Towards a new architectural understanding of birth spaces grounded in women's experiences of giving birth

This thesis proposes a new philosophy of birth space design that values the diverse spatial practices and space-based experiences of childbearing women, across all types of birth venues and experiences of birth. The research aligns with the philosophy of woman-centred maternity care. It critically examines this as an intervention imposed on to a pre-existing medical system of care - a system which, in turn, influences the techno-rational basis of healthcare evidence-based architecture and the tendency for researchers to investigate the birth environment in quantifiable ways. The thesis proposes that birth space should be interrogated in a number of new qualitative ways: by user experience-based spatial design starting with the interiors of buildings; by examining women’s patterns of use of space over time, especially in relation to social interactions; and by interpreting space-based experiences within women’s birth stories. The literature review draws from a wide-range of literature: architectural, spatial, birth-environment, social theory, midwifery, obstetrics and policy documents. It critiques the naive readings of homely, control, safety and risk, and architecture understood as a techno-rational domain, in the extant research relating to birth spaces. This thesis has an interpretative methodology that crosses disciplinary boundaries, and the definitions of architectural space and childbirth, that have previously limited knowledge of birth spaces. The nature of what is appropriate evidence for design, the spatial understanding afforded by using visual qualitative methods, semiotic meaning within policy documents, the nature of personal experiences of childbirth, and the application of a critical spatial methodology to birth spaces, all inform the selection of methods. Representations of architecture are used to interpret the social and spatial meaning that architecture represents to birth space producers and users. Spatial practices for producing birth spaces are interpreted from the three policy design guidance documents commonly used in the context of maternity care in the UK; and the spatial practices of childbearing women are interpreted from the experiences of twenty-four women who took part in qualitative interviews. The transcripts, policy guidance documents and drawings were thematically-analysed and the visual data was also examined as semiotic materials. The findings demonstrate that birth spaces are prosumed and curated by women. Birth space is experienced as a socially-situated progression through time - and not contained within one room as current guidance implies. Women’s spatial experiences are embodied and influenced by prior experience and expectations of birth venues. Space is experienced in multiple ways (visually, via perceived affordances, and via movement) that are contingent on the venue. Experiences of waiting and of labour as a ‘physical journey’ are both spatially significant. Women want to use spatial strategies to self-manage the ebb and flow of companionship in labour. Women build personally-meaningful intergenerational stories from where birth took place. The discussion chapter develops spatial insights into the design guidance and maternity policy goals (choice, control, continuity of carer and personalised care) from the interpretation of women’s experiences. The thesis creates a new critical understanding of the value of social architecture for improving midwifery practice and women’s birth experiences. Practical recommendations to be applied to existing maternity spaces are proposed. Existing spatial and social theory is applied to the new area of birth space, and its lacunae identified. The thesis concludes with a new situated spatial theory derived from women’s experiences of childbirth as inspiration for much needed further interdisciplinary research and design development in this area.