alternative birthing centre - margret hurrelbrink

8/6/2019 Alternative Birthing Centre - Margret Hurrelbrink

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Declaration

This thesis contains no material which has been accepted for the award of any other degree ordiploma in any University.

To the best of my knowledge and belief this thesis contains no material previously published by any

other person except where due acknowledgement has been made.

Signature: ……………………………………………

Date: ……………………………………………



This thesis is dedicated to Charlotte Crombie, Uni wouldn’t have been the same without you.

I would like to thank Studio Awesome, you’re the best; special thanks also to Studio Strange Sounds

for all your late night company.

Of course thanks to my family and friends for all your support.

Finally, thank you to my thesis supervisor Simon Pendal who told me to be less of a woman and more

of an architect, you managed to keep me on track somehow. However, I prefer the advice of Ranulph

Glanville who told me to be less of an architect and more of a poet.

Margret Hurrelbrink - Woman, Poet, Architect



TABLE OF CONTENTS

ABSTRACT 2 RESEARCH QUESTIONS 4 BACKGROUND 5

History 5 Mind/Body Connection 6 Birth Options in WA 7 Hospital birth 7 Home birth 9 Birth Centre 10 Family Birth Centre KEMH 11 Maggie Centres 12

PROGRESS/PROCESS OF LABOUR 14 SIGNIFICANCE 15 DESIGN DEVELOPMENT 17

Design Brief 17 Site Selection 20

DESIGN OUTCOMES 22 Snoezelen Features 22 Courtyard 23 Choice 23

CONCLUSION 25 GLOSSARY 26 REFERENCES 27 IMAGES 29 APPENDIX A 31



2

Abstract

A Free Standing, Alternative Birthing Centre

next to the South-West Health Campus

(Bunbury, Western Australia)

Architecture honouring life.

Birth is not the beginning of life, but the

transition from an interior world to the exterior; a

momentous occasion for those being born and

those giving birth. It is a life marker

We mark momentous events in our lives like

christenings, weddings, and funerals with

ceremony and tradition. Such occasions are

celebrated or observed in beautiful, purposebuilt spaces, such as Tadao Ando’s Chapel on

Mt Rokko for weddings or the funerary chapel

by Friis and Moltke in Aalborg.

The significance of these events is coded into

the fabric of the building and helps us relate to

these occasions on a level above the every day.

Image 1: celebrations of life events

Childbirth however has been tucked away in

functional rooms designed for maximum

sanitation. While highly efficient and necessary,

these spaces can be excessively utilitarian and

they tend to lack any comfort or connection to

spirit they might have offered.

As noted by Jain Malkin, president of the Centre

for Health Design, in her book on hospital

interior architecture “[a]rchitecture, when it is

well executed, can express the spirit of an



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institution more powerfully than words” (Malkin

1992 p.48). The aim of this thesis project is to

express respect and reverence for the act of

childbirth while providing women with a choice

of places to birth.

Women in WA are limited in their choices when

it comes to deciding where they want to givebirth. This is especially true of women living

outside the metropolitan area. My project aims

to increase a woman’s options by offering a

choice between the two polar extremes of

hospital birth and home birth.

This is a timely project in light of the new draft

policy published by the State Government

Department of Health; Improving Maternity

Choices: working together across WA, whichrecognises the need for greater care options

which include family birth centres for low risk

pregnancies (WA Health Department 2007).

Beyond the issue of choice, this thesis explores

the possibilities offered by architecture in raising

the level of reverence and respect for the act of

birth, by honouring the physical and

psychological process, the progenitors (the

woman and her partner) and the outcome (the

child).

Image 2: “woman tries to ignore her surroundings and concentrateon her contractions” from (Harper 1994 p. 15)



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Research Questions

Primary research question

“How can architecture support the birthing

experience?”

Secondary research question

‘How can architecture infer reverence and

respect for the act of giving birth?”



5

Background

History

Prior to modern medicine and our scientific

knowledge of the physiology of the birth

process, birth was relatively dangerous, with a

maternal mortality rate much higher than it is

today. However there was also a reverence for,

and a spiritual connection to, the act of bringing

of new life into this world, with birth typically

occurring at home, with a local village

woman/midwife in attendance.

Prior to industrialization and the move into

cities, the cycles of life, nature and fertility were

observable to a population that worked andrelied upon the land. This connection to nature

resulted in a variety of practices and folklore

surrounding childbirth, many of them linking

childbirth and the natural world. For example,

natural phenomena such as the phases of the

moon, ocean tides, or the seasons, were

believed to hasten delivery (Vries 2004).

Whilst it is easy to romanticise the image ofvillage life in history, we should not look back

with rose coloured glasses thinking that was the

golden age of childbirth, the sharp decline in

risks attached to childbirth in the last two

hundred years is an achievement humanity

should not overlook (Gelis 1991)p.xvi. However,

there is also the argument that then pendulum

has swung too far and childbirth has become

overly medicalized.



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Image 3: caesarean section

Maternity practices have changed a great deal

since the rise of the hospital. Advances in

scientific study have led to a greater medical

knowledge of the human body. This has led tospecialised fields of knowledge in medicine and

in some cases the body is viewed as a

collection of discrete parts. This highly

compartmentalised view of the body is being

challenged by medical and alternative

practitioners that recognise the limitations of

reductionist thinking in regards to the body, and

instead, propose a more integrated approach of

holistic medicine.

Mind/Body Connection

An important aspect of this new holistic view of

the body and its processes is the mind/body

connection. Studies are showing how important

the mother’s state of mind is to the smooth flow

of the birth process. One of the crucial reasons

is that an emotional state affected by stress

releases adrenalin hormones (the fight or flight

hormones) and their secretion is known to

inhibit labour contractions or intensify labourpains (Odent 1984).



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Emotional states can be affected by architecture

and the built environment, this in turn has an

effect on the body’s regulatory systems and

hormone levels. In relation to the design of

health care facilities this has been shown to

effect recovery times and the perception of pain.

Many areas of study have started looking at this

phenomenon. This has led to the developmentof therapeutic environment theory, based upon

a combination of outcomes from environmental

psychology, psychoneuroimmunology and

neuroscience. These fields study the psycho-

social effects of environment, the effects of

environment on the immune system and how

the brain perceives architecture respectively

(Therapeutic Environments 2007)

Birth Options in WA

The women of Perth are restricted in their

choices when it comes to deciding where they

want to birth their babies. At the present time

there really is no choice, women can either have

their babies at a private hospital or a public

hospital. If they are lucky, they could be one of

the 1% (Gee, Hu, and Ernstzen 2006)of women

who, in any given year, get to have their babies

at the family birthing centre attached to King

Edward Memorial Hospital for Women (the onlysuch birthing centre in the state). The other

alternative is for a woman to have her baby at

home, and even this choice is restricted as the

government only provides funding for 150

homebirths a year (Stateline 2007). In short,

hospital births, home births, and birth centre

births, are the three main options available to

pregnant women in Australia

Hospital birth

In a traditional hospital birth, a woman will

spend the first part of her labour in a regular



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looking hospital ward, often with a number of

other women also in the first stages of labour.

As labour progresses into the advanced stages,

the labouring woman is removed from the group

and taken to a separate, sterile delivery room.

After giving birth she is then moved to a

recovery room, where, after a period of rest, she

is finally moved to a fourth room on a postpartum ward (Jones 1990). This practise of

moving from room to room has the potential to

be highly disruptive for the new family.

The image below, shows the progression of

rooms a woman can expect to encounter during

her labour at Osborne Park Hospital in Perth’s

northern suburbs. Firstly, she will spend most of

her time waiting for her labour to progress in the

early labour room. If she is admitted during thenight in early labour, and if she is not sent

home, her partner will be allowed to stay with

her in the overnight room.

When she is in second stage labour she will be

moved to the delivery room and following

delivery she will be moved to her post delivery

bed in a six bed ward, where her partner may

only see her during visiting hours. Whilst the

reason given for disallowing partners to stay

overnight after delivery is so that the new

mothers may rest, the reality of sharing a roomwith up to five other new mothers and their

newborn, make the quantity and quality of any

sleep or rest questionable.

Image 4: initial observation/early labour room, overnight room,delivery room, and post delivery room at Osborne Park Hospital



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Osborne Park Hospital Is a 205 bed community

hospital, and despite being quite traditional, has

a unique therapeutic room that women can use

for breastfeeding and relaxation during early

labour. Osborne Park is the first hospital in

Australia to install such a room, known as a

snoezelen room, for maternity patients.

Image 5: snoezelen rooms

Snoezelen Originally developed in the seventies

to help treat patients with mental disabilities,

snoezelen represents a type of sensory

stimulation therapy that uses sounds, images,

special lighting and aromatic oils, to promote

deep relaxation and wellbeing. The distracting

qualities of snoezelen have been found

beneficial in the area of pain relief from both

acute and chronic pain, which is particularly

useful for women to help take their focus away

from the pain of their contractions and find a

relaxed state of mind.

Home birth

Despite evidence to the contrary, medicalorganisations such as the AMA (The Australian

Medical Association) continue to argue against

the safety of homebirth. In contrast, the World

Health Organisation published a book in 1986

that states:

“It has never been scientifically proven that the

hospital is a safer place than home for a

woman who has had an uncomplicated

pregnancy to have her baby. Studies ofplanned home births in developed countries

with women who have had uncomplicated

pregnancies have shown sickness and death



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rates for mother and baby equal to or better

than hospital birth statistics for women with

uncomplicated pregnancies” (Homebirth in the

UK 2002)

The argued benefits of homebirth are that, the

home, being a familiar environment, does not

trigger a stress response in the labouringwoman and that the woman has greater control

to make choices for herself rather than be

subject to standardized practices according to

hospital protocol.

image 6: typical homebirth in a blow up birthing pool

There is also another advantage in terms of a

newborn’s immunity. In a hospital, virus and

bacteria are generally more virile than the

surrounding environment due to resistance built

up from the continued use of disinfectant. In

contrast, in the home, the mother has built up

her own immunity to the particular infectious

agents in her environment, with that immunitybeing naturally passed in turn to the newborn.

Birth Centre

There is no standard definition of a birth centre,

but a commonly accepted definition is “a birth

centre is an institute that offered care to women

with a straightforward pregnancy and where

midwives take primary professional

responsibility for care. During labour and birth,medical services, including obstetric neonatal

and anaesthetic care are available should they



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be needed, but they may include transfer by car

or ambulance” (Stewart et al 2005 p.3).

Australia has a very low rate of alternative birth

with only 1% of babies being born out of a

hospital setting in Western Australia in 2005

(Gee, Hu, and Ernstzen 2006)

Image 7: River ridge birth centre NZ, designed around thephilosophy of Austrian philosopher Rudolf Steiner

Family Birth Centre KEMH

Perth only has one birth centre at present and it

is attached to a hospital. This birth centre is the

King Edward Memorial Hospital for Women

Family Birth Centre and it is the only birth centre

in Australia that does not offer water birth.

Consequently, if a woman wants a water birth inWestern Australia, her only option is a home

birth.

As a birthing option, water births have been

shown to be safe and Australia is lagging

behind by not offering this option to women. In

the UK, for example, one in three hospitals

offers water births and it has been

recommended, since 1992, by the House of

Commons Health Committee, that all hospitalsmake provisions to offer water births (Beech

1998). Although giving birth in water was

originally viewed as alternative, it is currently



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quite common and is starting to be offered in

some hospitals in Australia (Davidson 2006).

The KEMH birth centre only handles about 350

births per year out of over 26 000 births in

Wester Australia, based on 2005 statistics (Gee,

Hu, and Ernstzen 2006).

Image 8: KEMH Family Birth Centre, birthing suite and solitarybath shared amongst the centres three birth suites. The bath isused for pain relief but women must exit the bath in time fordelivery

Maggie Centres

Although not birthing centres, Maggie’s Cancer

Caring Centres embody the philosophy caring

by providing space where people feel welcome

and comfortable. Their aim is to provide

information, relaxation and stress management,

and emotional support within a thoughtfullydesigned environment that makes people feel

respected as individuals. As quoted by Carol

Venolia in Healing Environments “ ...people can

be made to feel degenerate or divine by the

mere fact of their physical environment. I saw

everything around me as a reflection, and

understood that we feel ourselves to be what

our mirrors tell us” (Ismael as reported in

(Venolia 1988).



13

Image 9: Maggies Centres in Edinburgh and Glasgow respectively

Maggie Jencks, the inspiration behind the

cancer caring centres, understood the ability of

space to convey a sense of caring and other

encoded messages in architecture and Maggie

centres achieve their aims by designing spaces

that are domestic in scale, bright and

welcoming, and unusual enough to inspire

peoples’ imagination, curiosity and optimism(Maggies Programme ).



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Progress/Process of Labour

Labour is broken up into three stages; the first

stage is made up of early labour and active

labour; the second stage is pushing; and the

third stage is the delivery of the placenta.

Labour, for first time mothers, lasts on average

for 15 hours, although individual times can vary

greatly. Occasionally some first time mothers

experience labours that go for longer than a day

(Stages of Labour 2005).

The onset of contractions indicates the start of

the first stage of labour, which ends when the

cervix is fully dilated to approximately 10cms

(big enough for a baby’s head to pass through).

Following full dilation, the second stage of

labour continues until the baby is born. This is

the stage where the mother feels the urge to

push and is transferred to the delivery suite.

Once the baby is born, contractions continue to

push out the placenta, which constitutes the

third stage of labour. This process takes around20 minutes and following the pushing out of a

baby, is often claimed to be generally easy and

comfortable (Gaskin 1977).

The benefit of choosing a birth centre or home

birth is that all of these stages, taking around 15

hours or longer, are allowed to occur in the

same space.



15

Significance

A woman giving birth in a hospital is more likely

to be subject to a routine caesarean section and

other medical interventions, such as episiotomy,

forceps delivery or vacuum extraction. Western

Australia has the highest incidence of

caesarean section in the country, which stands

at almost 34% (Gee, Hu, and Ernstzen 2006).

The World Health Organization recommends a

caesarean rate of around 10% and no higher

than 15%. Although required in certain

situations, needless caesarean sections put the

foetus at unnecessary risk.

Statistics and anecdotal evidence show

favourable outcomes for mothers and babiesfrom their birth centre experiences. In fact a

recently released study of perinatal mortality

rates in Australia between 1999 and 2002 found

significantly lower death rates attributed to birth

centres than those attributed to hospitals, taking

into consideration only low risk pregnancies.

The death rates were 1.4 versus 1.9 per 1000

for full term low risk primiparas and 0.6 versus

1.6 per 1000 for full term low risk multiparas.

(Tracy et al. 2007).

In Bunbury, Western Australia, growing birth

rates indicate a need for increased maternity

infrastructure and services. Interviews with a

Nurse Unit Manager on the maternity ward at

Bunbury Regional Hospital (part of the South

West Health Campus) also revealed

inadequacies of the current facilities to service

the southwest’s growing population’s maternity

needs.

The southwest also has Birth Choices, which is

a strong consumer group that is actively

campaigning for a local birth centre to increase



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birth options in the area and to give families the

same choices available in the metro area.



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Design Development

Design Brief

Schedule of AccommodationActivity Space Area

m2Qty Total

m2Comments

Reception 10 1 10 The reception should be located at the entrance to theunit.

Toilet – public 3 2 6Staff station 10 1 10 Inc. file/stationary storage.

Utility Room 18 1 18 3 x 6m for sluicing of bodily fluids and clean up ofinstruments and disposal of soiled linen etc. Includeplacenta storage fridge or freezer.

Equipment Store 25 1 25 To house extra portable lights, portable nitrousequipment, birth accessories (mirrors, squat stools, birthballs etc.). Emergency resuscitation trolley

Supply Store 25 1 25 Clinical suppliesBay – linen/blanket 3 1 3(o) Optional (allowed for in equipment store)Bay – mobile equipment 4 1 4(o) Optional (allowed for in equipment store)Bay – resuscitation trolley(adults)

2 1 2(o) Optional (allowed for in equipment store)

Support AreasConsulting rooms 15 3 45 For antenatal checks. Small desk, 3 chairs, examination tableLarge group room >35 1 35 For antenatal classes, room for audiovisual equip.Breastfeeding room 9 1 9 For demonstrations, breastfeeding or using breast pumps. May



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also be used to prepare and store formula/breast milk substitutes.Bench with an inset sink. Hand basin (type b). Comfortable chairssuitable for breastfeeding. Storage for pump and attachments.Power outlets for use of breast pump. Visual and acoustic privacy.

Waiting – patient/visitor

12 1 12 Sofa, TV, small dining table and chairs, play area for siblings,kitchenette

Overnight staff room 10 1 10 To fit two single bedsStaff bathroom 4 1 4 Toilet, basin, shower

Birthing SuitesBirthing Rooms(LDR)

28 3 54

En Suite 10 3 30 Includes peninsular bathStore 3 3 9 For clinical supplies and equipment to be stored when not in use

to maintain a domestic environment.

Total 302With 30% circulation 402Plant 50 1 50

Dedicated parentparking

12.5 3 37.5

489.5



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Functional Relationship Diagram – Maternity Unit

Diagram 1



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Site Selection

Bunbury was chosen as the site for the Birth

Centre due to a meeting with a Nurse Unit

Manager from the Maternity wing of the regional

hospital in Bunbury, where I became aware of

the need for more maternity services in the

southwest and the desire in the community for a

birth centre in particular.

Originally, the site chosen was on the grounds

of the South West Health Campus adjacent to

the maternity wing of the public hospital.

However, the growth of the hospital over the site

has not been master planned and it was

decided that the left over parcels of land were

too tight to allow a free standing birth centre

with its own character.

A more appropriate site adjoining the health

campus was selected for its natural condition

and proximity to the hospital and its services.

The site is a westward facing slope on a good

sized hill, covered in native bushland. This bush

setting, though natural, has previously been

degraded by being used as a sand quarry

(presumably for the construction of the hospital).

This added to the appropriateness of the site as

it mitigated damage to surrounding bush. The

depression in the earth left by the removal of the

sand also offered an interesting landscape for

consideration.

Situated on the Bussell Highway, the site has

excellent access for the residents of Bunbury

and also for the wider community of people in

neighbouring towns



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Image 10: aerial photograph of Bunbury Regional hospital and site Image 11: joiner photographs of site and view from the hill



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Design Outcomes

Snoezelen Features

The centre has a dedicated snoezelen room. As

these rooms are generally more about

snoezelen gadgetry, such as bubble tubes,

mirror balls etc, than the architecture, it was

decided to incorporate snoezelen features into

the suites as well.

The Interior Suite is an introverted room; looking

to its centre, there is a living wall of water. An

aquarium is often included in snoezelen rooms

and is a feature of the Osborne Park Maternity

Wards snoezelen room. Watching the fish,

taking in the colours of the aquatic scene, and

the soothing effect of water, all help in

producing a therapeutic outcome.

The Sky Suite makes use of high level windows

to give views of the sky and the stars. During

the day, one can observe out the windows the

passing of hours from the movement of the sun

and the shadows cast on the walls. The weather

is also on view, providing a connection to

natural phenomena, such as fluffy white

cumulus clouds blown across the sky or

brooding storms and rain. During the night one

can view the moon and stars, the moon in

particular being considered a feminine entity.

The Sky suite also has an opaque glass wall

running alongside the birth pool which gives

privacy whilst acting as a backdrop for the

shadow of nearby trees to play in silhouette.

This is similar in effect to the display of images

projected on to the walls of snoezelen rooms by

projectors with rotating heads.



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The Horizon Suite has an extended view across

and up the hill in one direction and a framed

view looking out to the bushland in the other.

The birthing pool in this suite is positioned right

next to a large floor length window with a

corresponding pool of water on the other side of

the window. This will give the sun the

opportunity to bounce off the surface of the

water on to the interior walls and ceiling of the

suite acting like a giant mirror ball, a standard

snoezelen device. At other times the sun may

just glint and wink on water surface and be quite

dazzling in and of itself.

Courtyard

All three birth suites have their own private

courtyard giving access to nature both

physically and visually. Like snoezelen, views of

nature have been shown to lower blood

pressure and help with feelings of wellbeing.

There is also provision with nearby exit points

for women in early labour to access the larger

central court of the centre or the surrounding

bushland. Women may also chose the courtyard

as the space in which they give birth.

Choice

Studies are revealing how women in labour

move spontaneously when unrestricted. One

such researcher concluded that

"Women who can give birth naturally do not need

particular colo[u]rs, nor beautiful furniture that

reminds them of their homes: They need a space

in which to express themselves, in which to wait;

they need the space-time to let it happen. The

only thing they really need is not to be forced into

a particular position. Even pain dissolves with

movement” (Lepori 1994 p.6).



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This is facilitated in the birthing suites by giving

women the choice between birthing inside or

outside, water birth or not water birth and by

allowing the space for women to choose their

preferred birthing position. The beds in the birth

suites all fold away so as not to be prescriptive

in the expectation that they will be used.

Furniture has also been built in that the women

can lean on or hang off as they feel the need.

Image 12: woman using built in f urniture to support herself in a

hanging position (Horizon Suite)

Image 13: woman using built in furniture to lean on (Sky Siute)



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Conclusion

In conclusion, our buildings are not human and

do not have emotions, but rather they arouse

emotions in us and speak to us. As

anthropomorphizing as that may be, it is

important that, as architects, we consider what it

is that our buildings are saying to the people

that use them. At significant points in our lives,

such as welcoming a child into the world and

transitioning into parenthood, we should hope

that our buildings speak to us kindly and with

love and respect. This thesis aimed to produce

a design that offers more choice to pregnant

women and their families, while encoding a

reverence for the birth process; to design a

building that celebrates life.



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Glossary

Episiotomy A s urgical incision of the perineum to enlarge the vagina and so facilitate

delivery during childbirth.

Multipara A woman who has had two or more pregnancies resulting in viable offspring

Perinatal The period immediately before and after birth

Primipara A woman who bears a child for the first time

Snoezelen Room A multi-sensory environment developed in the 1970’s for use with the mentally

disabled. It is now used in many fields including maternity where it offers a

distraction from pain and has been shown to lower blood pressure.

Vacuum extraction The removal of a foetus from the uterus or vagina via a suction device.



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References

Australasian Health Facility Guidelines Part B:Health Facility Briefing and Planning. Health Capital andAsset Management Cosortium in association with the University of New South Wales.

Beech, B. L. 1998. Choosing A Water Birth : AIMS.

Davidson, A. 2006. Birth in Water at John Flynn Hospital . Queensland: Film in Motion. DVD.

Gaskin, I. M. 1977. Spiritual Midwifery . Fourth Edition ed. Summertown: Book Publishing Company.

Gee, V., Q. Hu, and A. Ernstzen. 2006. Perinatal Statistics in Western Australia, 2005. Twenty-third Annual Report of the Western Australian Midwives' Notification System . Perth: Department ofHealth, Western Australia.

Gelis, J. 1991. History of Childbirth: Fertility, Pregnancy and Birth in Early Modern Europe . Cambridge:Polity Press. Original edition, L'arbre et le fruit.

Homebirth in the UK. 2002. Midwifery Today . http://www.midwiferytoday.com/articles/homebirthuk.asp(accessed 3 June 2007).



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Jones, C. 1990. Alternative Birth: the complete guide: healthy options for you and your baby . 1st ed.Los Angeles: Jeremy P. Tarcher.

Maggies Programme .http://www.maggiescentres.org/maggies/MAG_Main.jsp?pContentID=674&p_applic=CCC&p_service=Content.show& (accessed 8 August 2007).

Odent, M. 1984. Birth Reborn . New York: Pantheon Books.

Stages of Labour . 2005. http://www.babycenter.com/0_the-stages-of-labor_177.bc?Ad=com.bc.common.AdInfo%40710268a9 (accessed 16 September 2007).

Stateline. 2007. Australia: ABC, 18 May 2007.

Therapeutic Environments . 2007. http://www.wbdg.org/design/therapeutic.php (accessed 5 Nov 2007).

Tracy, S., H. Dahlen, S. Caplice, P. Laws, Y. A. Wang, M. Tracy, and E. Sullivan. 2007. Birth Centresin Australia: A National Population -Based Study of Perinatal Mortality Associated with GivingBirth in a Birth Centre. Birth 34 (3):

Venolia, C. 1988. Healing Environments . Berkely: Celestial Arts.

Vries, A. D. 2004. Elsevier’s dictionary of symbols and imagery. London. Elsevier.Original edition,Dictionary of symbols and imagery. London.



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Images

Diagram 1 (Australasian Health Facility Guidelines Part B:Health Facility Briefing and Planning)

Image 1 Image compiled by author from unknown sources 2007.

Image 2 Harper, B. 1994. Gentle Birth Choices [Image] . Rochester: Healing Arts Press. P.15

Image 3 01-c-section_birth_sm [Image[http://www.anders.com/pictures/public/02-haiti-hospital/01-c- section_birth_sm.jpg (accessed 20 September 2007).

Image 4 Authors own images

Image 5a orangeGrove4 [Image] . http://www.flaghouse.com/orangeGrove.asp (accessed 17 August 2007).Image 5b Snoezelen [Image] . http://www.gemm.nl/2003/12/de_hele_wereld_snoezelt.php (accessed 8

Nov 2007).Image 5c Snoezelruitme [Image] . http://library.thinkquest.org/04oct/00880/jobs/homejobs.htm (accessed 7

July 2007).

Image 6 Birth [Image] . http://i68.photobucket.com/albums/i11/midwifemama/birth4.jpg (accessed 8 Nov2007).



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Image 7 River Ridge East Birth Centre NZ Hamilton . http://www.riverridgeeastbc.co.nz/ (accessed 15August 2007).

Image 8 Authors own image

Image 9a . Edinburgh Interior [Image}.http://www.maggiescentres.org/maggies/maggiescentres/home/centres/edinburgh/introduction.html(accessed 14 August 2007).

Image 9b Maggies Centre, Glasgow [Image].http://www.glasgowarchitecture.co.uk/maggies_glasgow.htm(accessed 15 June 2007).







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Appendix A

alternative birthing centre - margret hurrelbrink

Documents