ICF Framework:

To help in the analysis, we adopted a framework specifically designed for architectural research and case studies, the ICF Framework (Issues, Concepts, Forms) (Oxman, 2001, 2004). The framework itself is a part of our research project, and is modified on an ongoing bases to build a comprehensive list and definitions of issues that need to be addressed for better birth environment design. The value of the ICF approach is that it connects architectural concepts to actual built environments.

  • Information related to the goals and issues of the problem class.

    eg. intimacy and privacy

  • formulation of a solution principle

    eg. an intimate environment

  • specific artifact that materialize the solution principle

    eg. privacy curtains as an important architectural consideration

  • design providing positive rather than negative impact on birth hormones (oxytocin, melatonin) to support undisturbed birth processes

  • design providing places for movement and activities during various stages of labour

  • design with attention to psychological meanings of spatial elements/factors that impact mind/body neurohormonal responses

  • design with attention to enhancing physical and psychological comfort for birthing women,  supporters, caregivers

  • design with awareness of the capacity of environment  to ameliorate pain through use of distraction (views, sound, variety of destinations/doing/activities), movement, bathing, and sensory stimulation

  • design with attention to the role of privacy and intimacy in supporting physiology of birth and  undisturbed birth as crucial for optimizing labour and birth

  • design with awareness of how environment can contribute to hierarchies of power and control, and limit autonomy and self-expression - focus on providing more autonomy and personal agency for birthing woman

  • design with attention to aspects of architectural/spatial design that privileges personal and cultural dignity and respect

     

  • design focused on opportunities for improving mind/body health and wellness during the birth journey, and aware of potential for use of trauma-informed design to ameliorate anxiety and fear

  • design with attention to providing beautiful, meaningful, joyful, emotionally fulfilling birth experiences for all involved

  • design with awareness of needs of continuous caregivers in particular, including beautiful/sensitive places (interior, exterior, with views/natural light) to sit, rest, and take personal and social respite

  • design with awareness of birth supporters' experience, including ability to participate actively or as desired, and need for rest/respite

  • design with attention to the infant as part of birth story - influenced by mother's stress or comfort, but at birth, experiencing the world for the first time

  • design to support optimal communication between all birth participants

     

  • design entire birth facility and labour/birth spaces with awareness of spatial relations that can contribute to best outcomes for birthing women

     

  • design to develop spaces and affordances that  best support lowest intervention  practices and processes,  and optimal user experience for all involved

     

  • design for continuous care model, to accommodate best care practices for birthing women

     

  • design for calm and quiet mood, with ambience of 'flow', 'peacefulness', sensual beauty

  • design for the element of time, to aid in the unfolding of the birth journey

     

  • design for the possibility of pandemics or other large-scale disasters that can suddenly impact birth care spaces

     

  • design for the possibility of death as part of birth

  • design to enhance the possibility of pleasure during birth

     

  • design to accommodate traditional rites and rituals

  • design to embody 'Venustas', visual quality in architecture that would arouse the emotion of love

  • design to create/enhance feelings of safety

  • design to remind all of birth as related to the spiritual realm

  • design with an awareness of the potency of nature for birth experience

  • design for concentrated attention/immersion in image or atmosphere

Issues

Concepts

  • Calming Environment

  • Family Friendly Environment

  • Familiar Environment

  • Comfortable Environment

  • Private

  • Intimate

  • Culturally Sensitive

  • Flexible Environment

  • Customizable Environment

  • Therapeutic Environment

  • Sensory Environment

  • Birth Journey Oriented

  • Welcoming

  • Customizable environment

  • Active Environment

  • Non-Clinical Environment

  • Emotionally Sensitive Environment

  • Newborn Friendly Environment

  • Relationship Oriented Environment

The ICF Framework connects these core issues to design concepts and finally to architectural forms. The following chart is used in our case study visits to demonstrate how each Birth Center is addressing these issues through their architectural and design innovations.