decrease pain which in turn
reduces or in many cases avoids medical
intervention. Birth as a natural process is not only
a lifetime event in the life of a woman but also for
the family as a whole. Natural birth centers
promote birth as a family event in which the
participation of family and friends is encouraged.
21
INTRODUCTION • PROJECT OVERVIEW
TYPOLOGY: HEALTHCARE / HOSPITALITY
The nature of maternity units is healthcare, but in this project the
intention is to take maternity to the next level and achieve the perfect
combination of a hospitality / residential facility that satisfies women’s
needs and provides comfort and safety during and after their
pregnancy and delivery process. The “client”/ owner of the facility
would benefit from a program that not only leaves profit from the
delivery of babies but also from other activities. Providing all services
for pregnant women in one single facility will increase the demand for
such birth center. The idea is to provide a place that serves as a birth
center and also as a sort of fitness club / spa for pregnant women.
The “user”, pregnant women who attend to the birth center will be
able to have all services in one place to satisfy their needs, women
will no longer have to schedule different appointments in different
places to perform all activities desired. They will have the opportunity
to visit their midwife/ doula / doctor and following that, attend to yoga
classes, get a spa treatment, assist to prenatal classes, or enjoy
coffee with other pregnant women without having to move from one
facility to another.
22
INTRODUCTION • PROJECT OVERVIEW
Such facility would include different programs for women during their pregnancy
such as: Yoga classes, Prenatal couple classes, Aerobics, Spa Coffee shops
Children care
Research suggest that depression during and after pregnancy is a result of
feeling overwhelmed with all the changes in their life’s and in many cases not
having help from family members. Having the opportunity to meet with other
women and share similar experiences can decrease the chances of depression.
(Goodman , 2009)
Potential activities:
•Public
Coffee shop (Social Place)
Day Care
Lobby
Walking areas
•Semi public
Yoga Room
Kitchen
Family rooms / waiting areas
Kids care
Kids care office
Kids restrooms
Reception
restrooms
•Private
Birthing Rooms
Birthing room restrooms
Spa treatment rooms
Offices
Medical equipment room
•Semi Private
Pools
Sun Rooms (for babies)
Activity rooms for couples
23
INTRODUCTION • PROJECT OVERVIEW
24
INTRODUCTION • PROJECT OVERVIEW
LOCATION: SHANGHAI, CHINA
When selecting the best location for the design of
a birth center, China became the best option for
the following reasons:
•Highest rate of cesarean section in the world (
Rates tend to be higher in the eastern region
including Beijing, Shanghai, and Tianjin)
•Pregnant women lack of education
•Economic Growth
•Healthcare industry manipulation to increase
rates on cesarean section
Rates of caesarean section in many countries
have increased beyond the recommended level of
15%, 1 almost doubling in the last decade,
especially in high-income areas such as Australia,
France, Germany, Italy, North America and the
United Kingdom of Great Britain and Northern
Ireland . Similar trends have also been
documented in low-income countries such as
Brazil, China and India, especially for births in
private
hospitals.
Advanced
health-care
technologies are becoming more widely available
Following
health-care
in different
regions of
China. reforms introduced
in the 1990s, a large proportion of
Chinese women, including those from the
less-developed western region, now seek
early antenatal and delivery care in
health institutions
The number of caesarean-section births has
increased sharply especially in the eastern region,
which covers the major cities of Beijing, Shanghai
and Tianjin. Recent evidence also shows
increasing demand for caesarean section among
young, educated women residing in urban areas.
Many Chinese couples now delay childbearing,
aim to have not more than one birth experience
and opt for delivery by caesarean section to avoid
pain. Data from hospital-based studies in urban
China showed rates of caesarean section of
between 26% and 63% during the late 1990s.
Another population-based study reported a
substantial increase during the last three decades,
from 4.7% to 22.5%. These trends are expected
to persist in view of the unparalleled economic
growth and rapid expansion of private health care
and health insurance systems across China. Apart
from the clinical indications for caesarean section
– breech presentation, dystopia and suspected
fetal compromise – there is growing evidence that
many women choose delivery by caesarean
section for personal reasons, particularly in profitmotivated institutional settings that may provide
implicit or explicit encouragement for such
interventions.
25
INTRODUCTION • PROJECT OVERVIEW
The present findings are consistent with the national
pattern of a steady increase in caesarean sections in
China, a country where health-care services are
undergoing rapid expansion and modernization. There is a
huge demand for the procedure across urban and rural
areas of China in the context of the overall acceptance of
the “one-child norm”. The finding that women with only one
child were more likely to undergo a caesarean section may
reflect women’s perceptions regarding the efficacy of the
procedure as a means to ensure newborn survival and to
avert the risks of birth complications or stillbirth. Women
are increasingly inclined to opt for delivery by caesarean for
nonmedical reasons such as fear of labor pain, concerns
about date or time of birth that are traditionally believed to
be auspicious and the belief that delivery by caesarean
ensures protection of the baby’s brain.
Aside from the medical benefits and risks of caesarean
delivery for individual women, an important consideration is
the economic impact of this new trend. Data gathered
during evaluation activities in one of the study areas in
2005 indicated that the cost of caesarean delivery is
approximately 2000–3000 Chinese Yuan (approximately
US$ 262–394) in rural areas. This includes the cost of the
actual
more than 10 000 Yuan (approximately US$ 1312)
in major hospitals in big cities. While fees are not
typically paid by mothers directly to obstetricians,
in the context of a diversifying health economy in
which institutions benefit from increasing activity
there are performance-related incentives for staff
in some hospitals, depending on the number of
procedures and the revenue that physicians
generate for their hospitals.
The rise in rates of caesarean section in China
presents problems of both equity and scale. Some
of the increase in demand could be financed by
patients, and might have taken place in new or
expanded private hospitals particularly during
1990–2002, when the contribution of public
funding to local public health revenues declined by
almost two-fifths. However, current models of
community-based health insurance that typically
involve low premiums but high payments at the
time of use have tended to benefit wealthier urban
households more than poorer rural households.
delivery, a 1-week hospital stay, food and
transportation. The corresponding costs
in an urban facility range from 5000 to
7000 Yuan (approximately US$ 656–918)
to
26
INTRODUCTION • PROJECT OVERVIEW
Despite a rise in private or insurance-based funding,
there is an inevitable additional burden on the public
health system, especially on the training and
deployment of obstetricians, theatre nurses and
anesthesiologists able to meet the demand for
surgery. Other infrastructure such as hospital beds,
operating theatres, and laboratory and transfusion
services will also be placed under strain as demand
increases. Given the emergence of secondary-level
hospitals as major providers of caesarean section,
efforts to contain the increase based on clinical
review and monitoring will need to consider case mix,
i.e. the complexity of cases seen. In a British study,
34% of the variance in rates of caesarean section
could be ascribed to case mix differences. Service
frameworks and clinical guidelines are important
policy instruments for containing inappropriate
medical practice, and they are now receiving attention
in China. However, even where implemented,
international experience shows that guidelines are not
always observed by obstetricians: incomplete
compliance with United States of America national
guidelines on caesarean delivery for
suspected fetal distress in labor was
commonplace. Other avenues that
might have the potential to contain the
rise in caesarean delivery such as
promotion of midwifery-led
maternity care models and
active involvem-ent of new
mothers
in
the
development of local health
services that emphasize
birth
as a normal
process have so far
received limited attention in
China.
Doctor recommendations
as well asreluctant
some pregnant
women's
attitude towards natural birth are
regarded as important factors behind China's high
cesarean sections rate, a report from the Beijingbased magazine China Economic Weekly showed.
A survey by the World Health Organization (WHO)
revealed earlier this year said nearly half of all births in
China are delivered by cesarean section, the world's
highest rate, while the recommended level is no more
than 15%.Natural birth is medically believed to be the
ideal way of delivery and C-sections should be
performed only when a vaginal delivery may put the
baby's or mother's life or health at risk.
The WHO study found that women undergoing Csections that are not medically necessary are more
likely to die or be admitted into intensive care units,
require blood transfusions or encounter complications
that lead to hysterectomies, according to an earlier
report of the Associated Press.
27
INTRODUCTION • PROJECT OVERVIEW
Reasons for elective C-sections are not simple but
mixed in China, as in many cases hospitals and
expectant mothers have different considerations
when they have to make a decision between natural
birth and C-sections. Financial incentives do motivate
some hospitals to perform C-sections, and some
doctors recommend surgery to women for this
reason."If all expectant mothers choose natural birth,
we will go broke," Dr Guo from a town-level hospital
in Henan province told China Economic Weekly. Guo
said prices for natural birth and C-section are about
500 yuan ($73) and 1,000 yuan ($146) respectively in
the hospital he works for. All the wages of doctors
and nurses in his department are directly proportional
to the whole department's income. The price
differentiation also exists in large cities. In
Guangzhou, the price for natural birth in top level
hospitals is about 3,000 yuan ($440) and for Csection is at least 6,000-7,000 yuan ($880 to 1026),
according to a report by Xinhua News Agency.
"Besides, C-sections also mean the greater use of
medial equipment and medicines, which means
more income to hospital and sometimes
more 'off-the-books income' to some
doctors," Dr. Gao Ling from Beijing
Amcare
Women's
and
Children's
Hospital told China Economic Weekly.
Some doctors also pointed out the price of natural
delivery in public hospital set by government is
indeed so low that it could not even recover the costs
of performing it, the magazine said.
Avoiding medical disputes is also an important reason
that drives doctors to recommend C-sections. Natural
birth costs much more time and involves more
medical workers than C-sections, and doctors have to
stay alert and concentrating for hours at a time, ready
to deal with any accident. On the other hand, a Csection usually takes only one hour and is more
controllable for doctors, which means lower possibility
of accidents and therefore fewer medical disputes.
As for those expectant mothers, many of them are
reluctant to suffer the pain of a natural birth and
believe it is easier to regain their figure after a Csection than after a natural birth. "Half of C-sections
are performed at the demand of expectant mothers,"
a doctor who did not give his name told China
Economic Weekly.
In addition, there are also some women who opt for
surgery to choose a "lucky" delivery date or year. The
magazine said the C-section rate from the 1950s to
1970s was only 5% in China. It rose dramatically from
30% to 40% in 1980s and has ranged from 40% to
60% since the 1990s.
28
INTRODUCTION • PROJECT OVERVIEW
SHANGHAI
China may be taking its first tentative baby steps to
change its landmark one-child policy. In particular,
Shanghai has indicated a relaxation in the policy by
encouraging couples to have two children. China is
rethinking the “one child norm” not because it has
failed but because it actually worked. In fact its
success is China’s biggest problem today. Rigorous
implementation has seen China’s average fertility rate
falling below replacement levels. As a result, China as
a whole may be having around 1.4 to 1.5 births per
woman, with Shanghai registering a low of 0.96.
Official estimates claim that the policy has prevented
more than 400 million births since its inception. But
this has brought in its wake several disturbing social
and economic challenges.
China’s gender gap has steadily grown worse from a
relatively normal ratio of 108.5 boys to 100 girls in the
early ’80s to now stand at 123 boys for every 100
girls. This has also gone on to worsen the deeplyentrenched cultural preference for a male child. The
stringent implementation of the one-child
norm has resulted in a sharp spike in
“gendercide” through illegal prenatal
sex determination and sex-selective
The policy-induced crisis means that the country will
have to grapple with a whole set of social, productivity
and fiscal challenges. To begin with, growing gender
gaps have set off an intense competition for wives. It
is estimated there could be as many as 40 million
“surplus” men in China by 2020 unable to find a wife.
Hence a highly organized criminal network of
trafficking in girls and women: anywhere between
2000 and 3000 girls and women kidnapped a year.
Particularly perverse is the rising incidence of baby
bride trafficking, where armed gangs are kidnapping
baby girls for farmers who want wives for their sons
when they grow up.
China is already home to half the elderly in Asia, with
those above the age of 65 expected to rise to 320
million by 2040. A fast ageing society will also induce
a prolonged period of labor pains. It is estimated that
China’s labor force could peak by 2016 and structural
shortages of labor could become an endemic feature
of the economy. Inter-generational tensions are also
on the rise as the one-child policy grapples with what
has come to be known as the 4-2-1 problem. This
means that there will only be one child left in a family
to care for two parents and four grandparents.
abortions.
29
TYPOLOGY: HEALTHCARE
HISTORIC DEVELOPMENT OF HEALTHCARE
The original facilities for the sick were most likely
temples dedicated to “healing gods.” Imhotep was
the Egyptian healing god while Asclepius was
revered in the Greek civilization. Prayers,
sacrifices, and dream interpretations played a role
in their healing process, but the ancient physicians
also stitched wounds, set broken bones, and used
opium for pain. Plans for a 5th century BC temple
in Athens dedicated to Asclepius show a large
room 24 x 108 for multiple dreamer-patients.
Some believe the earliest dedicated hospitals
were in Mesopotamia, while other researchers
believe they were at Buddhist monasteries in India
and Sri Lanka. Ancient writings indicate that the
Sinhalese King Pandukabhaya had hospitals built
in present day Sri Lanka in the 4th century BC.
The oldest architectural evidence of a hospital
appears to be at Mihintale in Sri Lanka which can
be dated to the 9th century AD. The extensive
ruins suggest there were patient rooms which
measured 13 x 13 which is surprisingly close to
the patient rooms used today. (Gormley, 2000)
While the Greeks were recognized as the
originators of “rational” medicine, they did
not have hospitals. The physicians made
calls and treated patients in their
homes, a practice that continued for hundreds of
years. The Romans provided us with the root of
the word “hospital” from the Latin word “hospes”
for host or “hospitium” meaning a place to
entertain. While medical schools were established
in Greece in the 6th Century BC, there is general
consensus that the first teaching hospital with
visiting physicians and scholars from Egypt, India,
and Greece was founded at Gondisapur in
present day Iran in 300 AD.
Among the early,
well-documented
healthcare
facilities were the
Roman military
hospitals. The
plans for the one
in Vindossa in
present day
Switzerland built
in the 1st century
AD shows small
patient rooms
with ante rooms
built around
Google 2010
30
HISTORIC DEVELOPMENT OF HEALTHCARE
courtyards. Each room was thought to hold three
beds indicating the ward concept was used early
in the history of hospital development. One source
indicated that similar hospitals may have also
been built for gladiators and slaves due their
financial value, however public hospitals were not
available and physicians made house calls.
(Gormley, 2000)
As the Roman Empire turned to Christianity, the
Church's role in providing for the sick became
firmly established. After 400 AD, many
monasteries were constructed generally including
accommodations for travelers, the poor, and the
sick. The monarchs of the 6th century reinforced
this role with emperors, such as Charlemagne,
who directed that a hospital should be attached to
every cathedral that was built in his empire.
Religious institutions continued to provide most of
the healthcare to the poor in large, open wards,
while physicians continued the practice of making
house calls to the upper class. The religious
influence in early healthcare is illustrated by duties
Hospital
in England ofinSt1390.
of the Warden
(Administrator)
Mary's“He was
required to not only satisfy himself of the
seriousness of the medical complaint, but
to also hear the confession of the patient
before admission.” (Gormley, 2000)
The wards housing multiple patients continued to
be expanded and became the standard for the
public hospitals for many years. Often the wards
were configured so the sick could see the altar to
assist with their recovery. The cross-shaped plan,
which is thought to have originated in Florence,
Italy, in the 1400s, achieved this goal with the altar
in the middle and multiple wards radiating from it.
The plan is similar to many hospitals today with
the nurse's station rather than the altar at the
center. (Gormley, 2000)
As the wards became larger, they often became
more dangerous. By the mid 1700s the “HotelDieu, one of the earliest and largest hospitals in
Paris, had deteriorated to horrific conditions”
(Gormley, 2000). Some wards had over 100 beds
with multiple patients per bed. The wards were
dark, poorly ventilated, unsanitary, and often
located adjacent to other wards with infectious
patients. The answer to this problem was the new
“pavilion” plan, which was first implemented in the
Hospital. (Gormley, 2000)
31
HISTORIC DEVELOPMENT OF HEALTHCARE
Lariboisiere built in 1854. This approach was
consistent with the improvements pioneered by
Florence Nightingale after seeing a mortality rate
of over 42% at a military hospital in Turkey during
the Crimean War. The pavilion plan provides fresh
air and daylight, which improved patient
recoveries and reduced infections. This plan
retained the multiple patient ward approach, which
was sometimes called the Nightingale Ward. The
pavilion plan was used on two notable facilities, St
Thomas Hospital in London and later on Johns
Hopkins in Baltimore with 24 beds per ward.
(Gormley, 2000)
As North America was explored and settled, the
ward approach to hospital design was imported.
The oldest hospital on the continent was built in
Mexico City in 1524. The first North American
Hotel-Dieu (House of God) was built in Quebec in
1639 with one 10-bed ward. In 1672, a second
ward with 24 beds was added, which permitted
segregation by gender. In the 13 colonies,
Bellevue Hospital in New York was built in 1743
and Pennsylvania Hospital in
Philadelphia received a charter from the
crown in 1751. (Gormley, 2000)
There were exceptions to staying in a
ward. One option that had been available
for years was to simply pay for better
accommodations. Even at the old monastic
hospitals, nobles could have better housing by
making donations. The approach was expanding
in the late 1800s and the first “pay” hospital was
opened in London in 1842 with eight single-bed
rooms. At Johns Hopkins, there were two pay
floors with 13 single rooms on each floor and one
semiprivate room. The other option for a private
room that was becoming accepted was the
separation room for infectious, dirty, or hysteria
cases. (Gormley, 2000)
With the improvements in hospital facilities and
the advancements in medical practices and
technology, the public and religious hospitals
started to become the choice for both the upper
classes as well as the poor. The perception was
fading that “home was where the sick should be
treated and hospitals were associated with
pauperism and death”. Even though the
perception of hospitals was changing, the use of
multiple-bed wards continued. There were
numerous attempts to improve the ward layout
and to adapt the wards to multistory buildings. In
1910, the Superintendent of the Mt. Sinai Hospital
in New York City developed a plan with 26-bed
wards that were connected vertically on multiple
floors
.
32
HISTORIC DEVELOPMENT OF HEALTHCARE
to conserve land and help reduce travel distances
related to separate pavilions. He did include quiet
rooms, three of which were private. The Beaujon
Hospital built in France in 1935 was one of the
early multistory facilities with 13 floors. It
contained 16-bed wards and private rooms as
well. The need for private rooms in public
hospitals was increasingly being recognized.
(Gormley, 2000)
In spite of this recognition, the wards continued to
be the predominant design approach. The number
of patients per ward, however, was dramatically
declining. During the rebuilding of a portion of St.
Thomas Hospital in London in the 1950s, the
largest ward contained four beds. The Montefiore
Hospital in New York City built in 1955 has a
unique layout with modules containing two- to
four-bed wards and one private room sharing two
toilets. Thompson and Golden's 1975 book on the
history of hospitals quotes an unnamed hospital
planner that said in 1962: “The semiprivate patient
rooms will be as antiquated in
5 to 10 years as the four-bed wards are
today”. While the planner's timing was
overly optimistic, the prediction is coming
true as the 2006 Guidelines for the
Design and Construction of Hospitals
states: “In new construction, the
maximum number of beds-per-room shall be one
unless the functional program demonstrates the
necessity of a two-bed arrangement”. This is
clearly the trend in the United States as almost all
new general hospitals are being built with private,
hotel-style patient rooms even if not required by
the local codes. (Gormley, 2000)
Private rooms are not a given in many European
countries and Canada. The British National Health
Services (NHS) has a Web site with an interesting
description of the differences between a hospital
ward and a private room. While it quickly points
out that many would prefer a private room, it is not
always possible unless “we are paying to go
private.” The advantages of a single occupancy
room are obvious and include privacy, less noise,
and reduced risk of no socioecomial infections.
Interestingly, the disadvantages of a private room
are also noted. These include:
- the patient may suffer from the lack of social
interaction in a private room;
- It is easier to get a nurse's attention without
using a buzzer; and
- It is more likely that someone will notice if you
fall on the way to the toilet.
33
HISTORIC DEVELOPMENT OF BIRTH CENTERS
Hopefully, this brief history of hospitals helps
illustrate the tremendous advances over the past
2,000-plus years from the temples and pauper
wards to private rooms. The challenge facing us
now, as in the past, is how to continue to improve
the quality of the patient environment by providing
cost-effective and innovative solutions. (Gormley,
2000)
The new inclination of hospitals in the past few
years is very diverse. What we have witnessed in
many of these iconic, groundbreaking hospitals is
the adaptation of a whole series of other building
types to healthcare. We have hospitals that, when
you hear the vocabulary, sound more like
shopping malls—such as, “one-stop care.” We
have hospitals that are based on the Greek
healing temples and are more like religious
facilities in their approach. We have other
hospitals that are really focused on the hospitality
side of things. They are birthing centers and spalike atmospheres. Designers and architects at the
onset know they are doing a healthcare facility but
they reach out to other building types as a means
of providing a design strategy that will
work for the kind of care desired or the
culture of the organization they are
designing to. (Gormley, 2000)
Google 2010
As women gave birth, they sought and received
care from supportive others. At an unknown point
in the cultural evolution, some experienced
women became designated as the wise women to
be in attendance at birth. Thus, the profession of
midwifery began. Indeed, as historians have
noted, midwifery has been characterized as a
social role throughout recorded history, regardless
of culture or time.
Biblical recognition of the functions of midwives
included
several
verses
recounting
the
experiences of two Hebrew midwives who refused
to kill male infants in defiance of the King of
Egypt.
34
HISTORIC DEVELOPMENT OF BIRTH CENTERS
Other verses in the Bible also make passing
references to midwifery attendance at birth,
implying that it was ubiquitous. Historians have
found the practice of midwifery referred to in other
papyri as well as in ancient Hindu records.
In Greek and Roman times, midwives functioned
as respected, autonomous care providers to
women during their reproductive cycles. Some
qualifications for the practice of midwifery began
to evolve during this period. For example, in
Greece the midwife was a woman who had born
children herself. This requirement has remained a
commonality in the practice of midwifery
throughout several cultures and exists even today.
"Midwife" is a word which in English was
translated to mean "with woman", implying the
supportive, not interventive, functions of the
practitioner. In French a midwife is a sage femme,
or a "wise woman". A general thread in all of the
references regarding ancient midwifery was
support of the woman in labor. Labor was
perceived as a basically natural process.
The profession of midwifery continued
without major changes throughout the
centuries, even through the Dark and
Middle Ages. In their practices,
midwives routinely used herbs and potions, as
forerunners of today's modern pharmaceuticals.
The midwives of these centuries generally
continued to learn by the apprentice model. As an
apprentice, skills and knowledge were shared
from generation to generation but without the
development of a formalized system of university
education. Therefore, midwives did not benefit
from the scientific inquiry that developed early in
medical schools. Eventually midwifery in most
affluent countries developed formalized programs,
although apprenticing still may be part of some.
Like clinics, birth centers arose on the coasts of
the U.S. in the 1970s, as alternatives to heavily
institutionalized health care. Today, use of birthing
center facilities is generally covered by health
insurance. Several of the practices which were
innovated in birth centers are beginning to enter
the mainstream hospital labor and delivery floors
including:
- Bathtubs or whirlpools for labor and/or birthing
- Showers for mothers to labor in
- Hospital acceptance of the mother choosing to
walk during labor, use a labor/birthing ball, not use
pain medication during labor and rooming in of the
infant after birth
- Beds for family members to stay with the mother
during labor and birth
35
HISTORIC DEVELOPMENT OF BIRTH CENTERS
There are certain requirements that a woman
needs to meet in order to be able to birth at a birth
center. First, she must have an uncomplicated,
low-risk pregnancy. Twins, vaginal births after
cesarean section, and breech babies are not
allowed to be delivered at free-standing birth
centers. Free-standing birth centers require
hospital backup in case complications arise during
labor that require more complex care. However,
even if a delivery cannot happen at the birth
center due to a high-risk pregnancy, birth center
midwives might provide prenatal care up to a
certain week of gestation or at the hospital
alongside an obstetrician.
The nationwide organization supporting and
promoting birth centers is the American
Association of Birth Centers (AABC). Many birth
centers nationwide, like hospitals, chose to
become accredited through the Commission for
the Accreditation of Birth Centers (CABC). There
are strict guidelines for this accreditation to
support birth centers as a place for normal birth.
These include things such as no continuous fetal
monitoring in labor to allow women full mobility.
There has been much research in
recent years to support out of hospital
birth especially birth center birth- as
not just safe but at times safer than hospital birth
because of its judicious use of technology,
licensed professionals and connection to the
health care system.
Michel
Odent,
Introduced in the 1970s
the concept of birthing
pool, in order to replace
drugs in the case of
difficult births.
Michael also introduced in
the 1970s the concept of
home-like birthing room in
maternity hospitals
Malet on, Michael founded
the
Primal
Health
Research Centre (London,
UK). The objective is to
test the assumption that
human health is shaped
during the ‘primal period’,
which includes fetal life,
perinatal period, and year
following birth.
Google 2010
36
CASE STUDIES
GENERAL INFORMATION
The Hollywood Birth Center is located in
Hollywood Florida; it is an independently owned
freestanding birthing facility. The philosophy of this
institution is based on “a home away from home”
environment for expectant parents. They offer
different services and techniques for the delivery
of babies based on the mother’s preference. All
techniques are natural and their intention is to stay
away from medicine and intrusive procedures as
much as possible. The institution also provides
different ways to relax mothers such as aroma
therapy, massage tools and birth balls and stools.
The environment in Hollywood birth center
provides facilities for family and friends to
accompany the mother during and after the
process of delivery
Debbie Marin is the owner of the Hollywood Birth
Center and has been a licensed midwife for over
20 years. In 1983 Debbie had her first daughter, a
water birth at home in a state where direct entry
midwifery was not legal. That experience was just
the beginning. For several years Debbie attended
births as a lay midwife and in 1998, upon
returning to Florida she attended the
South Florida School of Midwifery for 3
years. Debbie was instrumental in
helping to change the
midwifery law to allow more licensed midwives to
practice in Florida including serving as president
of the Broward chapter of Friends of Midwives.
She wrote a midwifery curriculum that was
implemented in a National School of Technology
in South Florida and was the clinical director,
administrator, teacher and a student in that
program. The two classes of women she
graduated have gone on midwives in Florida.
Debbie opened The Hollywood Birth Center in
1993 has since trained countless midwives. She
has dedicated her life to empowering women and
keeping birth safe.
37
CASE STUDIES
A Birth Center
A birth center’s philosophy is based on choice.
They promote the mothers choice of where and
how she wants to deliver the baby. The center
gives mothers the option of having the baby in the
birth center or in a conventional hospital
atmosphere but always accompanied by the
midwife and pregnancy coach. Staff will also
accompany the mothers through the entire
process from prenatal care to labor and birth.
Wayne P. DiGiacomo MD, FACOG Owner/Director
founded the birth center in 1889. "Dr. D" as he is
usually known, provides multi-level delivery
options such as a birth center birth and a hospital
birth. Dr. DiGiacomo is a fellow of American
College of Obstetrics and Gynecology, a member
of Broward Medical Society. He is unique in that
he believes that nature intended women to deliver
babies without a lot of medical intervention. He
believes that women have better and healthier
results if you let nature take its course. Dr. D
believes in the natural birth process therefore he
along with Deborah DiGiacomo Licensed Midwife,
founded Coalition for Childbirth Choices.
38
CASE STUDIES
SITE VISITS
The spaces selected are spaces in which the
physical environment resembles more of a
residential than a health care environment. Both
facilities were visited several times to observe
different issues during the study. Observation of
the space through pictures took place in order to
list the different design elements that support a
homelike environment and the relaxation of the
mother.
The images taken from each birth center were
presented to 3 randomly chosen women. Women
were informed of the general purpose of the study
and how the environment can potentially relax
mothers during delivery, in order to create a better
perspective of their decisions. Images presented
to the participants ranged from pictures of all the
birthing rooms in each facility to common areas
such as family areas, waiting areas, kitchens and
bathrooms. The pictures were not presented as
two different piles according to the center. All
pictures from both centers were mixed. The idea
was for participants to rate individual features of
the environments and not the entire
center as a whole. By doing this, the
participants rated individual qualities of
the space that created a homelike
environment. All participants were
allowed a lapse of time to view the pictures
several times. After the general view of the
pictures, they were asked to rank the pictures
before them. Participant women were asked to
separate the pictures into 3 different piles labeled:
Most Homelike, Sort of homelike and Not
Homelike at all. None of the aspects of a home
environment discussed in this study were
discussed with the participants, the intention was
for them to rate the different pictures based on
their impressions of a home environment and to
avoid influencing their decisions. Once all the
pictures were rated, they were once again
separated by center in order to find put which birth
center was rated as a homier environment.
39
CASE STUDIES
A Birth Center
Most Homelike Sort of Homelike Not Homelike at all
1. Kitchen Area
xxx
2. Hallway
x
xx
3. Birthing Room No.1
xxx
4. Birthing Room No.1 - Jacuzzi
x
xx
5. Birthing Room No.1 - Bathroom
xxx
6. Birthing Room No.2
xxx
7. Birthing Room No.2 - Jacuzzi
x
xx
8. Birthing Room No.3
xxx
9. Birthing Room No.3 - Jacuzzi
xxx
10. Birthing Room No.3 - Bathroom
xxx
11. Check up room
xxx
12. Family Room
xx
x
For the most part, both centers were perceived
as homelike environments, although Hollywood
Birth Center presented higher rates than A Birth
Center did. The main difference between the two
centers was the presence of medical equipment
in the different areas of A Birth Center. Also,
based on the opinion of the participants, the
presence of safety signs inside of
the birthing room implied a hospital
environment. The ceiling played an
important role as well; even though
the center has the same height
throughout the space the use of acoustical ceiling tiles also
implies a hospital or an institutional environment. Based on
the results of Hollywood Birth Center and the comments
made by the women participating, the Hollywood Birth
center was perceived as a homier environment for the
following reasons. All medical equipment was concealed in
the birthing room’s closets. All Birthing rooms have their own
set of equipment but it’s only taken out when need it. There
were very few labels if none throughout the space, none of
the restrooms had any labels indicating gender. For the most
part all ceilings were made out of drywall. There were only 3
different conditions that were rated as
40
CASE STUDIES
Hollywood Birth Center
Most Homelike Sort of Homelike
2. Waiting Area 1
xx
3. Last babies born
xx
4. waiting Area 1
xx
x
5. Waiting Area 2
x
6. Family area
xx
x
7. Family Area
x
xx
8. Babyes born in the center
x
xx
9. Kitchen
xxx
10. Hallway
xxx
11. Check up room
xxx
12. Massage Room
xxx
13. Birthing room No. 1
x
xx
14. Birthing room No. 1 - screen
xx
x
15. Birthing room No. 1 - jacuzzi
x
16. Birthing room No. 1 - bathroom
xxx
17. Birthing room No. 2
xxx
18. Birthing room No. 2
xxx
19. Birthing room No. 3
xxx
20. Birthing room No. 3
xxx
21. Birthing room No. 3 - bathroom
xxx
Not Homelike at all
x
x
xx
NOT Homelike at all,
those included areas
in which he furniture
layout reassembled
more of a waiting
area and the birthing
room that had the
plastic Jacuzzi. Built
in Jacuzzis tend to be
perceived as homier
than plastic Jacuzzis.
xx
41
HOLLYWOOD BIRTH CENTER
Totality and Unity
In general the building addresses issues
of totality and unity. The overall design of
the building and its different spaces
supports the functional requirements of a
natural birth center. The overall design is
successful at creating a homelike
environment and supporting birth as a
natural process. It also supports the
administrative part of the business and
even though birth is promoted naturally,
medical equipment is present in the center
but is kept concealed in order to reinforce
the natural process; such equipment is
only taken out in the birthing rooms in
case of emergencies.
All different areas of the building have a
direct relationship with one another. There
is connectedness by the way the center is
set up. All different component parts of
Activity types and numbers
indicated:
oReception and administrative
offices.
oWaiting area
oFamily rooms / waiting areas
oBirthing rooms
oMassage room
oBarefoot room / couples activities
/ yoga room
oBathtubs
oCheck up rooms
oKitchen
oAcupuncture room
oRetail
the building such as waiting
areas, reception, birthing rooms,
kitchen and restrooms present
homelike qualities that unify the
space.
Google 2010
42
HOLLYWOOD BIRTH CENTER
Site
Entry:
The entry to Hollywood Birth Center is
very successful at representing a
homelike environment
as a first
impression. As you walk into the center
the first environment is a small waiting
room connected to the reception window.
Even though the window is very typical of
healthcare environments in which you
arrive sign your name in and then wait to
be called, the rest of the room overpowers
that window and gives a sense of a home
environment. The furniture arrangement
and quality are those to be found in living
rooms area. The space is decorated with
side tables, plants and curtains on the
windows that allow partial lighting come in
making it a very cozy atmosphere. One of
the walls has pictures of the most recent
babies born in the center. This display sends
Picture by Andrea Leano
messages of familiarity.
Picture by Andrea Leano
43
HOLLYWOOD BIRTH CENTER
Google earth 2010
Exterior elevations and perspectives
The exterior of the building is made out of concrete,
some of the columns are visible but it is hard to tell
which of those are structural elements or more of a
decorative feature. The building in general represents
a commercial facility which is reinforced by the
location and adjacent spaces. The center has tried to
include some elements to the outside to give clues of
what’s inside the building; such elements include two
rocking chairs and plants at the entrance of the
building. The warm color of the building also helps
soften up the institutional look. As mentioned before
the exterior of the building is not the most
adequate for the function of the space,
none of the less the center has been
successful at recreating the space as a
homelike environment.
Views and approach:
The location of the birth center is on Hollywood
Boulevard, inside of a shopping center. The
exterior views do not represent much importance
to the birth center, which is surrounded by
parking adjacent to Hollywood boulevard. The
approach to the building does not afford for an
appropriate first impression to a birth center.
Hollywood boulevard has a lot of activity and the
adjacency to such busy street does not reflect
the tranquil environment of a birth center. There
seems to be and adaptation of the birth enters in
a commercial area.
Picture by Andrea Leano
44
HOLLYWOOD BIRTH CENTER
Interior:
In general, the overall features of the space are very
engaging and complete. The colors throughout the
space are neutral but at the same time very sudding
and relaxing. All birthing rooms have a different color
to offer mothers different choices when giving birth.
The entire center is formed by a series of intimate
rooms that sort of create different experiences. In their
goal of making this space a home away from home
experience, Hollywood center provides a kitchen area
fully equipped with refrigerator, microwave, oven,
toaster and coffee maker along with a lounge area for
the family and friends comfort. The family room area is
very nice. It has different activities for family members
including toys for kids. The addition of different
pictures throughout the facility strongly presents the
facility as a homelike environment; it shows the many
memories that took place in the center. The use of
wood floors gives a warm feeling to the environment
along with the dim lighting throughout the space. Even
though the light is dimmed, they can
be controlled to afford different needs.
Such lighting is also included in the
birthing rooms in which the mother has
the opportunity to control them lighting
to satisfy her needs, likes and
Picture by Andrea Leano
Picture by Andrea Leano
45
HOLLYWOOD BIRTH CENTER
Picture by Andrea Leano
dislikes. All walls are made out of drywall as well as
the ceiling. The absence of typical ceiling acoustical
panels found in healthcare environments help the
facility to achieve a homier environment. Birthing
rooms also provide moveable screen elements that
provide privacy to the mother. Screens are usually
located at the entrance of the room to provide a
transitional space between the birthing room door and
the bed.
Not all rooms have access to natural lighting.
Because of the enclosure of the building there isn’t
much connection to the outside and therefore there
doesn’t seem to be a correspondence to the sun
path.
Picture by Andrea Leano
46
HOLLYWOOD BIRTH CENTER
Loop circulation
FLOOR PLAN
47
HOLLYWOOD BIRTH CENTER
ADJANCENCY DIAGRAM
The way finding throughout the
Hollywood Birth Center is minimal and
very discrete. The main signs found in
the space are those in specialized
offices such as the massage room and
main administrative offices. The idea of
minimizing the way finding to the
minimum is to reinforce the residential
look of the space. The addition of way
finding signs tends to be more typical in
healthcare environments. The size of
the space along with the loop circulation
makes it very easy to circulate around
the space. The birth center is only one
single floor and there is no vertical
circulation.
48
HOLLYWOOD BIRTH CENTER
The different zoning spaces are appropriately
defined. All public areas are the closest ones
to the entrance of the center. Semi public
spaces are located towards the back of the
birth center. Private and semi private areas are
organized towards the perimeter of the space.
Even though private zones are adjacent to
public areas, the transition elements such as
doors and screen elements help reinforce the
privacy level. As mentioned before the loop
circulation helps organize the space.
ZONING
DIAGRAM
49
HOLLYWOOD BIRTH CENTER
Picture by Andrea Leano
Fixtures
The furnishings throughout the space help
reinforce the concept of a residential
environment in the birth center. All beds in the
birthing rooms are regular beds found in a
house. The center refuses to use hospital beds
because they don’t allow for the woman to find
her desired position when delivering the baby.
Also, queen beds support family participation
by making room for the father in order to have
access to mother and child. During the
interviews with the head midwife, she stated
the importance of having a firm mattress does
doesn’t allow the mother to sink in the bed or
bounce as she moves in the bed.
Picture by Andrea Leano
50
HOLLYWOOD BIRTH CENTER
CONCLUSION
o What aspects of the design work well?
- Birthing rooms reflect a residential environment
- The space promotes birth as a family event by
providing comfort to family members
- Kitchen area is welcoming for all family member
to use
- Lighting controls available for the comfort of the
mother.
- Waiting areas are very comfortable
- The different spaces provide the right levels of
privacy
o Which feature need improvement
- Addition of garden
- Exterior look of the building
o How were original decisions made?
The center was originally designed by Debbie
Marin the head Midwife/owner of Hollywood Birth
Center. Debbie has over 20 years of experience
and the design of the space is the reflection of her
experience. During the interview she was asked
what aspects of the physical environment she
wished to be different and her
response was the building itself and its
connection to the outside. Debbie
wishes for a Birth Center that
resembles more of a residential
structure on the outside. She also explained how
her next birth center will have a garden. Debbie
explained that during labor many women walk
around to alleviate the pain and naturally
accelerate the process. Currently women walk
around the parking lot, but it is not the ideal space
for such activity. Marin also commented on the
importance to the exposure to natural elements to
relax the mother, hence her wishes to have a
beautiful garden in the heart of her future center.
o How is the design related to the organizational
structure of the business?
The interior design is organized in a way that
public spaces are closer to the entrance of the
building, while semipublic environments are
located towards the back of the center. The
structure does not guide the organization of the
interior space. The intent of the design was
designed to fit in the interior of the space.
o What was the design intention of the design
profession?
To create a residential environment that provides
relaxation to the mother and promotes birth as a
natural process and family event.
51
A BIRTH CENTER
Totality and Unity
The design of “A Birth Center” partially addresses the
functional requirements related to a birth center. The
different spaces do provide the minimum
requirements to deliver babies, the problem lies in the
fact that some of the spaces do not necessarily
reflect a homelike environment and /or promote birth
as a natural process because of the presence of
medical equipment and institutional like qualities.
Different areas of the center such as the waiting area,
the hallways, some of the bathrooms and reception
area reflect an institutional environment. Other areas
such as birthing rooms and family rooms reflect more
of a homelike environment. There is not unity
between the different spaces because of the lack of
relationship between the different areas.
Activity types
Reception and administrative offices.
Waiting area
Family rooms / waiting areas
Midwife stations
Birthing rooms
Bathtubs
Check up rooms
Kitchen
Google 2010
52
A BIRTH CENTER
Entry
The entry to “A Birth Center” does not seem to be
very significant. The waiting area is very similar to a
hospital like environment. There is a series of chairs
set up around the perimeter of the room. The type of
lighting along with the pale color of the walls and the
quality of the chairs make a very cold environment.
The amount of square footage seems to be very big
in comparison to other areas of the facility.
Picture by Andrea Leano
Views and approach
The center is located in the second floor of a
commercial building situated in Hallandale Boulevard
very close to I95. The different views around the
building are not very significant to the center, as in the
previous case the building is surrounded by parking
spaces and the train tracks. The building is not the
most appropriate first impression to a birth center.
Being a commercial building, it does not provide an
introduction to a homelike environment.
Picture by Andrea Leano
53
A BIRTH CENTER
Elevations and perspectives
Exterior
The birth center is located in the second floor of a
commercial building in the interception of Hallandale
Boulevard and Dixie highway. The building is made
out of concrete, not much of the actual structure is
visible. The building in general represents a
commercial facility which is reinforced by the location
and adjacent spaces. There are no elements on the
outside that give any clues of the interior function of
the building. The location of the birth center is not the
most adequate because of its location, there train is
adjacent to the building and the noise level tends to
be high at times.
Picture by Andrea Leano
Interior:
The offices are located in a building along with other
offices for different business, the first impression of the
center is not perceived as a Homelike environment.
The waiting area looks like a typical hospital waiting
area. It is not until one crosses the waiting area that
some features start to resemble homelike qualities
such as the family room with furniture arranged in a
residential way and most windows have drapery. There
are three different rooms with furniture arranged as a.
Picture by Andrea Leano
54
A BIRTH CENTER
regular bedroom in a home; each room has a bathtub
and its private bathroom. In some of the birthing
rooms, some of the medical equipment is exposed to
the view of people which takes away from the
residential look. All rooms have windows to the
outside as well as window coverings that mothers can
control according to their needs The materials used
in the different rooms as well as the different areas of
the center, resemble residential materials. There is
one ceiling height of about 10’ ft throughout the
space, most of the areas have acoustical ceiling tiles
a feature that is not common for residential
environments
55
A BIRTH CENTER
FLOOR PLAN
Linear circulation
56
A BIRTH CENTER
ADJANCENCY DIAGRAM
The way finding throughout the center is
very clear. Every room has a sign
indication its function. The main corridor
also indicates where different areas are
located. Such signs contradict the
residential look of the space.
57
A BIRTH CENTER
ZONING DIAGRAM
The different zoning spaces are
appropriately defined. All areas are
grouped by their level of privacy. All
public areas are the closest ones to the
entrance of the center. Even though
private zones are adjacent to public
areas, the transition elements such as
doors help reinforce the privacy level.
The space has a very simple linear
circulation that along with the signage
throughout the space, provide a very
organized flow.
58
A BIRTH CENTER
FIXTURES
Picture by Andrea Leano
The furnishings throughout the space help reinforce the
concept of a residential environment in the birth center.
All beds in the birthing rooms are regular beds found in
a house. The center refuses to use hospital beds
because they don’t allow for the woman to find her
desired position when delivering the baby. Also, queen
beds support family participation by making room for the
father in order to have access to mother and child.
During the interviews with the head midwife, she stated
the importance of having a firm mattress does doesn’t
allow the mother to sink in the bed or bounce as she
moves in the bed.
Picture by Andrea Leano
59
A BIRTH CENTER
CONCLUSION
oWhat aspects of the design work well?
- The space promotes birth as a family event by
providing comfort to family members
- Kitchen area is welcoming for all family member to
use
- Lighting controls available for the comfort of the
mother.
oWhich feature need improvement?
- The presence of medical equipment in birthing rooms
does not promote birth as a natural process.
- The location of the bathtubs does not offer enough
privacy
- Bathtubs do not seem to provide comfort to the
mother.
- The site lines into some of the birthing rooms expose
the mother in labor, therefore not offering the adequate
privacy.
- The way finding along with the acoustical ceiling tiles,
give an institutional look to the environment.
- Family room should be closer to kitchen area
- Addition of garden
- Exterior look of the building
Theoriginal
centerdecisions
was originally
o How were
made? designed by a
Midwife who wished to create a homelike
environment to offer relaxation to the mother
as well as comfort. The location of the center
and the building itself are not the most
appropriate for such facility. The requirements of a
birth center were accommodated to fit in a
commercial space. During the interview the midwife
was asked what aspects of the physical environment
she wished to be different and her response was the
building itself and its connection to the outside. As
mentioned in the previous case study, the midwife
also wishes for a Birth Center that resembles more
of a residential structure on the outside. She also
explained how during labor many women walk
around to alleviate the pain and naturally accelerate
the process. Currently women walk around the
parking lot, but it is not the ideal space for such
activity.
o How is the design related to the organizational
structure of the business?
- The interior design is organized in a way that the
different spaces are sort of grouped according to
their level of privacy or how public they are. The
structure does not guide the organization of the
interior space. The intent of the design was
designed to fit in the interior of the space.
o What was the design intention of the design
profession?
To create a residential environment that provides
relaxation to the mother and promotes birth as a
natural process and family event.
60
CHA BIRTH CENTER
Cha maternity hospital is located in South Korea.
The idea of Doctor Cha was to create a state of the
art hospitals for pregnant women in south Korea,
and at the same time build a reputation
internationally as the best place to give birth.
As seen on the picture to the right the façade of the
hospital only gives a partial view to the outside in
order to provide a shelter and block some of the
views to the city side. There is also a curtain wall
exposed that allows for a partial view to the interior
of the facility. “ The building was constructed in a Ushape that left a lot of space invisible to the outside.
We brought spaces forward in order to flood them
with natural light” (Richmond, pg 60).
Even though the approach of the Cha hospital
towards child birth is not natural, this hospital was
selected as a case study because of the owners
tendency to make the hospital feel as much like part
of normal life as possible.
The tendency of the designers was to create a
homelike, comfortable atmosphere but at the same
time celebrating the modern technology in
healthcare. Contrary to the purpose of this project.
This hospital focuses on the aesthetics of the.
environment to resemble a more natural
atmosphere but the techniques are still
based on contemporary medicine. The
purpose of this project is to tie the
aesthetics to the nature of giving birth.
Contract magazine March ,2007
61
CHA BIRTH CENTER
The exterior of the building is very successful at
connecting to interior of the building. The different
exterior views allow for the user to have an idea of
what's on the inside and at the same time represent
an imposing structure.
The massiveness of the building definitely represent
a healthcare facility but the installation of the wood
planks suggest a warmer environment and a more
inviting as well.
The grand structure also carries a sense of luxury
and grandness that introduces the user to the highly
attractive spaces in the inside.
“what makes this project unique is that the strategy
is a crossover idea between hotel, spa, and hospital
that is perhaps the first of its kind in operation” says
Sangmin Lee, senior designer at KMD. This hospital
is known as the Prada of hospitals and caters to
women who are costumed to buy at high end retail
stores. The idea was not only to give a warm feeling
to a hospital atmosphere but to redesign the entire
space and create a combination of a spa/ hospitality
atmosphere. (Richmond, pg 62)
Contract magazine March ,2007
62
CHA BIRTH CENTER
INTERIOR SPACES
The interior spaces of the Cha Birth center reflects the
importance that the designers gave to the expose to
natural light. The building also includes gardens that
allow for a connection to nature. The finishes
throughout the space reflect a soft transition from the
exterior gardens to the interior spaces of the building.
The designer is very successful at creating a warm
and welcoming atmosphere. Aside from creating a
comfortable and pleasant atmosphere for mothers and
their babies, Cha also offers spaces for family and
friends that offer the same level of comfort and luxury.
Contract magazine March ,2007
63
CHA BIRTH CENTER
FLOOR PLAN
The building’s envelope is very sleek and
elegant. It consists of a curvilinear wall of
high tech glass. This curtain wall only
allows public spaces to be visible from the
outside . The buildings tendency to have a
U shape allows for a exposure to a garden
in the interior of the structure. The layout
of the space creates a connection to the
outside while keeping users in the inside
and protected by shelter.
The roof of the building has a garden that
has been a very successful design
feature. Different companies rent the
space
to have
conferences
and
symposiums. Cha “…has gotten itself on
the list of healthcare’s most need-to-be
places” according to Cha, owner of the
building.
Contract magazine March ,2007
64
CHA BIRTH CENTER
feel to it. As seen in the picture to the right, the
presence of the regular birthing bed gives a hospital
look to the environment.
Conclusion
The Cha birthing center is very successful in its design
and intention to create a high end atmosphere to deliver
babies. Many of the design features of the space tend
to connect to the exterior nature of the building. The is a
connections to the approach and views of the building
and the interior of the space.
Due to the nature of the business (conventional
medicine), the presence of medical equipment take
away from the spa look in some of the areas.
Contract magazine March ,2007
INTERIOR SPACES
As previously mentioned, the intention of the
birth center was to create a warmer atmosphere.
The picture above shows hoe the different
fixtures throughout the space, help accomplish
this matter. The fixture selection in.
some of the areas reflect a spa
atmosphere and not a healthcare
environment.
Some other spaces such as the
birthing rooms still have a healthcare
Contract magazine March ,2007
65
CLIENT OWNER
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
HEALTHCARE
Angela Pier
Senior Licensed Midwife, Acupuncture Physician,
and massage therapist
Angela Pier was born and raised in Bogota
Colombia. She attended to catholic school her
entire life and proceeded to study massage therapy
at the National University of Colombia. A few years
later, after graduating, she traveled to France to
study other oriental massage techniques such as
Shiatsu, yoga, relaxation and meditation.
Throughout her life she has been characterized for
her close relationship to nature. She is also very
passionate about helping people and having a
sense of compassion for all and justice.
When she returned to Colombia, she started
working with a doctor specialized in gynecology
and natural delivery of babies. Angela was in
charge of giving yoga classes and providing
massage therapy to mothers in order to help them
deal with pain or stress. Her experience in this
clinic grew as time went by, she not only gave yoga
classes and massage therapy; she also helped and
assisted the delivery of babies. Her relationship
with pregnant women became a long lasting
friendship and mothers came to her
for
any
pregnancy
related
problems. She soon got her license
as a midwife and decided to open a
clinic along with Dr. Espinoza,
who at the time became her husband and later on father
of her son.
In 1985 Angela had her first son, a water birth at home.
Her experience reinforced her passion for natural birth
and inspired her to encourage women to embrace birth
and to train other women who shared her same passion
and become midwifes.
She is currently the physical instructors and midwife at
Procrear, Colombia. She guides mothers during
pregnancy and provides not only guidance but also
friendship to all mothers that come to her. Her duties
are to train mothers to embrace pregnancy as a natural
process as well as to teach a healthier way of living.
Angela enjoys traveling and visiting natural scenes. She
also spends great portion of her time as a volunteer of
different organizations for poor children in Colombia.
She believes that an environment for the delivery of
babies should afford relaxation and warmth in order to
welcome the baby to the world in almost a ceremonial
way in which nature itself it’s celebrated. It is Angela’s
will to develop a birth center in china in which she will
help reduce the rate of cesarean and women dying at
the moment of birth. It is her mission to improve the
conditions of having a baby by promoting birth as a
natural process. She has a vast experience in the
different Chinese methods of massage therapy and
beliefs about embracing nature and using it as a model
of life.
66
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
Mauricio Espinato MD, FACOG
HEALTHCARE
Mauricio Espinato was born in Bogota Colombia and
comes from an Italian family composed of 3 sisters
and his parents. He also comes from a family of
doctors. His grandfather was and obstetrician and
his father was an anesthesiologist. His passion to
become a doctor started when he was very young.
Mauricio was always fascinated with the idea of
helping people. As he grew he became more
interested in the gynecology with a vision of
incorporating a more natural approach to it.
Coming from a big family he finds great importance
on the participation of the family as a whole in the
process of giving birth. When he graduated he
started to create workshops in which he promoted
the participation of the father in different pre and
post natal activities.
Dr. Espinoza is unique in that he believes that nature
intended women to deliver babies without a lot of
medical intervention. He believes that women have
better and healthier results if you let nature take its
course. Dr. Espinoza believes in the natural birth
process therefore he along with Constanza Martinez
Licensed Midwife, founded Procrear
In the event the pregnancy becomes complicated or
high risk or a hospital birth is necessary Dr. Espinoza
will be able to continue care for the woman and her
baby.
Today, Dr.Mauricio Espinoza provides multi-level
delivery options such as a birth center birth and a
hospital birth. Dr. Espinoza is a fellow of American
College of Obstetrics and Gynecology, and a
member
of
Colombia
Medical
Society
67
CLIENT OWNER
OVERVIEW
OF HISTOIC DEVELOPMENT OF
Aesthetic
Issues
The design concept should be no differentHEALTHCARE
than any other similar project in the United States
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Colors in the birthing room have a lot influence on the mother in order to help them relax
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The design should focus on environmental issues without compromising aesthetic standards
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The birthing room interiors should reflect actual Chinese homes
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
x
x
68
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
It is possible to incorporate Asian elements with a contemporary western design aesthetic
HEALTHCARE
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The different spaces in the birth center should provide and reflect home like qualities but at the same time have an
upscale hospitality feel to it
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The inclusion of natural elements throughout the space, helps reinforce the birth center’s philosophy on natural birth
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The design of the facility must be one that shows appreciation for its own environment even if it does not conform
to general design trends of the industry
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
69
CLIENT OWNER
OF
HISTOIC
OF
A luxuryOVERVIEW
approach to the birth center
conflicts
with its connectionDEVELOPMENT
to nature
STRONGLYHEALTHCARE
STRONGLY
USER
Angela
Dr. Espinoza
AGREE
AGREE
NEITHER
DISAGREE
DISAGREE
x
x
Cultural specific elements and issues
A design that focuses on environmental ideals will not be able to meet the aesthetic standards of the upscale
Chinese culture
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Activities should only be chosen when they harmonize with quite, meditative ambiance of the property
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The aesthetics of the property should appeal to Chinese women and relate to their superstitious tendencies.
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
70
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
Conductive to Well being
HEALTHCARE
All areas should be designed to create a warm and non- institutional atmosphere
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
It is very important that mothers are able to control the environment in the birthing rooms
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
DISAGREE
STRONGLY
DISAGREE
x
x
The birthing room should allow for the personalization of the space
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
x
x
The design of the birthing room should allocate space for the comfort of family members.
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
71
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
Environmental Sensitivity
HEALTHCARE
Conservation of nature and the environment reinforces the concept of natural birth
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
It is important to educate users of the space by incorporating recycling bins throughout the birth center
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Acoustic Requirements
Birthing rooms must be protected from noise in order to maximize privacy and relaxation
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Meditative spaces such as the sun room and barefoot rooms should provide high levels of privacy
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
72
CLIENT OWNER
OFin HISTOIC
DEVELOPMENT
OF
A water OVERVIEW
feature should be incorporated
different areas as a sound
masking device.
STRONGLYHEALTHCARE
STRONGLY
USER
Angela
Dr. Espinoza
AGREE
AGREE
NEITHER
DISAGREE
DISAGREE
DISAGREE
STRONGLY
DISAGREE
x
x
Organization of Activities and Adjacency Requirements
A spa is an essential element for the facility
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
x
x
A yoga pavilion will not be utilized enough to warrant its expense or space requirements
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
The idea of having walking areas aesthetically good and exposed to nature will be of great use for mothers during
labor
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
73
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
HEALTHCARE
Since the birthing room will provide a kitchen
for the use of family members, it should be accessible from all family
rooms and birthing rooms
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Security
Even though all birthing rooms have access to the outside, they should also provide a high level of security and
separation from the city
USER
Angela
Dr. Espinoza
STRONGLY
AGREE
AGREE
NEITHER
DISAGREE
STRONGLY
DISAGREE
x
x
Goals and objectives
•To be recognized as the best wellness center for
women and their families.
•To encourage women to regain their confidence on
the power of their bodies to give life naturally.
•To create an organization that supports women’s
needs during and after pregnancy
•To create a comfortable and
luxurious atmosphere in order to
make an unforgettable birthing
experience.
•To provide services to the mother that allows her to
nurture her mind and body and create a stronger
connection to the baby and family in general.
•To promote family participation in the pregnancy and
delivery process by offering couples and family
activities.
•To educate women on the advantages of natural birth.
•To promote healthy choices as a life style for all family
members.
74
CLIENT OWNER
OVERVIEW OF HISTOIC DEVELOPMENT OF
Design guidelines
HEALTHCARE
- The design concept is unique for this center
because it takes into account the Chinese culture
and it’s taken to the next level by combining
homelike qualities as well as hospitality ones.
- Environments should be well defined to provide
the adequate privacy but at the same time work
together to provide the homelike atmosphere.
- Organic design but at the same time
contemporary and luxurious
- Take into account Chinese design features
- Homelike / Hospitality environment
- Design should relate to the nature around it
- Birthing rooms should have operable windows
and provide shades
- Artificial lighting should be dimmable
- Neutral relaxing colors should be applied to the
birthing rooms in order to provide relaxation to
the mother
- Natural and artificial lighting should be provided
in all areas if possible
- Acoustic privacy is important for all rooms in the
birth center
- Sustainable materials can be incorporated into
the design
- The design of the birthing room should allocate
space for the comfort of family members.
75
“The engine of China’s
future, Shanghai dazzles,
beckoning millions with
promises of reinvention
and glamour. Some see it
as the city that finally
launched the country out
of rut of centuries-old
traditions; others portray it
as the place where an
ancient culture was traded
in for materialism and
calculated ambition. Either
way, its influence on
modern China has been
enormous” (Christopher
Pitts, 2010, p. 2)
LOCATION AND SITE
PROJECT LOCATION: SHANGHAI
POLITICAL ORGANIZATON
.
Christopher
Pitts, D. M. (2010). Shanghai City Guide.
New York: Lonely Planet.
http://www.traveldocs.com/cn/govern.htm
Government: Communist
In Shanghai’s sixth decade of communism rule, it has
become politically apathetic. With no forum for open
political debate and strict taboos in questioning
government policy, most shanghai Chinese people
instead get their heads down and work, exceptionally
hard, to create an economic future for themselves
and security for their families. There are a few ways
of dealing with political realities, and demonstrations
tend to occur only if they dovetail with the
government’s agenda
The Politics of Shanghai is structured in a dual partygovernment system like all other governing
institutions in the mainland of the People’s Republic
of China(PRC). In the last few decades the city has
produced many of the country's eventual senior
leaders. The city has been important politically to
China since the end of the 19th
Century. The Mayor of Shanghai is
the highest ranking official in the
People's Government of Shanghai
Since Shanghai is a centrally administered
municipality, the mayor occupies the same level in the
order of precedence as provincial governors.
However, in the city's dual party-government
governing system, the mayor has less power than the
Shanghai Communist Party of China Municipal
Committee Secretary, colloquially termed the
"Shanghai CPC Party chief”
Google 2010
Design guidelines related to political organizations
1. Shanghai possesses a much defined structure in
their form of government where hierarchy plays an
important role. Such hierarchy can be translated in a
environment where spaces are well defined into
primary and secondary areas and according to their
level of privacy
2. Shanghai’s community demonstrates a sort of
crave for security and financial freedom. Perhaps it is
important to emphasize the secure interior spaces.
Also, the economic boom and their desired to work
towards financial freedom, brings with it the desire of
a higher living standard. Interior spaces can portray
comfort and luxury that relate to that higher level of
living.
76
PROJECT LOCATION: SHANGHAI
ECONOMIC ORGANIZATON
Christopher
Pitts, D. M. (2010). Shanghai City Guide.
.
New York: Lonely Planet.
Shanghai is often regarded as the centre of finance
and trade in mainland China. Modern development
began with the economic reforms in 1992, a decade
later than many of the Southern Chinese provinces,
but since then Shanghai quickly overtook those
provinces and maintained its role as the business
centre in mainland China. Shanghai also hosts the
largest share market in mainland China.
Shanghai is an important economic, financial, trade
and shipping center in China. It contributes greatly to
the whole nation's economic structure and the
development of society.
Due to its excellent port, Shanghai has been a
leading power of China's economic and trade
development since ancient times. Since China's
reform in 1978, Shanghai has had a more open
environment and enjoys faster development
especially since
2000.
Shanghai's
economy has increased by
over 10% for 15 consecutive years.
Taking up only 0.06% of the country's
land area, Shanghai now generates
about 8.3% of China's gross industrial
output value, 10% of its ports' cargo-throughput, 25%
of the total value of the country's imports and exports
and 12.5% of the total revenue of China.
Shanghai is one of the most expensive cities to live
in, the income per capita is also one of the highest in
the country with an average per capita income of
around US$4400, its residents now enjoy some of
China’s highest salaries, residents for whom doing
business and making money seems to run in the
blood.
Perhaps Shanghais strongest plus point is its youth
and enthusiasm. Compared to its rival where a
growing staleness is apparent – a palpable buzz is in
the air. Shanghai’s energy and zest could carry it
across the lie, but this would depend on political and
social stability. Hong Kong’s myriad freedoms,
uncensored media, firm line on corruption and
protection of intellectual-property rights could also
give it the stamina for the long haul.
77
PROJECT LOCATION: SHANGHAI
Design guidelines related to economic environment
support
.
1. Because of the economic boom in Shanghai and
China in general there is an opportunity to implement
innovative designs and systems in an economy that
can afford the best quality.
2. Being Shanghaneses so focused on creating
wealth for themselves, luxury and comfort seems to
also be an important factor in their life style.
3. Implementation of programs such as massage
therapy, yoga classes, aquatic aerobics and daycare
facilities that people will be able to afford.
CULTURAL SOCIAL UNDERPINNING
Christopher Pitts, D. M. (2010). Shanghai City Guide.
New York: Lonely Planet.
Like Hong Kong, Shanghai maintains a deep
underlay of traditional Chinese practices and beliefs
beneath its often superficial modern guise. Chinese
society is conservative, conformist and resilient to
change, despite the simplistic presentations of
Shanghai as arapidly
Westernizing
city
where
designer labels have long been the new
face of town. Despite the individualism,
at the heart of Shanghai society is the
family, a tight-knit unit that is highly
idealized
Confucian in design, the Chinese family follows a
hierarchy from father to youngest child. The confusion
template is quite loose, but filial obedience- despite
the wayward behavior of the internet generation – is
far more marked in Shanghai than in the West. The
instinctive Chinese behavior that they are more a unit
rather than a collection of individuals encourages
family cohesion and a dampening of rebellious
impulses. This helps explain why resistance to the
communist monopoly is so hesitant and ambivalent.
Chinese people from other parts of China describe
the people from Shanghai as pragmatic and stingy.
Observing those very same traits that others see in
them, the Shanghainese describe themselves as
modern and individualistic.
High density levels and a tolerance for crowding
mean that personal space is generally not a highly
valued commodity in Shanghai. No one is ever going
to get a lot of space in a country of 1.3 billion people,
but the reasons for this are as much cultural as they
are physical. Chinese rarely have the sacrosanct
30cm halo of private space around them that
foreigners expect. Don’t expect someone to walk out
of your path if you are headed in a collision course.
And when you are standing right in front of a museum
exhibit or notice board don’t be surprised if someone
squeezes in front of you and the plate glass, blocking
out your view.
78
PROJECT LOCATION: SHANGHAI
EDUCATION
Christopher Pitts, D. M. (2010). Shanghai City Guide.
New York: Lonely Planet.
.
As a result of Confucian heritage, the teacher is
venerated and obediently respected by pupils. The
reverence of teachers creates a sense of efficiency
order and harmony in the classroom and encourages
academic excellence in Shanghai and other cities
across China.
The only child system has further heaped pressure on
Shanghai teeny academic shoulders. Every year, as
the university entrances examinations approaches,
hopeful parents flock to the Confucius Temple to light
incense in hope of a nod from the sage of sages. At
exam time, students and their parents avoid taxis with
a “four” or “six” in the registration number ( “four”
throughout China chimes with the word for death,
while “six” in the Shanghai dialect resembles the word
for fall). A mushrooming pharmaceutical industry
steps in to supply expensive brain-boosting drugs to
parents anxious to unleash their children’s full mental
powers.
Education in Shanghai is patriotic and is marked by a
semi regimented theme, as pupils are drilled in the
advantages of uniform behavior and
exacting discipline. Not surprising there
are downsides to this culture of
conformity. The absence of political
debate in Chinese society can be
partially traced back to the classroom taboos on
questioning the teacher, as children learn to agree to
what they are told.
ARTS
Despite Shanghai’s decadent past, the contemporary
art scene is something of an exasperating
conundrum> Given its reputation for fashionable
excess and flamboyant showiness, an invigorating art
world would seal Shanghais creative milieu stifles the
vital frisson that fires up the world’s eminent art
capitals.
As the white-hot crucible of China’s economic
overdrive, Shanghai funnels its energies into moneymaking, realizing epic steel and cocrte infrastructure
projects rather than nurturing bohemian creativity.
Abstract musings raise eyebrows, so both artists and
dreamers re seen as unfortunate outsiders. Blame it
on the one child policy, the matter of the fact,
educational system or the universal Shanghai dream
to own a Porsche SUV, but Shanghai is a lonely city
for the creatively inclines. Despite its more
authoritarian bent, grittier Beijing tends to pull in and
hang on to China’s creative idealist.
79
PROJECT LOCATION: SHANGHAI
Design Guidelines related to cultural and social
underpinnings:
.
1. Despite the individualism, at the heart of Shanghai
society is the family, a tight-knit unit that is highly
idealized. Create a holistic design is which all the
parts of the space complement each other but at the
same time work well individually.
2. Work around the connection to nature by following
basic feng shui guidelines.
3. Allocate space for shoes inside the birthing rooms
4. The instinctive Chinese behavior that they are
more a unit rather than a collection of individuals
encourages family cohesion and a dampening of
rebellious impulses. This helps explain why
resistance to the communist monopoly is so hesitant
and ambivalent. A cohesive design that unites the
entire space as a whole and but also identifies their
privacy levels.
5. The nature of birthing rooms is to create an
environment that feels hommi as well as an
environment that is connected to nature
by bringing such elements to the interior
spaces.
Because
of
Shanghais
mentality toward the economy and their
lifestyle. the environment in a birth
center in
Shanghai would have to reflect the
connection to nature and the resemblance to a home
environment, but it would also have to reflect the
technology and modernism. Technology in the
birthing room would have to be connected to the
materials used in the space as in natural birth the
idea is not to intervene the natural process of giving
birth.
6. People in Shaghai are still very tide with
superstition. Nowhere in the way finding or in any
numbering systems should the number 4 or 6 be
used in order to avoid its association to bad luck.
7. Shanghai as any big city is a place in which people
have a fast life style in which the stress levels are
above the average compared to other cities. The one
child norm in Shanghai has pushed the latest
generations to choose for carriers that represent high
economic standard, for such reason the stress level
in Shanghai is so high. The addition of different
elements that would improve the relaxation of the
mother would be very beneficial for her birth
experience given the vulnerable moments that a
woman has to face during pregnancy and delivery of
a baby
80
PROJECT LOCATION: SHANGHAI
THE GEOGRAPHIC CHARACTERISTICS
http://www.travelchinaguide.com/cityguides/shanghai/
geography.htm
Location
Shanghai is located on the east tip of Yangtze River
Delta and halfway along China's eastern coastline. It
borders the estuary of Yangtze River to the north,
Jiangsu and Zhejiang Provinces to the west and
Hangzhou Bay to the south. Due to its advantageous
geographical location, Shanghai has become a large
and prosperous port city.
Google 2010
81
PROJECT LOCATION: SHANGHAI
GEOGRAPHICAL FEATURES
The lower reaches of the Yangtze River running
through Shanghai brings lots of mud and sand to its
estuary. The wind, the river flow and the tide jointly
account for the alluvial plain including today's Yangtze
River Delta.
Shanghai on the east tip of the delta covers an area
of 6,340.5 square kilometers (2,448.1 square miles).
The altitude of the city lies between three and five
meters. With comparatively soft and loose earth,
Shanghai has a slightly higher coastal area in the
east and a lower hinterland to the west. The area
around Dianshan Lake in the west of the city is the
lowest. Plains cover most areas in the middle and
east of Shanghai including the city zone and part of
Nanhui, Jiading, Minghang, Fengxian and Jinshan
Districts.
There are a few hills and small mountains in the
southwest Qingpu and Songjiang Districts, including
Tianma Mountain, Fenghuang Mountain, Hengshan
Mountain and Xiaokunshan Mountain.
In additional, Shanghai
has some Island,
offshoreXiaojinshan
islands,
such as Dajinshan
Island and Fushan Island. Among
them, Dajinshan with an altitude of
103.4 meters is the peak of Shanghai.
There are three alluvial islands of
Chongming, Changxing and Hengsha
in the estuary
of Yangtze River to the north of Shanghai mainland.
Changxing and Hengsha are small islands under the
jurisdiction of Baoshan District of Shanghai.
Chongming is the only county of Shanghai. With an
area of 1,041.21 square kilometers, the island is the
third largest in China.
The water network inside Shanghai is the densest and
the most developed in China. A lot of rivers and lakes
in the city provide sufficient water to facilitate the
transportation and irrigation of Shanghai. The Yangtze
River running eastwards to the sea through the north
suburbs of Shanghai is one of the main rivers.
Huangpu River, the 'Mother River of Shanghai', is the
last main tributary of the Yangtze River. Originating
from the Taihu Lake in Jiangsu Province, Huangpu
River runs through the city zone of Shanghai. Being
wide, deep and never freezing, it contributes a lot to
the city's transportation. Huangpu River has many
tributaries such as Wusong River (alias Suzhou River).
Wusong River with various historical monuments and
buildings along its banks offers an important link
between Shanghai and its hinterland. Dianshan Lake
is the largest freshwater lake in the west Qingpu
District of Shanghai, producing various aquatic
products.
Natural resources are not abundant in Shanghai.
Natural vegetation is hardly seen except in a few areas
such as Dajinshan Island, Sheshan Mountain and
some cays and
82
PROJECT LOCATION: SHANGHAI
bottomlands. There are just cultivated crops, trees
and flowers. Shanghai is not a good habitat for wild
animals, so animals there are always domestic.
Shanghai also lacks mineral resources and energy
sources. Only crude oil and natural gas are found in
the offing of East China Sea and south Yellow Sea
near Shanghai.
CLIMATE
Shanghai has a humid subtropical climate and
experiences four distinct seasons. In winter, cold
northerly winds from Siberia can cause nighttime
temperatures to drop below freezing, although most
years there are only one or two days of snowfall.
Summer in Shanghai is hot and humid, with usually
8.7 days of the year exceeding 35 °C (95 °F). with
occasional downpours or freak thunderstorms. The
city is also susceptible to typhoons in summer and
the beginning of autumn, none of which in recent
years has caused considerable damage. The most
pleasant seasons are Spring, although changeable
and often rainy, and Autumn, which is generally sunny
and dry.
The city averages 4.2 °C (39.6 °F) in
January and 27.9 °C (82.2 °F) in
July, for an annual mean of 16.1 °C
(61.0 °F). Shanghai experiences on
average 1,878 hours of sunshine
per year, with the hottest temperature ever recorded at
40.2 °C (104 °F), and the lowest at −12.1 °C (10 °F).
The average number of rainy days is 112 per year, with
the wettest month being June. The average frost-free
period is 276 days.
Design Guidelines related to geographic
characteristics
1. Given the lack of natural vegetation in Shanghai, it
would probably be a positive aspect to bring some
nature into the interior design of the birth center. 2.
Study shows of the relaxation properties that nature
has on pregnant women (garden)
2. The location of the building is of great importance in
order to:
- Preserve energy by working with the sun pattern
- Orientation of the building according to Feng Shui
(see architecture guidelines)
3. Provide transitional spaces that allow for people to
dry out after rain or snow.
4. Shelter passage ways from exterior to the interior
83
PROJECT LOCATION: SHANGHAI
THE ARCHITECTURE OF THE AREA
http://www.travelchinaguide.com/cityguides/shanghai/e
conomy.htm
The great leap of Shanghai's economy benefited from
the amazingly fast development of industry. In the past
Shanghai gave priority to advanced manufacturing
industries and promoted the construction of its
industrial base and large projects. The manufacture of
automobiles,
electronic
and
communication
equipment, petrochemicals, steel products, equipment
assemblies and biomedicine had once been promoted
as the six pillar-industries of Shanghai.
Shanghai still pays much attention to its industry.
There are many industrial areas in Shanghai such as
Jinqiao Export Processing Zone in Pudong New Area,
Zhangjiang Hi-Tech Park and some other processing
zones in Jiading, Qingpu, Songjiang and Minhang
Districts. As a result the city's industrial production
continues to grow rapidly. There is no doubt that
industry makes a lot of economic profit; however, it is
much more costly to the environment.
The architectural industry has also developed quickly
in
Shanghai. The construction of airports, railways,
highways, expressways, subways, maglev lines, ports,
bridges and tunnels forms a convenient ‘buildings and
other infrastructure in Shanghai create an open and
pleasant environment for investment and further
development.
As in many other areas in China, Shanghai is
undergoing a building boom. In Shanghai the modern
architecture is notable for its unique style, especially in
the highest floors, with several top floor restaurants
which resemble flying saucers. The bulk of Shanghai
buildings being constructed today are high-rise
apartments of various height, color and design. There
is now a strong focus by city planners to develop more
"green areas" (public parks) among the apartment
complexes in order to improve the quality of life for
Shanghai's residents, in accordance to the "Better City
– Better Life" theme of Shanghai's
Shanghai is all about skyscrapers. The tall towers
have come to define a confident and brash, modern
China in the way that the Bund forever recalls the
indignity of foreign encroachment. The city has more
than 982
84
PROJECT LOCATION: SHANGHAI
high rise buildings,
32 of which were
over 200m tall.
Another 121 were
under construction
and a further 43
had
been
approved.
Shanghai has the
tallest 10th building
Google 2010
another even taller one in the way. in the world and
Yokohama Specie
Bank
Google 2010
Old Shanghai also posses the city’ genetic code and is
inseparable from its sense of identity as the former
“Paris of the East”. All those buildings mark the
neoclassical part of Shanghai including buildings
such as the Shanghai Banking Corporation building,
the Yokohama Specie Bank, Grosvenor House and the
Customs House.
Google 2010
The HSBC Building is
a six-floor neoclassical building in
the Bund area of
Shanghai, China. It
was the headquarters
of the Shanghai
branch of The
Hongkong and
Shanghai
Banking Corporation
from 1923 to 1955.
85
PROJECT LOCATION: SHANGHAI
Feng shui is a Chinese traditional discipline which
studies the way in which human beings co-exist in
harmony with nature. In ancient times, our Chinese
ancestors were aware of the existence of Qi in nature,
the natural rules discerned by them during their long
labors. To be specific, Qi is seen as a mystical drive
greatly influencing people's daily life. At first, they used
the rules of Qi simply to choose the locations of their
houses and graves. By following these rules, they
believed well-being would knock at the door, otherwise
bad luck would befall.
There are three principles of Feng shui: The unity of
human beings with nature, the balance of Yin and
Yang, and the attraction and repulsion of five elements
- metal, wood, water, fire and earth. These principles
are set up to help people pursue good fortune and
avoid disaster, thus improving their living standard.
Feng shui gives people many suggestions on how and
where to build houses. For example, houses should
have their backs to the north and fronts to the south.
Because when they face south, houses can easily
absorb sunshine and avoid cold north winds in winter.
This is a benefit to people's health. So
this tradition has come down to the
present, especially in rural areas. Also,
the size of a house must be moderate,
neither too big nor too small. A small
house with too many people living in it
Google 2010
Google 2010
is not recommended; neither
is a large house with a few
people. This is in accord with
the doctrine of the Mean.
Feng
shui
has
strict
requirements on the proper
positioning of the central axis
in building cities. Generally
speaking, the central axis
should run from north to
south, with its north end
pointing directly to a mountain
running from east to west.
The mountain is regarded as
the guardian of the city. A
winding river around the city
is believed to be an
auspicious
feature.
The
Firbidden City was built
strictly abiding by these rules.
Nowadays, Feng shui still
plays an important role in
people's lives. To improve
their quality of life, many
people decorate their houses
according to Feng shui rules.
For example, beds shouldn't
Google 2010
86
PROJECT LOCATION: SHANGHAI
And
be put too close to windows because beams of light
would directly affect the quality of sleep. Mirrors should
not be hung on walls opposite beds in case you may
be scared by reflections at night. And beds should not
be put directly opposite doors, otherwise you may feel
unsafe.
Feng shui is a great treasure of Chinese traditional
culture. It embodies a simple recognition of nature by
our Chinese ancestors. Though there are many people
who believe it's a kind of superstition, its wisdom can
be made use of to enhance our lives.
http://www.jurock.com/fengshui.html
Geomancy (feng-shui) is the branch of classical
cosmology, which gives a blue print for us to build our
homes in splendid harmony with the elements of our
natural environment. The Chinese exponents of FengShui believe that where you live and how you allocate
and arrange the elements of your home or workplace
can significantly affect the harmony of your health,
wealth, and happiness.
The xiansheng considers four factors: the Chi or
"breath of life" potential of the neighborhood; the site
orientation or the importance of the
direction in which the building faces;
the five elements -- fire, water, wood,
metal, earth -- and their mutual
influence upon a location; the power of
water and its significance in relation to
the property.
While feng-shui is thousands of years old and has
seemingly strange rules, it contains much common
sense useful to understand by anyone. For example,
Feng-Shui proposes that the best site for a home
that will take advantage of the vital Chi is for that
home to be on a south-facing slope - preferably
between two hills of unequal size (the Azure Dragon
and the White Tiger). Ideally, a river will be running
along one side of the structure. The river should
then turn in front of the building and then disappear.
Design Guidelines related to architecture of the area
1. There is now a strong focus by city planners to
develop more "green areas" (public parks) among
the apartment complexes in order to improve the
quality of life for Shanghai's residents, in accordance
to the "Better City – Better Life" theme of
Shanghai‘s
FENG SHUI
2. The unity of human beings with nature, the
balance of Yin and Yang, and the attraction and
repulsion of five elements - metal, wood, water, fire
and earth.
3. Houses should have their backs to the north and
fronts to the south. Because when they face south,
houses can easily absorb sunshine and avoid cold
north winds in winter. This is a benefit to people's
health. So this tradition has come down to the
present, especially in
87
PROJECT LOCATION: SHANGHAI
rural areas. Also, the size of a house must be
moderate, neither too big nor too small. A small house
with too many people living in it is not recommended;
neither is a large house with a few people. This is in
accord with the doctrine of the Mean.
4. Feng shui has strict requirements on the proper
positioning of the central axis in building cities.
Generally speaking, the central axis should run from
north to south, with its north end pointing directly to a
mountain running from east to west. The mountain is
regarded as the guardian of the city. A winding river
around the city is believed to be an auspicious feature.
The Forbidden City was built strictly abiding by these
rules.
5. Beds shouldn't be put too close to windows because
beams of light would directly affect the quality of sleep.
Mirrors should not be hung on walls opposite beds in
case you may be scared by reflections at night. And
beds should not be put directly opposite doors,
otherwise you may feel unsafe.
6. Avoid having a straight road leading directly to the
home, with people coming and going it will dissipate
the good influences.
7. Avoid building at the junction of a Tstreet or at the end of.
a cul-de-sac because these locations
are on the receiving end of the
straight-flowing Sha. A dead-end street traps the bad
Sha.
8. The front entrance should not face the
upstairs stairway.
9. The front door should not have a view of the back
door. The through hallway is a no-no.
10. Heavy beams in the recreational room are a
burden and interfere with Chi.
11. To have the right side low and the left side high
are both unlucky. The hills to the left should be
higher than those to the right.
12. Houses or buildings on triangular plots of land
are ill-omened as the strange shape attracts Sha.
13. Water is very important and its positioning is vital
to improving Chi and confounding Sha
88
PROJECT LOCATION: SHANGHAI
THE DECISION OF THE ACTUAL SITE
Location and Site
The selection of the
site was based on a
place that would be
close to the city but at
the same time would
be exposed to nature.
Google earth 2010
Google 2010
89
PROJECT LOCATION: SHANGHAI
THE DECISION OF THE ACTUAL SITE
Location and Site
The pictures show the
different adjacent
areas to the site. And
the different views in
all adjacent streets
Google earth 2010
Google 2010
90
PROJECT LOCATION: SHANGHAI
THE DECISION OF THE ACTUAL SITE
Location and Site
A closer look shows
the sites exposure to
nature.
Google 2010
91
CLIENT / USER
CLIENT / USER
USER TYPES
Description of the Project
.
The birth center is a place that provides the
environment that allows pregnant women to
reconnect with their bodies and find the power of
giving birth naturally. The birth room provides the
flexibility that the mother needs in order to reach
her own comfortable atmosphere that will help
increase relaxation levels that will in turn reduce
the pain and will allow the mother to have more
control over the delivery process. The birth center
also helps promote birth as a family event by
providing the accommodations for family members
to be part of the delivery process.
The facility will also include a day care center for
mothers with older kids who do not have someone
to look after them. Such commodity will allow the
mother to enjoy the different activities offered in the
center, such as yoga classes, water aerobics and a
café area that allows the mother to socialize with
other pregnant women.
92
CLIENT / USER
BUILDING TYPE
The building type should indicate what’s on the
. It should have a connection to the type of
interior.
activity of the interior. The birth center has a homelike
environment approach, but in many cases, it also has
a hospitality approach to it. The idea is to achieve a
combination of a familiar, comfortable and luxurious
building that does not represent an institution or
healthcare center.
USERS
ADMINISTRATION
Receptionist (1)
Activities: what does the user do?
Attend to visitors and deal with inquiries on the phone
and face to face. Supply information regarding the
organization to the general public, clients and
customers.
Main Job Tasks and Responsibilities
•Answer telephone, screen and direct calls
•Take and relay messages
•Provide information to callers
•Greet persons entering organization
•Direct persons to correct destination
•Deal with queries from the public and
customers
•Ensures knowledge of staff movements in and out of
organization
•General administrative and clerical support
•Prepare letters and documents
•Receive and sort mail and deliveries
•Schedule appointments
•Maintain appointment diary either manually or
electronically
•Organize meetings
•Tidy and maintain the reception area
Key Competencies
•Verbal and written communication skills
•Professional personal presentation
•Customer service orientation
•Information management
•Organizing and planning
•Attention to detail
•Initiative
•Reliability
•Stress tolerance
FF&E Requirements
•Counter
•Credenza
•Telephone
•Computer
•Printer
93
CLIENT / USER
Profile
Age is not significant to hold the position of a
.
receptionist
as long as the person is over 18 and has
some work experience. The receptionists will
preferably a woman since the client user (pregnant
women) will be in contact with this person.
The receptionist is for the most part the first contact
that users have with the facility. It is important that the
receptionist is a people’s person; she will need to be
able to be very attentive and eloquent to the user’s
needs. It is also the job of the receptionist to be able
to pass on important messages to other staff
members of the facility.
The receptionist should be able to make decision on
her own when dealing with costumers to be able to
direct them in the best way, but she has hierarchical
relationship with office manager. The receptionist
should follow directions and report to office manager
for any work related issue. There should be a level of
acoustical privacy in the reception area in order for
the receptionist to communicate with costumers
without the interference of unwanted noise.
The job description of the receptionist
requires a constant contact with
costumers whether is face to face or
over the phone, such activity requires a
temporal retreat for the health of the
receptionist. Areas such as employee lounge should
be provided for such retreat.
The reception area is usually the face of the company
and the first impression the user has of the facility.
The space should reflect the nature of the business
and make at the same time make a statement for a
positive good impression. Receptionist needs a place
where they feel comfortable since they sit in the same
place for the most part of the day.
Secretary (1)
Activities: what does the user do?
Provide personal administrative support to
management and the company through conducting
and organizing administrative duties and activities
including receiving and handling information.
Main Job Tasks and Responsibilities
•Prepare and manage correspondence, reports and
documents
•Implement and maintain office systems
•Maintain schedules and calendars
•Arrange and confirm appointments
•Organize internal and external events
•Handle incoming mail and other material
•Set up and maintain filing systems
•Collate information
•Maintain databases
94
CLIENT / USER
•Communicate verbally and in writing to answer
inquiries and provide information
. with internal and external contacts
•Liaison
•Coordinate the flow of information both internally and
externally
•Operate office equipment
•Manage office space
FF&E Requirements
•Desk
•Chair
•Credenza
•Computer
•Fax / copier / scanner
•Telephone
Profile
The secretary should have strong analytical skills in
data and English language. It is very important also
for the secretary to communicate pro-actively and
have a good ability to manage and quality-control
large quantities of papers, reports and documents in
order to keep the organization of the company. The
secretary has to interact with
different staff member in the center
so it is important to establish
excellent relationship with other staff
members. Excellent planning,
organizing and project management skills and
deadline-disciplined
The secretary has a hierarchical relationship with the
office manager; even though there are many
situations in which the secretary has to make
decisions on her own he/she should coordinate with
office manager when in doubt of how to proceed. The
acoustical privacy in the secretary office is of great
importance since she/he deals with sensitive
information of the company.
Administrator (1)
Activities: what does the user do?
•Oversees all aspects of the birthing center including:
reception, maintenance, finance, team building and
staff development.
•Must possess strong communication skills, both
verbal and written
•Demonstrate outstanding leadership
•Safeguard and grow the assets of the organization
for future generations while providing sound returns
to current owners
FF&E Requirements
•Desk
•Chair
•Credenza
95
CLIENT / USER
•Computer
•Fax / copier / scanner
.
•Telephone
•Conference table
Profile
The administrator is the person that oversees all the
activities sand personal in the center. He has to be on
top of the financial aspect of the organization as well
as making sure that all aspects of the center are
working properly. All members of the administrative
branch of the organization report and are under the
supervision of the administrator.
The administrator reports to the owner of the center.
Privacy is crucial for the administrator spaces since
as mentioned before he deals with the financial
aspects of the company that include payroll and
income to the company. He or she potentially has
private conversations and meetings with different
members of the center.
96
CLIENT / USER
QUESTIONS
Privacy is a key component to better perform your daily activities
USER
STRONGLY AGREE
AGREE
Recept ionist
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Secret ary
x
Administ art or
x
Having control over the lighting dramatically improves the performance of my job
USER
STRONGLY AGREE
AGREE
Recept ionist
x
Secret ary
x
Administ art or
x
NEITHER
DISAGREE
STRONGLY DISAGREE
Having control over temperature makes me feel more comfortable in my work space
USER
STRONGLY AGREE
Recept ionist
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Secret ary
x
Administ art or
x
97
CLIENT / USER
Exposure to natural lighting makes me feel better when I’m working
USER
STRONGLY AGREE
Recept ionist
x
Secret ary
x
Administ art or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
I spend most of my time at my desk
USER
STRONGLY AGREE
Recept ionist
x
Secret ary
x
Administ art or
x
AGREE
NEITHER
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
A comfortable chair is important for me
USER
STRONGLY AGREE
Recept ionist
x
Secret ary
x
Administ art or
x
DISAGREE
STRONGLY DISAGREE
98
CLIENT / USER
Design Guidelines
Reception
•Reception area should make an aesthetic statement
that allows the client user to predict or get an idea of
what to expect in the rest of the facility.
•The counter and working area should provide
enough spacing to allow for receptionist to feel
comfortable throughout the day.
•There should be a level of acoustical comfort in
order to allow receptionist to easily communicate with
costumers over the phone or face to face.
•Thermal comfort is important to allow the receptionist
to feel comfortable staying in the same area during an
entire day.
•Exposure to natural lighting would improve the work
efficiency and mood of the receptionist.
•There should be an area allocated for the
receptionist to be able to retreat during the day.
(
employee lounge)
Secretary and Administrator
•Offices should have temperature and lighting
controls.
•Exposure to natural lighting is preferred.
•Acoustical privacy is imperative for
both offices.
•Offices should be aesthetically
pleasant and relate to the overall
design of the space.
•The location of the offices should not be easily
found by the client users.
•A comfortable chair for both offices is very
important; both users spend most of their time at
their desks.
SERVICE STAFF
Maintenance (2)
Activities: what does the user do?
•Responsible for the cleanliness of the birth rooms,
hallways, fitness area, and offices
•Servicing birthing rooms after each delivery is a key
factor of the safely of the mother and baby. A
rigorous routine should be followed.
•Supplying birthing rooms with towels and clean bed
sheets in accordance with established procedures.
•Strong attention to the detailing of the birthing
rooms
•Ability to communicate with other staff members
•Ability to bend, lift, and be standing or walking for
the most part of the shift.
FF&E Requirements
•Room to be able to store all cleaning supplies
•Vacuum
•Durable finishes specially water resistant
99
CLIENT / USER
Profile
It is very important for housekeeping personal to have
a thorough working knowledge of the equipment,
materials and methods used in cleaning and custodial
work. Service staff members also have a remarkable
ability to understand and carry out simple directions
as well as a Strong ability to communicate effectively
both verbally and in writing. Also, it is required to have
a strong ability to perform a variety of tasks often on
short notice and also have an ability to work alone, be
self-motivated and organized and a proven ability to
lift 25 pounds of load. Working as a team is also a
preferred characteristic.
The maintenance personnel reports to the secretary
or administrator of the center. He or she should be
none of the less be able to make decisions to keep
the order of the center.
Food service workers at coffee shop (3
Activities: what does the user do?
Sales and service of Food and Beverage to guests.
Presents guest with bill and accepts payment, server
banking.
•Individuals who perform the various
jobs associated with food and
beverage services
•Job includes: food preparation,
serving and selling.
•Contributing to the preparation of
quick and delicious dishes.
•Food safety is an overriding concern.
•Good interpersonal skills
•Must be able to work effectively as a team.
FF&E Requirements
•Dishwasher
•Oven
•Blender
•Microwave
•Cash register
•Phone
•Refrigerators
•Coffee maker
Profile
Level of Authority & Restrictions
• Will be responsible to make own change.
• No supervisory authority.
Physical & Mental Demands
• Must work well under pressure.
• Must be able to stand for longer than 8 hours.
• Must be able to lift up to forty pounds on an
intermittent basis.
• Must be able to bend, stoop lift, reach, push, pull,
twist, walk, crouch, and squat.
• Must be able to speak, hear and see.
Working Conditions & Environment
100
CLIENT / USER
• Must be able to work all shifts, weekends, holidays
& special events as needed.
Minimum Job Requirements
• Must be at least 18 years of age
• Must possess current OLCC Servers Permit.
• Must possess current Food Handlers card.
• Excellent oral communications skills
• Excellent hygiene habits.
• Must possess reasonable ability to communicate in
English.
• This position is subject to pre-employment drug
testing and criminal history background check which
may include fingerprinting.
• Must have employment eligibility in the U.S.
101
CLIENT / USER
Questions
Employees need a private, comfortable place to relax with co-workers in order to keep their upbeat attitude
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Exposure to natural lighting makes me feel better when I’m working
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
It makes me feel better to have a space where I can safely place my personal belongings
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
102
CLIENT / USER
My job is a lot easier when I have access to all equipment and utensils in an organized way.
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Certain materials are easier to maintain cleaner than others.
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
103
CLIENT / USER
My job is a lot easier when I have access to all equipment and utensils in an organized way.
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Certain materials are easier to maintain cleaner than others.
USER
STRONGLY AGREE
Maint enance
x
Food Service
x
AGREE
Design Guidelines
•Since maintenance and food service staff do not
have their own private space and their jobs can be
stressful at times, it is important to provide spaces
where they can safely leave personal belongings.
•There should be space allocated for maintenance
and food service staff to relax and socialize with
other employees
•Exposure to natural lighting
seems to be of great importance
to all staff members across the
board
NEITHER
DISAGREE
STRONGLY DISAGREE
•Management must provide support staff with the tools
they need to perform their jobs in an effective manner
•The spaces and equipment staff engages with while
performing their jobs must be efficiently designed and
installed to ensure maximum productivity and minimum
stress.
•Material selection throughout the space should take
into account durability and maintenance.
104
CLIENT / USER
SPECIAL SERVICES
Massage therapist (4)
Activities: what does the user do?
Provide safe, appropriate and effective massage
techniques for pregnant women. Massage during
pregnancy must be performed very careful in order
to keep the mother and the baby safe. It is
important that the massage therapist has a deep
understanding on required massage for pregnant
women.
•Perform a health history on clients and update
prior to each session: ascertain precautions /
contradictions for massage prior to each session.
•Explain procedures and apply techniques
appropriate to client needs and preferences
•Observe the mother’s reaction to the massage and
modify as necessary> solicit feedback and respond
accordingly.
•Document all sessions performed to establish
guidelines
FF&E Requirements
•Massage bed
•Shelving for massage products
•Telephone
•Computer
•Lighting controls
•Stereo
Profile
Massage is an increasingly popular form of therapeutic
treatment. Individuals seek massage therapy to treat
ailments and injuries or simply for relaxation purposes.
Therapists work with the soft tissue of muscles in order
to heighten circulation and eliminate waste products
within the muscles. There are more than 80 different
types of massage, and therapists tend to specialize in
one or more of the modalities.
When meeting with clients, the therapist will survey
them to explore their goals for the treatment and
determine the best modality to use. Therapists can work
in a variety of settings such as their home, clients’
homes, hospitals, spas, fitness centers, physical
rehabilitation facilities, or private offices. Many
therapists will work in more than one setting.
The massage therapist works collaboratively with other
special services in order to provide clients with the best
service possible and in order to achieve their relaxation
and enjoyment. None of the less the massage therapist
should follow the centers rules and regulations.
105
CLIENT / USER
Fitness instructor (3)
Activities: what does the user do?
Instructors work in a number of different settings,
from major corporate complexes to small dance
studios. Early morning, evening, and weekend work
is frequently required, since most clients exercise
before or after work or during their leisure time.
•Offer alternatives during classes to accommodate
different levels of fitness.
•Plan routines, choose appropriate music, and
choose different movements for each set of
muscles, depending on participants' capabilities
and limitations.
•Observe participants and inform them of corrective
measures necessary for skill improvement.
•Teach proper breathing techniques used during
physical exertion.
•Instruct participants in maintaining exertion levels
in order to maximize benefits from exercise
routines.
•Teach and demonstrate use of gymnastic and
training equipment such as trampolines and
weights.
•Conduct therapeutic,
•Maintain fitnessrecreational,
equipment. or athletic activities.
•Monitor participants' progress
and adapt programs as needed.
•Evaluate individuals' abilities, needs, and physical
conditions, and develop suitable training programs to
meet any special requirements.
•Plan physical education programs to promote
development of participants' physical attributes and
social skills.
•Provide students with information and resources
regarding nutrition, weight control, and lifestyle issues.
•Administer emergency first aid, wrap injuries, treat
minor chronic disabilities, or refer injured persons to
physicians.
•Advise clients about proper clothing and shoes.
•Teach individual and team sports to participants
through instruction and demonstration, utilizing
knowledge of sports techniques and of participants'
physical capabilities.
•Promote health clubs through membership sales, and
record member information.
•Maintain equipment inventories; and select, store, and
issue equipment as needed.
•Massage body parts to relieve soreness, strains, and
bruises.
FF&E Requirements
•Stereo
•Speakers
•Microphone
•Lighting controls
106
CLIENT / USER
Profile
Almost all personal trainers and fitness instructors
work in physical fitness facilities, fitness centers,
and health clubs, mainly within the amusement and
recreation services industry or civic and social
organizations.
Personal
trainers
provide
individualized fitness programs that include
education and guidance on proper food intake,
cardio-respiratory exercise, supplementation and
resistance training. Their main goal is to assist their
clients in achieving fitness goals. They may also
evaluate, advice, and treat athletes to assist in
recovery from injury. Personal trainers must be
strong motivators. Dedication and commitment to
clients is necessary for success. Fitness instructor
is a very general term for someone who specializes
in the teaching of a particular exercise technique.
Fitness instructors include people who teach yoga,
aerobics, weight training, pilates, spinning, circuit
training, martial arts, and many other activities.
They normally instruct or coach groups or
individuals
in
exercise
activities.
Fitness
instructors typically lead by example,
demonstrating techniques and
methods of participation. They
observe participants and inform
them of corrective measures
necessary to improve their
skills or techniques. Some employers also require
workers to be certified in first aid. Knowledge of current
fitness trends and safety practices is also a must. And
excellent health and physical fitness are essential due
to the physical nature of the job. Physical effort will be
required daily for duties that may include lifting heavy
weights, squatting, bending, reaching, spotting, and
prolonged standing, walking, and other physical
activity.
The personal trainer as well as the massage therapist
works collaboratively in order to achieve customer
satisfaction to achieve the client’s fitness goals. None of
the less the personal trainer should follow the centers
rules and regulations.
Baby sitters (4)
Activities: what does the user do?
Child care staff must be: able to monitor and organize
activities for children; compassionate; able to work with
children and communicate effectively with parents;
collaborate with staff; become dynamic, perceptive,
prompt; able to make correct decisions and plans when
children are at risk.
Childcare assistants are responsible for the following
obligations: to control and monitor childcare trainees in
offering services and to oversee children when play
activities are taking place; develop activities that will
increase the social, educational and behavioral actions
107
CLIENT / USER
of children; offer care services for children of all
ages; maintain a polite, professional relationship
with parents; ensure that children are kept safe;
maintain information and details of each child and
explain policy to parents; ensure that activities are
organized according to curriculum objectives;
employ other assistants for coordinating position
advancement; create and apply strategies on a
variety of educational subjects.
FF&E Requirements
•Computer
•Telephone
•Stereo
•T.V.
•Chairs and tables for kids
108
CLIENT / USER
Questions:
Filtered natural light is a relaxing feature in the massage room
USER
STRONGLY AGREE
Massage Therapist
x
Trainer
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
The sound of water adds to relaxation and an Asian water feature will be a stunning design
USER
Massage Therapist
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
DISAGREE
STRONGLY DISAGREE
x
Trainer
x
Clients expect and adjacent restroom to fitness area or massage room
USER
STRONGLY AGREE
Massage Therapist
x
Trainer
x
AGREE
NEITHER
109
CLIENT / USER
The color palette used in the massage room has an impact on how the mother will relax.
USER
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Massage Therapist
Trainer
x
A good sound system is a key component of the fitness room and massage room
USER
STRONGLY AGREE
Massage Therapist
x
Trainer
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Lighting controls is a highly desired feature for fitness room and massage room
USER
Massage Therapist
Trainer
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
x
110
CLIENT / USER
Providing kids furniture provides more comfort to children and care taker.
USER
Baby sittter
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
The different spaces in the children’s care area should afford some discovery of different activities in order to keep
Children active and entertained
USER
Baby sittter
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Beds and cribs should be provided for children to nap.
USER
Baby sittter
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
The daycare layout should allow for supervision of kids at all times without any visual obstruction
USER
Baby sittter
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Color in the child care unit is an important feature that affects children’s behavior
USER
Baby sittter
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
111
CLIENT / USER
Design Guidelines
•The massage room should be exposed to filtered
natural lighting
•There should be a water feature in the massage
room in order to improve the relaxation of the mother
while getting the massage.
•There should be a restroom adjacent to fitness
room and massage room
•A sound systems should be provided for the fitness
room
•Lighting controls are important in the massage
room in order to adjust lighting to meet the client’s
needs.
•The layout of the Children’s care area should be
interesting and give children a sense of discovery
but it should also be open enough to allow for
constant supervision of the care taker.
•Beds should be provided in order to allow kids to
take naps when desired.
•There should be a careful selection of colors in
order to avoid overstimulation of kids.
MEDICAL SERVICES
Midwifes (5)
Activities: what does the user do?
A midwife has a range of responsibilities, including
the care of mother and baby, adhering to hospital
policy and maintaining an awareness of issues
such as health and safety. Typical work activities
include:
•Diagnosing, monitoring and examining women
during pregnancy;
•Developing, assessing and evaluating individual
programmers of care;
•Identifying high risk pregnancies and making
referrals to doctors and other medical specialists;
•Arranging and providing parenting and health
education for the woman, her partner and family
members;
•Encouraging participation of family members in the
birth to support the mother and enhance both
mother/baby bonding and family relationships;
•Providing counseling and advice before and after
screening;
•Offering support and advice following events such
as miscarriage, termination, stillbirth, neonatal
abnormality and neonatal death;
112
CLIENT / USER
•Supervising and assisting mothers in labor.
•Giving support and advice on the daily care of the
baby, including breast feeding, bathing and making
up feeds;
•Providing advice and guidance on a safe and timely
transfer home;
•Liaising with agencies and other health and social
care professionals to ensure continuity of care;
•Engaging in professional development to meet
PREP (post-registration education and practice)
requirements;
•Participating in the training and supervision of junior
colleagues.
FF&E Requirements
•Beds for pregnant mother
•Comfortable chair
•Lighting controls
•Sound system
•Computer
•Phone
•Desk
•Chair
Profile
Midwives provide advice, care and support for
women, their partners and families before, during
and after childbirth. They help women make
their own decisions about the care and services
they access. They care for newborn children,
providing health education and parenting support
for the first 28 days, after which care transfers to a
health visitor.
Midwives are personally responsible for the health
of both mother and child and only refer to
obstetricians if there are medical complications.
They work in multidisciplinary teams in both
hospital and, increasingly, community healthcare
settings.
The midwife requires very little furniture in the
birthing room since the idea of natural birth is to
have a s less intervention in the delivery process as
possible. But midwifes do need to have an office in
which to keep track of paper work, and provide
space work to coordinate classes for mothers and
families.
The midwife usually does not have a set schedule
and has to have the ability to work during add
hours. Being able to work at night time it’s a must
since labor times are very unexpected.
113
CLIENT / USER
Midwife assistants (7)
Activities: what does the user do?
•Assist women with hygiene and nutrition when
required.
•Under the supervision of the midwife, assist women
with the care of their babies when required.
•Under the supervision of the midwife, assist in
infant feeding when required.
•To assist in providing emotional support for women
and their families.
•Support cultural and religious beliefs of women,
babies and their families.
•Chaperone when required, ensuring the women’s
privacy and dignity are maintained.
FF&E Requirements
N/A
Profile
Midwife assistants as well as midwifes need to be
able to work during add hours and are always on
call. The assistant should always report to the
midwife.
Doctor (1)
Activities: what does the user do?
•To assist midwifes in case there are any
complications in the delivery of the baby.
•Diagnosing, identifying and treating pregnancy
related problems are amongst the most important
duties of an obstetrician.
•Further, their duties also involve, keeping a track
of the patient's health during the entire pregnancy
period and consulting the patient for better health
care during those days.
•As being trained in gynecology, obstetricians also
advise the women on their reproductive system,
counseling them on birth control methods, diseases
such as cervical and breast cancers, etc.
•Explaining all the pregnancy related tests and also
discussing results pertaining to them, with the
person.
•Carrying out cesarean sections and many other
surgical procedures, to ensure safe delivery and
also maintain the patient's health.
•Obstetricians also work in the areas of fetal health
problems and high risk pregnancies and counsel
the patients on the same. For more advanced or
aggravated cases, patients are referred to
specialized doctors or physicians.
•Other duties involve, maintaining medical records
for future references and preserving patient history.
114
CLIENT / USER
•For effective patient care working on developmental
programs regarding the prevention of pregnancy
related problems and diseases in coordination with
other fellow doctors.
•Handling administration work such as managing
patient appointments, purchasing office and medical
supplies.
FF&E Requirements
•Desk
•Chair
•Computer
•Phone
• Exam chair
Profile
An obstetrician is a physician that specializes in
caring for pregnant women through childbirth.
Women with complicated or difficult pregnancies
make up a majority of their work. Many obstetricians
also train as gynecologists so they are able to give
medical advice and treatment concerning a woman's
reproductive system. Most students in residency
study both gynecology and
obstetrics and then decide on their
career path.
Some of the most rewarding
aspects of an obstetrician's career
is helping pregnant women and their unborn babies
and solving often difficult and life threatening
problems. They specialize in managing pregnancy,
labor and the period directly following childbirth.
This is often stressful so they should possess the
ability to deal with stress, have excellent clinical
skills, and yet remain compassionate. Some of the
subspecialties that an obstetrician may specialize
in are gynecologic oncology, reproductive
endocrinology, critical care medicine and maternal
fetal medicine. An obstetrician is invaluable when it
comes to high-risk pregnancy and births and their
expertise and training often results in a healthy
mother and child.
Common work activities include:
Consulting with pregnant women that have been
screened as at risk for problems with their
pregnancies.
Conducting regular pregnancy examinations for
women during the pregnancy including ultra-sound
examinations, blood pressure and physical
examinations as required.
Assisting mothers in understanding the pregnancy
and the stages of development of the baby.
Monitoring high risk pregnancies and referring
mothers to specific specialists to help monitor and
support the pregnancy.
Delivering babies and performing the first
115
CLIENT / USER
examination of the baby to ensure the baby is
healthy or responding to any problems that may
occur.
Keeping up-to-date on current advances in treating
mothers and infants.
Charting and keeping accurate records of treatments
for both mothers and newborns.
The obstetricians work collaborative with the
midwife. In the case of natural birth the presence of
the obstetrician during labor depends on the
presence of complications during delivery.
116
CLIENT / USER
Questions:
A low and stable bed is more comfortable for the delivery process.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Dim lighting is required in the birth room in order to provide a smoother transition for the mother and baby
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Temperature control should be accessible in order to meet the needs of the mother.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
117
CLIENT / USER
The size of the birthing room should be big enough to fit family members and not interfere with my work.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
Many mothers like to hear music during the delivery of the baby, a good sound system should be provided.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
The color of the birthing room influences the mother there should be a careful selection of colors that promote
relaxation.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
118
CLIENT / USER
Exposure to natural lighting seems to have a positive impact on pregnant mother.
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
The tub should have enough space around it to be able to allow the midwife to work and at the same time the presence
of family members
USER
STRONGLY AGREE
Midwife
x
Assist ant
x
Doct or
x
Design Guidelines:
•A low and stable bed is more comfortable for
the delivery process.
•Dim lighting is required in the birth room in
order to provide a smoother transition of the
mother and baby
•Temperature control should
be accessible in order to meet
the needs of the mother.
•The size of the birthing room
should be big enough to fit
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
family members and not interfere with my work.
•Many mothers like to hear music during the
delivery of the baby, a good sound system should
be provided.
•The color of the birthing room influences the
mother there should be a careful selection of colors
that promote relaxation.
•Exposure to natural lighting seems to have a
positive impact on pregnant mother.
•The tub should have enough space around it to be
able to allow the midwife to work and at the same
time the presence of family members
119
CLIENT / USER
CLIENT USERS
Pregnant women
Activities: what does the user do?
Pregnant women that seek to deliver their babies in
a birth center, hope to have a more natural birth than
she would at a hospital. The mother attending a birth
center also seeks the close relationship and
coaching that midwifes as such centers have to
offer. Family involvement during pregnancy and
delivery seems to be an important issue for
expectant mothers at birth centers. In general
mothers are looking for a place where they can
customize their birth experience. Privacy needs fro
the mother vary depending on her own needs. Each
woman has a different need for privacy and the
space should allow for such flexibility.
FF&E Requirements
•Bed
•Warm and cozy finishes
•Table
•Crib
•Closet space
•Rocking chair
•Lighting controls
•Temperature controls
Family members
Activities: what does the user do?
Family members provide support to the expectant
mother. Their presence during the delivery depends
on the desire of the mother. Privacy levels for family
members should be met by allocating an space were
they can comfortably enjoy the welcoming of the
new baby.
FF&E Requirements
T.V
Sofas
Beds
Radio
Video games
Toys
Books
CD’s
Microwave
Small oven
Refrigerator
Sink
120
CLIENT / USER
Questions:
I like music during the delivery process
USER
Pregnant Women
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Family members
x
It makes me feel comfortable to know my family members are comfortable
USER
Pregnant Women
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Family members
x
I want the presence of my family but I don’t want to feel crowded
USER
Pregnant Women
Family members
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
x
121
CLIENT / USER
I like to know when someone is coming into the room
USER
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
DISAGREE
STRONGLY DISAGREE
x
Pregnant Women
Family members
x
I like to have control over the lighting in my room
USER
STRONGLY AGREE
AGREE
NEITHER
x
Pregnant Women
Family members
x
I want to bring my own food
USER
STRONGLY AGREE
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
x
Pregnant Women
Family members
x
It is easier to bring kids when there are activities for them
USER
STRONGLY AGREE
Pregnant Women
x
Family members
x
AGREE
NEITHER
DISAGREE
STRONGLY DISAGREE
122
CLIENT / USER
Design Guidelines
•Mothers present different needs according to their
cultural background, likes and dislikes. The design
of the room should allow the mother to have control
over the lighting, temperature and exposure to
natural lighting.
•Transition elements should be provided at the
entrance of the room in order to let the mother know
if someone is coming into the room
•Family members need space to feel comfortable
and rest
•Different activities should be provided for family
members and their kids.
•Sound system should be provided in the birthing
room
123
GOALS AND OBJETIVES
GOALS AND OBJETIVES
GOALS AND OBJECTIVES
MISSION STATEMENT / ORGANIZATIONAL
.
GOALS
Mission Statement
The purpose of this project is to provide pregnant
women unforgettable birthing experiences in
complete harmony with their own natural process
and to carry out our vision of promoting birth as a
family event.
Organizational Goals
What do you want for the environment to do to the
users?
•To reflect a connection to nature in the different
environments and reinforce birth as a natural
process.
•Meet the specific needs of each mother with a
professional, friendly, prompt, courteous, and
enthusiastic attitude from all staff at all times.
•Attract pregnant women and their families who
appreciate the goals
and
services
thatand
the who
birth will
center
has
to offer
contribute to the natural tendency
it promotes.
•Offers services that are in
harmony with the needs of the
mother including: prenatal and
postnatal education for mothers and their family, spa
and yoga activities.
•To provide mothers with support to deal with the
psychological changes of pregnancy.
Facility Goals
Form
•Create a luxurious spa and homelike atmosphere
where pregnant mother can relax.
•Create serene meditative environments that reflect
the connection to nature and allow for family
workshops and mothers relaxation.
•To achieve an aesthetic fit that reflects the
connection to nature.
•To retain a smaller scale that helps prevent an
institutional look.
•To employ a contemporary design concept.
•Utilize elements of feng shui rules in order to make
the users more comfortable and relate more to their
believes.
•Utilize color symbolism of the feng shui culture
•Create a meditative spa like atmosphere where
mothers can achieve relaxation and feel pampered.
•Heighten the exotic feel of the spa through the use of
water features, the sound of water, and abstract
visualizations of water.
124
GOALS AND OBJETIVES
•Evoke the natural surroundings with soft and
muted colors, setting the natural meditative mood
of the.birth center.
•Create a family room that has the feeling of an
intimate living room with several semi private
conversation areas. Family members will be
encouraged to interact in a warm, unthreatened
and friendly manner.
•Separate administrative spaces from public
spaces so that their more business like aesthetic
will not interfere with the rest of the design.
•Make acoustic privacy in birthing rooms and
administrative spaces a priority.
•Create a kitchen area that allows for family
members and staff to relax and prepare small
meals.
•Design recycling bins in the kitchen area in an
appropriate, unobtrusive way that encourages its
use.
Function
•Design a birthing center that allows for 10 birthing
rooms, café area, yoga room and massage rooms,
and an indoor pool
•To
foster
and
encourage
socialization of pregnant women
by providing social areas such as
the Café
•To provide mothers with a service of child care in
order to allow them to participate in the different
activities provided by the center.
•To create an environment in the birthing room that
allow for mothers to customize their birth experiences
according to their cultural background, likes and
dislikes.
•Set the stage to allow mothers to relax, enjoy and
embrace their pregnancies and birthing experiences.
•Provide social interaction and learning for mothers
and their families.
•Offer mothers pampering services including an
exception spa experience.
•Provide spaces that also offer the necessary safety
and protection to the mothers and their babies.
•Provide an efficient, pleasant, and safe environment
for all employees.
Economy
•Make a substantial initial investment in ecologically
advanced technology in order to prioritize long term
economies associated with conservation and self
sufficiency.
•Establish an emphasis of quality in all furniture and
finishes.
•Maintain a construction budget of $1,000,0000
125
GOALS AND OBJETIVES
•Take an active approach in promoting efficient
energy practices such as: energy efficiency
.
appliances,
quality insulation, and regular
maintenance of HVAC systems.
•Promote water, energy, and resources waste
minimization among employees and clients.
•Building orientation considered in relation to sun
path to minimize direct heat
Time goals
•The design must allow for shifts in a number of
employees and guests as business needs fluctuate
•Complete construction in a period of 18 months
•Provide for changes in disaster recovery methods,
conservation and preservation methods.
•Plan site for mid range growth of 10 years.
•Provide a design that will not be outdated in a
couple of years ( i.e avoid trends)
126
QUANTITATIVE
d
SITE DOCUMENTATION, BUILDING SELECTION
SITE SELECTION, BUILDING DOCUMENTATION
ider
SITE SELECTION
.
As previously
mentioned, the
site selection was based on its
proximity in order to be more
accessible to pregnant women.
At the same time it was
important to select a site that
would be exposed to nature.
One of the objectives of the
birth center is to reconnect the
mother to nature and have a
natural birth. Exposure to a
natural site reinforces the
concept of natural birth.
130
SITE SELECTION, BUILDING DOCUMENTATION
BUILDING SELECTION
The process of selecting a building was based on
the different features that made the business center
the best option for the project. It was important to
keep in mind the amount of windows, the
accessibility to the outside , more solid sides that
would block city views, and the shape of the
building to allow for a courtyard .
The location of the building on the site was made
so mothers have access to the outside. The yellow
on the plan represents the side with the most
windows facing towards nature. The blue on the
plan represents the more solid side of the building.
Security is a major issue to birth centers and
blocking mothers to the city views gives them a
better sense of protection. The shape of the
building tends to embrace nature and block the
outside. Such shape creates a retreat in the middle
of the city.
A prominent entrance into the building was very
important too. It is important for
mothers to recognize that the center
is like other facility from the moment
they enter. The entrance will create
a welcoming environment to new
costumers as well as creating the
statement of the organization.
131
SITE SELECTION, BUILDING DOCUMENTATION
132
d
MENTOR SESSION
d
PROGRAMMING ISSUES AND
DESIGN GUIDELINES
DESIGN GUIDELINES
CLIENT OWNER
- The design concept is unique for this center
because it takes into account the Chinese culture
and it’s taken to the next level by combining
homelike qualities as well as hospitality ones.
- Environments should be well defined to provide
the adequate privacy but at the same time work
together to provide the homelike atmosphere.
- Organic design but at the same time
contemporary and luxurious
- Take into account Chinese design features
- Homelike / Hospitality environment
- Design should relate to the nature around it
- Birthing rooms should have operable windows
and provide shades
- Artificial lighting should be dimmable
- Neutral relaxing colors should be applied to the
birthing rooms in order to provide relaxation to
the mother
-Natural and artificial lighting should be provided
in all areas if possible
- Acoustic privacy is important for all rooms in the
birth center
- Sustainable materials can be
incorporated into the design
- The design of the birthing room
should allocate space for the
comfort of family members
DESIGN GUIDELINES RELATED TO POLITICAL
ORGANIZATIONS
- Shanghai possesses a much defined structure in their
form of government where hierarchy plays an important
role. Such hierarchy can be translated in a environment
where spaces are well defined into primary and secondary
areas and according to their level of privacy
-Shanghai’s community demonstrates a sort of crave for
security and financial freedom. Perhaps it is important to
emphasize the secure interior spaces. Also, the economic
boom and their desired to work towards financial freedom,
brings with it the desire of a higher living standard. Interior
spaces can portray comfort and luxury that relate to that
higher level of living.
DESIGN GUIDELINES RELATED TO ECONOMIC
ENVIRONMENT SUPPORT
- Because of the economic boom in Shanghai and China
in general there is an opportunity to implement innovative
designs and systems in an economy that can afford the
best quality.
- Being Shanghaneses so focused on creating wealth for
themselves, luxury and comfort seems to also be an
important factor in their life style.
- Implementation of programs such as massage therapy,
yoga classes, aquatic aerobics and daycare facilities that
people will be able to afford.
135
DESIGN GUIDELINES
DESIGN
GUIDELINES
RELATED
TO
CULTURAL AND SOCIAL UNDERPINNINGS:
- Despite the individualism, at the heart of
Shanghai society is the family, a tight-knit unit
that is highly idealized. Create a holistic design is
which all the parts of the space complement
each other but at the same time work well
individually.
- Work around the connection to nature by
following basic feng shui guidelines.
- Allocate space for shoes inside the birthing
rooms
- The instinctive Chinese behavior that they are
more a unit rather than a collection of individuals
encourages family cohesion and a dampening of
rebellious impulses. This helps explain why
resistance to the communist monopoly is so
hesitant and ambivalent. A cohesive design that
unites the entire space as a whole and but also
identifies their privacy levels.
- The nature of birthing rooms is to create an
environment that feels hommi as well as an
environmentbringing
that is connected
to nature by
such elements
to the
interior
spaces.
Because
of
Shanghais mentality toward the
economy and their lifestyle. the
environment in a birth center in
Shanghai would have to reflect the
connection to nature and the resemblance to a home
environment, but it would also have to reflect the
technology and modernism. Technology in the birthing
room would have to be connected to the materials used in
the space as in natural birth the idea is not to intervene
the natural process of giving birth.
- People in Shaghai are still very tide with superstition.
Nowhere in the way finding or in any numbering systems
should the number 4 or 6 be used in order to avoid its
association to bad luck.
- Shanghai as any big city is a place in which people have
a fast life style in which the stress levels are above the
average compared to other cities. The one child norm in
Shanghai has pushed the latest generations to choose for
carriers that represent high economic standard, for such
reason the stress level in Shanghai is so high. The
addition of different elements that would improve the
relaxation of the mother would be very beneficial for her
birth experience given the vulnerable moments that a
woman has to face during pregnancy and delivery of a
baby
.
136
DESIGN GUIDELINES
DESIGN GUIDELINES RELATED TO
GEOGRAPHIC CHARACTERISTICS
DESIGN GUIDELINES RELATED TO ARCHITECTURE
OF THE AREA
- Given the lack of natural vegetation in
Shanghai, it would probably be a positive aspect
to bring some nature into the interior design of
the birth center. 2. Study shows of the relaxation
properties that nature has on pregnant women
(garden)
- The location of the building is of great
importance in order to:
o- Preserve energy by working with the sun
pattern
o- Orientation of the building according to Feng
Shui (see architecture guidelines)
- Provide transitional spaces that allow for people
to dry out after rain or snow.
-Shelter passage ways from exterior to the
interior
- There is now a strong focus by city planners to develop
more "green areas" (public parks) among the apartment
complexes in order to improve the quality of life for
Shanghai's residents, in accordance to the "Better City –
Better Life" theme of Shanghai‘s
FENG SHUI
- The unity of human beings with nature, the balance of
Yin and Yang, and the attraction and repulsion of five
elements metal, wood, water, fire and earth.
- Houses should have their backs to the north and fronts
to the south. Because when they face south, houses can
easily absorb sunshine and avoid cold north winds in
winter. This is a benefit to people's health. So this tradition
has come down to the present, especially in rural areas.
Also, the size of a house must be moderate, neither too
big nor too small. A small house with too many people
living in it is not recommended; neither is a large house
with a few people. This is in accord with the doctrine of the
Mean.
- Feng shui has strict requirements on the proper
positioning of the central axis in building cities. Generally
speaking, the central axis should run from north to south,
with its north end pointing directly to a mountain running
from east to west. The mountain is regarded as the
guardian of the city. A winding river around the city is
.
137
DESIGN GUIDELINES
believed to be an auspicious feature. The
Forbidden City was built strictly abiding by these
rules.
- Beds shouldn't be put too close to windows
because beams of light would directly affect the
quality of sleep. Mirrors should not be hung on
walls opposite beds in case you may be scared
by reflections at night. And beds should not be
put directly opposite doors, otherwise you may
feel unsafe.
- Avoid having a straight road leading directly to
the home, with people coming and going it will
dissipate the good influences.
- Avoid building at the junction of a T-street or at
the end of.
a cul-de-sac because these locations are on the
receiving end of the straight-flowing Sha. A deadend street traps the bad Sha.
- The front entrance should not face the
upstairs stairway.
- The front door should not have a view of the
back door. The through hallway is a no-no.
- Heavy beams in the recreational
room are a burden and interfere
with Chi.
- To have the right side low and
the left side high are both unlucky.
The hills to the left should be higher than those to the
right.
- Houses or buildings on triangular plots of land are illomened as the strange shape attracts Sha.
- Water is very important and its positioning is vital to
improving Chi and confounding Sha
RECEPTION
- Reception area should make an aesthetic statement that
allows the client user to predict or get an idea of what to
expect in the rest of the facility.
- The counter and working area should provide enough
spacing to allow for receptionist to feel comfortable
throughout the day.
- There should be a level of acoustical comfort in order to
allow receptionist to easily communicate with costumers
over the phone or face to face.
- Thermal comfort is important to allow the receptionist to
feel comfortable staying in the same area during an entire
day.
- Exposure to natural lighting would improve the work
efficiency and mood of the receptionist.
- There should be an area allocated for the receptionist to
be able to retreat during the day.
( employee lounge)
Secretary and Administrator
- Offices should have temperature and lighting controls.
- Exposure to natural lighting is preferred.
.
138
DESIGN GUIDELINES
- Acoustical privacy is imperative for both offices.
-Offices should be aesthetically pleasant and
relate to the overall design of the space.
- The location of the offices should not be easily
found by the client users.
-A comfortable chair for both offices is very
important; both users spend most of their time at
their desks.
SERVICE STAFF
- Since maintenance and food service staff do
not have their own private space and their jobs
can be stressful at times, it is important to
provide spaces where they can safely leave
personal belongings.
- There should be space allocated for
maintenance and food service staff to relax and
socialize with other employees
-Exposure to natural lighting seems to be of great
importance to all staff members across the board
- Management must provide support staff with
the tools they need to perform
their jobs in an effective manner
- The spaces and equipment staff
engages with while performing
their jobs must be efficiently
designed and installed to ensure maximum productivity
and minimum stress.
- Material selection throughout the space should take into
account durability and maintenance.
SPECIAL SERVICES
- The massage room should be exposed to filtered natural
lighting
- There should be a water feature in the massage room in
order to improve the relaxation of the mother while getting
the massage.
- There should be a restroom adjacent to fitness room and
massage room
- A sound systems should be provided for the fitness room
- Lighting controls are important in the massage room in
order to adjust lighting to meet the client’s needs.
- The layout of the Children’s care area should be
interesting and give children a sense of discovery but it
should also be open enough to allow for constant
supervision of the care taker.
- Beds should be provided in order to allow kids to take
naps when desired.
- There should be a careful selection of colors in order to
avoid overstimulation of kids.
.
139
DESIGN GUIDELINES
MEDICAL SERVICES
CLIENT USER
- A low and stable bed is more comfortable for
the delivery process.
-Dim lighting is required in the birth room in order
to provide a smoother transition of the mother
and baby
- Temperature control should be accessible in
order to meet the needs of the mother.
- The size of the birthing room should be big
enough to fit family members and not interfere
with my work.
- Many mothers like to hear music during the
delivery of the baby, a good sound system
should be provided.
- The color of the birthing room influences the
mother there should be a careful selection of
colors that promote relaxation.
- Exposure to natural lighting seems to have a
positive impact on pregnant mother.
- The tub should have enough space around it to
be able to allow the midwife to work and at the
same time the presence of family members
- Mothers present different needs according to their
cultural background, likes and dislikes. The design of the
room should allow the mother to have control over the
lighting, temperature and exposure to natural lighting.
- Transition elements should be provided at the entrance
of the room in order to let the mother know if someone is
coming into the room
- Family members need space to feel comfortable and rest
-Different activities should be provided for family members
and their kids.
- Sound system should be provided in the birthing room
140
REFERENCES
REFERENCES
Ellen D. Hodnett, R. P. (2009). Re-Conceptualizing the Hospital Labor Room: The
PLACE (Pregnant and Laboring in an Ambient Clinical Environment) Pilot Trial. Birth
, 159-166.
Eshelman, J.-H. a. (2004). Hospital Birthing Room Design: A Study of Mothers
Perception of Homines. Journal of Interior Design , 23-36.
Eshelman, J.-H. a. (2004). What are the unique requirements of a child birth
environemnt? Journal of Interior Design , 23-36.
Gifford, R. (2007). Environmental Psychology: Principles and Practices 4th Edition. Colville: Optimal Books.
Goodfriend, C. (2001). Aromatherapy for Pregnancy and Birth. International Journal of Childbirth Education , 18-19.
Gormley Tom, March 2000, The History of Hospitals and Wards, Retreived from:
www.history/healthcaredesignmagazine.com
Janice H. Goodman, P. (2009). Women's Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal
Depresion. Birth , 60-69.
Janice H. Goodman, P. (2009). Women's Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal
Depression. Birth , 60-69.
Jessiman, W. C. (2009). Immersion in Water: use of a pool by women in labour. British Journal of
Midwifery , 583- 587.
141
REFERENCES
Judith A. Lothian, R. P. (2001). Back to the Future: Trusting Birth. Aspen Publishers, Inc. , 13-21.
Kitzinger, S. (2008). Letter From Europe: Home Birth Reborn. Birth , 77-78.
Leonie A.M. van der Hulst, M. M. (2004). Does a Pregnant Woman's Intendd PLace of Birth Influence Her Attitudes
Toward and Ocurrence of Obstetric Interventions? Birth , 28-33.
Lisa Borup, R. W. (2009). Acupuncture as Pain Relief During Delivery: A Randomized Controlled Trial. Blackwell
Publising Ltd. , 5-12.
M., R. (2008). Women as consumers of maternity care: Measuring "satisfaction" or "dissatisfaction"? Birth , 73-76 .
Mei-Yueh Chang, C.-H. C.-F. (2008). Effects of music therapy on psychological health during pregnancy . Birth ,
2580-2587.
Mei-Yueh Chang, C.-H. C.-F. (2008). Effects of music therapy on psychological health of women during pregnancy.
Clinical Nursing , 2580-2587.
News. (2010). Birth , 172-174.
Phil Leather, D. B. (2003). Outcomes of Environmental Appraisal of Different Hospital Waiting Areas. Environment and
Behavior , 843-868.
Ronald L. Cole, M. (1998). The Gentle Greeting. Naperville : Sourcebooks, Inc.
Schuster, M. L. (2006). A Different Place to Birth: A Material Rhetoric Analysis of Baby Haven, a
Free- Standing Birth Center. Women's Studies in Communications , 1-38.
142
REFERENCES
van der Hulst, L. A., Teijlingen, E. R., Bonsel, G. J., Eskes, M., & Bleker, O. P. (2004). Does a pregnant woman's
intended place of birth influence her attitudes toward and occurrence of obstetric interventions? Birth , 28-33.
Vania Jimenez, M. C. (2010). A Mirage of Change: Family- Centered Maternity Care in Practice. Birth , 160-166.
Vania Jimenez, M. C. (2010). A Mirage of Change: Family-Centered Maternity Care in Practice. Birth , 160-166.
Whitehouse, S. (2001). Evaluating a Children's Hospital Garden Environment: Utilization and Consumer Satisfaction.
Journal of Environmental Psychology , 301-312.
Young, D. (2009). What is Normal Childbirth and Do We Need More Statements About It? Birth , 1-3.
143