MH+D ASKS HOLDEN TO TELL US MORE.

Q. How can the process of birth be considered a design problem?

A. Labor progression is an anatomical and physiological design problem, as is creating an environment that fosters labor and birth, rather than hinders it. By design “problem” I don’t mean “problematic” but, rather, something that can be better understood through the lens of design.

A birthing room can, by its design, either support a normal physiological birth or support a risk approach to childbirth. Ideally, the design should create a sense of safety and privacy, foster one’s sense of agency, allow freedom of movement and change of position, and reduce stress and fear, all of which release birth hormones that allow labor to progress and pain to be more manageable.

However, the design of many contemporary labor and delivery spaces remains modeled on acute hospital care, and are the antithesis of these qualities, designed for the benefit of the practitioner, rather than the birthing person. This has led to an increase in unnecessary C-sections, rampant birth trauma, racial disparities, and mortality. In short, we are in the midst of a full-blown maternal healthcare crisis.

Q. Are there specific elements within the birth experience that could benefit from intentional design thinking?

A. Understanding how one’s body works during labor is essential to having an empowered and positive birth. Design is integral to the baby’s descent and engagement with the pelvis during labor. There are simple tools and props, like birth balls, hanging silks, and birth stools, and also techniques that can potentially shorten labor, decrease pain, and reduce the likelihood of unnecessary interventions, including cesarean section. Movements, lunges, and inversions during pregnancy and labor can facilitate positioning and rotation of the baby in a way that creates a path of less resistance for easier delivery, regardless of whether that birth is medicated or nonmedicated. But many labor environments do not facilitate this, making them a mismatch for childbirth.

Q. How do you approach the intersection of healthcare and design in your work at Doula X Design, especially when thinking about the birth experience?

A. One of the greatest obstacles to the work I do is a general lack of education and awareness about birth. Birth has been medicalized, even pathologized, and is often viewed as a condition to be managed, rather than as a normal life event. Through the media and other channels, we have been conditioned to fear birth. So I always start with the basics: what are the stages and hormones of labor, the differences between a midwife and a doula, and between different birth environments, including a hospital labor/ delivery room, a freestanding birth center, and homebirth? The policy makers in charge, for the most part, don’t know the answers to these questions, which is inherently problematic.

Q. What role do you see user-centered design playing in the creation of birth-related products or environments?

A. Examples of user-centered design in birth are offering a bed larger than a twin-size hospital bed; not making the bed the focal point of the room; and creating a circuit for movement and change of position during all phases of labor, including pushing, which is least effective when lying on one’s back. Incorporating visual, audio, and lighting options is important, as is offering hydrotherapy and reducing the number of spaces a laboring mom cycles through (lobby, triage, labor/delivery, OR, recovery, postpartum) because with each change of environment, she has to reacclimate and get labor back on track. When you check in to a hospital as a pregnant person, you’re asked to put on a gown, and from the very beginning, you are made to feel like a sick patient. Your sense of agency is compromised, your confidence erodes, and the “fight or flight” hormones kick in, potentially leading to a stalled labor and ultimately a less than positive birth experience.”

Birth centers provide a person-centered, midwife-led, collaborative model of care. They are a safe alternative to hospital births for low-risk pregnancies, offering positive outcomes, lower cesarean rates, better breastfeeding initiation rates, and decreased risk of trauma and postpartum depression. But without sufficient access, there is a limited path to improvement.

Over the past decade, 11 birthing centers in Maine have closed. After July 1, MDI Hospital’s unit will join that list, bringing the total to 12, with 4 closing just this year. In addition, less than half of Maine’s hospitals offer birthing services at all, and more labor and delivery units are expected to close in the future. High out-of-pocket costs and insurance coverage issues limit most births to hospitals, which can be intervention-suggestive and prioritize medical providers over patients. These closures have created maternal healthcare deserts, particularly in rural areas, and have contributed to the maternal health and mortality crisis, disproportionately affecting low-income communities, immigrant populations, and communities of color.

Q. What are some innovative solutions or technologies you’ve explored that could improve the birth experience for those involved?

A. For the most part, the medieval-looking design of women’s health tools and instruments has not changed in decades. However, there are exceptions. In Sweden, midwives are experimenting with plasma screen walls that can be customized to provide a calming, private environment.

There is a new, simple wireless monitor that can track contractions and the baby’s heartbeat as an alternative to wearing two monitoring belts and being tethered with many wires. Designers are working on prototypes for more user-friendly OB/GYN instruments, including speculums and self-collection cervical screening swabs. They are experimenting with less-clinical finishes, concealed medical equipment, dedicated birth furniture, and how to provide hydrotherapy options in every birth room.

Q. What long-term impact do you hope your work will have on the experience of birth and its design solutions?

A. Childbirth is a universal experience. We are all born and have all been impacted by the design of birth spaces, whether we realize it or not.

In many other countries, family life is integrated into how businesses operate. Education about how babies are made and born is a priority, and birth is demystified starting at a young age. Along with this, there is a general attitude that if you support birthing parents, and families, to help children get a good start in life—through enhanced benefits and initiatives, family leave, and flexibility—there will be a positive ripple effect that will ultimately translate into better lives, more productive work, and a happier society.

My goal is to create awareness of how environment, at the scale of the individual and the scale of the structure, profoundly impacts birth and postpartum experience, outcome, disparity, and mortality, and to reframe childbirth as a societal topic rather than a “women’s issue.” Everyone deserves a safe and dignified birth that is not driven by profitability or fear.

MH+D is proud to partner with acclaimed architectural photographer Trent Bell on his architecture, design, and photography podcast. To hear Bell’s conversation with Holden, please visit adppodcast.com.