Friday, December 21, 2007

"Homelike" birth spaces: a photoessay

These are photos I took for a research paper about the meanings of "home" in institutional birth spaces. The first set of pictures are from the University of Iowa's new Maternity Center. The second set are from a freestanding birth center in Des Moines, the Almost Home Birth Center.

UI Maternity Center
Text reads:
Labor/Delivery/Recovery room.
Labor & Delivery rooms adjacent to NICU.
Technology is hidden but still accessible.
Internet access.
Rooms offer a home-like environment.
Custom beds.
Whirlpool bath.
A La Carte menus available.
DVD/CD players.
Beautiful views from many rooms.
The "home-like environment" of the L/D/R room
The Stryker Adel bed, covered and uncovered
Equipment closet inside room
Sliding artwork

Almost Home Birth Center
Birth Room 1
Birth Room 2
Living/waiting room
Library/reading room


  1. Amazing the differences when you compare them in photos. There is really no comparison. The birthing rooms in the birth center are gorgeous and that die for!
    As a home birth advocate, I believe nothing compares to home for birthing. However, I've also come to a point in my rally cry where "if NOTHING else" hospitals need to total revamp to accommodate the process of birth. It's funny because when I saw your post it reminded me of something similar I wrote here:
    But your pictures do justice where my words could not.
    Great work.

  2. Wow, that birth center is gorgeous! I wanna LIVE there!

    "Hidden technology" indeed. Pfft. That means it's hidden during the tour, but bursts out of every cabinet and door and corner as soon as you arrive in labor. "Home" doesn't look so homey anymore!

    Makes you think, though, that if "home" is what the hospitals are striving for, doesn't that set "home" as the NORM? ;)

  3. that hospital birth center... I was there at the open house too. I went with friends of mine expecting their first baby. She wanted home birth, he wasn't into it. He was very pleased: next best thing to home, he gleamed. Come the big day though, there was no available suite, so she had the baby in a regular delivery room with the nurse yelling 'push' and counting to ten, the cord cut immediately, baby passed to a three-member neonatal team in the far corner of the room, then a few seconds for mom to see baby, followed by a 3 hour 'observation' in the nursery. Not exactly home-like care.

    Had my friends been shown the room they ended up getting... had he been told about the staff's protocols... he might have agreed to the home birth his wife desired?

  4. wow - what a difference. the birthing center is gorgeous.

    i think jill made a very interesting point about home being the norm. if women so want the home look and feel, why don't more choose to give birth AT home? i think the answer is so many don't even know it's an option.

  5. Or they are afraid to deal with the consequences of the problems caused by their own fear surrounding birth.

    I think that is what this whole thing comes down to. Do women in this country truly believe that birth is a normal, physiological process, rather than a pathological problem just waiting to show its ugly head? How many times have you heard "But what if (name a problem) comes up?) Yes, there are some things that truly do need a medical help, but the vast majority of births could be completely free of interventions, and still result in healthy moms and babies. The problem is that if women, and their partners, continue to mistrust birth, birth will continue to be a problem, and home will not really be the ideal for which they are striving.

  6. "Home like" is so misleading. There is nothing "like" home unless you have actually lived there. Even a snazzy birth center is going to feel like...a hotel room, at best. Not like your home, not like your space.

    The hospital approach, "hiding" equipment is just...ugh. Hate hate hate. Like having monsters inside the walls waiting to jump out at you. I mean, I don't hide medical equipment in MY closet. A thin veneer of cheesy paintings and ugly curtains doesn't hide the ugly impersonality of the hospital. Lipstick on a pig.

  7. What I wrote about in this paper (for a "Built Environment" American Studies seminar my 2nd year of the PhD program) is that the meaning of "home" in the two settings are quite different. In hospitals, it means that thin veneer of tacky decorations (wallpaper, art, bedspread, lamp). In birth centers, even though they "look" more like someone's house than hospitals do, "home-like" refers more to "homebirth-like". In other words, the standards of practice during labor and birth at a FSBC are more what like you'd find at a home birth, hence the term home-like.

  8. The birth center is very pretty but... it's really just as much veneer as the hospital. Like a stage set for a performance (as so many women feel about their birth experience.)

    The bedroom is set up all wrong. The bed too high, too flat, too exposed. The old Pithuviers birthing rooms are much better -- a low wide platform in a corner.

  9. Actually, it just occured to me, isn't it silly to try to mimic the home-like environment when it's just not going to be home no matter what you do? I think they'd be much more successful if they were more honest about the point of giving birth outside the home, and have the decor and architecture somehow reflect that. I don't mean by making it more clinical, but making it more itself, with its own visual identity.

  10. That's an interesting idea, Linda, and I can think of a lot of things you could have in a birthing space.
    Comfortable bed/mattress of course. Birth pool: must be large and deep enough to be fully immersed.
    Large shower with multiple sprays and limitless hot water, of course! A seat in the shower would be a great addition.
    Birth balls.
    Fireplace mantle (just the right height to lean on).
    Birth sling suspended from the ceiling, the kind designed by Penny Simkin so the woman can totally suspend her weight from it.
    Sturdy rail attached to the wall to help with squatting.
    Table or countertop to lean over.
    Knotted rope suspended from ceiling to pull on/hang from.
    Chin-up bar to hang from (this would have come in very handy at one home birth I attended, where the woman was essentially hanging from the door frame during contractions).

    The room would send the message: this is a place to labor and give birth in all sorts of ways and positions. This is a place to move your body, not a place to lie trapped in bed.

    1. Many years later - and some of us are still grappling and researching how to make such spaces as you describe part of the hospital 'home-like' narrative. As Fannin argues, 'home-like' creates an unsatisfying hybrid space. I am conducting my dissertation on the experience of childbirth supporters in the built hospital environment. I have real design ideas and I work with bright minds to study Birth Unit Design shift that we hope can create real change for women and babies. And their families. Come visit me at Paradigm Spaces. Many thanks for your original post and the insightful comments.

  11. rixa, I have thought for a long time that someone needs to start a birth-equipment company to make stuff like that--not just stools, but ropes (with handles, soft, padded), bars (ditto, at various heights or adjustable), slings, and other nifty kinds of equipment--labor is very like a workout, yes?

    Or even a self-contained jungle-gymy thing, like a multipurpose workout machine, not scary looking...

  12. I wouldn't say labor is like working out. Working out is something you force your body to do through willpower, stamina, and determination. The "work" of labor is mostly getting out of the way and letting things happen. So the tools of labor aren't ones that encourage exertion or test strength; instead, they facilitate surrender, relaxation, and comfort.

  13. Home birth isnt about some "gorgeous" anything. My house doesnt have 4 poster Oak beds or special jetted tubs, gleaming floors or a library. But my uterus and my spirit couldnt care less about that crap, especially n LaborLand.

    Homebirth is about being in your own home, where you are the boss. The Woman. The Homeowner. The person on the mailbox. You ask me for permission, not the other way around.
    Home is where you dont have to ask "Can I go pee? Where is the water kept? Is it ok if my husband lies in the blue chair? Can we take pictures? Am I allowed to eat? Can I take another bath? Can we turn the lights down? Can I wear my bra in the tub? Do I have to ABCDEFGXYZ?"

    Thats what homebirth is about to me. Being a grown woman in my house. With a servant/helper or alone, I am the mother and I am the capable adult and I am not under any pressures or expectations to be a gracious guest, a polite performer or an ideal customer. Im BIRTHING, on my turf, where I feel most safe and capable. I might be weird and I couldnt care less. Its my house.

  14. Housefairy, I think you just summed up exactly what I have been trying to explain to people when they think I am insane for wanting to birth future babies at home. I really did feel like I was on stage at a performance in the hospital, and both my husband and myself afterwards realized how much they belittled us and our choices, and how they made us feel like small children at elementary school. This is also one reason I am hesitant to have a midwife--I know I will feel like I have to be a hostess and ask her she is in charge, even though it's my home. And I don't want that feeling like I'm being watched, or that people are sitting around waiting on me to give birth.

    You are not weird at all for wanting to be in charge and safe on your own turf for birthing, that makes complete and total sense. Every woman should have that mindset.

    As a last thought, I have to say, the way the medical technology can suddenly burst out from behind a picture frame is almost laughable, isn't it? Why go through all that trouble to hide it, and even brag about how great a job you've done masking it with cheap artwork? That seems like such a waste of time because you've just told the patients what's behind the pictures...the pictures might as well not even be there.

  15. I think it's weird that people think that the benefits of home in birth come from aesthetics. Like if it LOOKS nice, you'll feel comfortable, so what's the difference?

    Except I wouldn't want to birth even in someone ELSE'S house. Just like it sucks to be really ill at someone else's house -- even if it's someone you love, or they have a great bathroom. It isn't HOME. (Don't get me wrong, I would love to spend a weekend at that birth center right now, and given the choice between it and UIHC no contest -- but it's still DIFFERENT.) Home isn't a "look." Home is a feeling and whole environment that allows a women to completely relax, surrender, and be free to birth. Home is smells and comforts and familiarity. It can't be replaced or replicated.

  16. i cant imagine, even if they took my things and set them up in their room, feeling at home anywhere but *at home*. home, and birth at home, is so much more than just familiar things. a place you have been in. lived in, vomited in, pottied in, made love in. no one is going to expose you there, no one is going to mind you. it's yours.

    tabitha not karl

  17. I know this is old, but I just want to put in my two cents (as a future birthing mum trying to educate myself well before I need to make any decisions!) - I think the point of a 'homelike' birthing centre is not exactly to make it feel like your own home, because like you have all said, it can't do that. Instead, it is taking away the clinical, anonymous feel of a hospital room, while still having access to emergency help if required. For many women, at least as I see it, the barrier to homebirth is the 'what if' and some may never be able to get to the point of completely trusting birth - at least not with their first baby. Birthing centres like this therefore provide a good middle ground - not the scary, interventionist reality of a hospital, but not completely without a 'safety net' either. I would probably consider birthing in a centre like this (as long as it was midwife-directed and there was no chance of an OB trying to intervene!), particularly for a first birth, and especially if I lived somewhere that had lots of barriers to homebirth. The bottom line is giving women lots of choices, so they can make one they are completely comfortable with - while many of you would not be comfortable giving birth in any institution, for others it would be their only comfortable option outside of a hospital (which can only be a good thing!)
    (Interestingly, the Northern Territory in Australia, where I grew up, now has government-supported homebirth - access to free homebirth for any woman! If I got pregnant right now I'd pack up and move back in a heartbeat. I don't think any other states in Australia have anything similar - in fact it is quite discouraged in some places thanks to bad press in the last few years.)


Related Posts Plugin for WordPress, Blogger...