alternative birthing centre - margret hurrelbrink
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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: ……………………………………………
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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
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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
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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?”
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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).
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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.
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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).
Image 10 Authors own image
Image 11 Authors own image
Image 12 Authors own image
Image 13 Authors own image
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Appendix A
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