ABSTRACT 
 
 
 

 
Title of Thesis: FIGHTING MATERNAL MORTALITY: 

INVESTIGATING THE INFLUENCE OF 
ARCHITECTURE ON WOMENS HEALTH 
AND WELLNESS 

  
 Amanda Nicole Sparks, Master of Architecture, 

2023 
  
Thesis Directed By: Associate Clinical Professor, Michael Abrams, 

School of Architecture Planning and 
Preservation 

 
 

Every year 700 women die of pregnancy related complications in the United 

States and it is estimated that half of these deaths are preventable. The maternal 

mortality rate (MMR), in the US is steadily rising. Making Newark, NJ (home of 

Rutgers University and Hospital) an ideal site for investigation. 

This thesis seeks to explore how the use of community based and empathetic 

design, providing equitable access to nature, and life cycle planning strategies could 

improve care and redefine how we think about women’s health care in the United 

States. To understand the complex topic of Maternal Mortality exploration into 

medical history, healthcare practices, the statistics surrounding Maternal Mortality 

Rate, and Postpartum Depression are necessary. While architecture alone cannot fix 

the problem of maternal mortality in the United States, reimagining the spaces in 



  

which care is provided to mothers can provide a framework for changing our cultural 

beliefs and attitudes toward women’s health and wellness. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

FIGHTING MATERNAL MORTALITY: INVESTIGATING THE INFLUENCE 
OF ARCHITECTURE ON WOMENS HEALTH AND WELLNESS    

 
 
 

by 
 
 

Amanda Nicole Sparks 
 
 
 
 
 

Thesis submitted to the Faculty of the Graduate School of the  
University of Maryland, College Park, in partial fulfillment 

of the requirements for the degree of 
Masters in Architecture 

2023 
 
 
 
 
 
Advisory Committee: 
Professor Michael Abrams, Chair 
Professor Brian Kelly, Committee Member 
Professor Ronit Eisenbach, Committee Member 



  

 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

© Copyright by 
Amanda Sparks 

2023 
 
 
 
 
 
 
 
 
 
 
 
 
 



 

 

ii 
 

Table of Contents 
 
 
 
 
 
Table of Contents .......................................................................................................... ii 
List of Figures .............................................................................................................. iv 
Chapter 1: Healthcare and Women ............................................................................... 1 

Women and Medical History .................................................................................... 1 
Ancient Times ....................................................................................................... 1 

Medical Bias ............................................................................................................. 4 
Overview of Bias .................................................................................................. 4 
Bias Against Women ............................................................................................ 5 
Racial Bias ............................................................................................................ 6 

Health and Wellness ................................................................................................. 7 
Differentiating Health from Wellness ................................................................... 7 

Chapter 2: Maternal Mortality ...................................................................................... 9 
What is Maternal Mortality ....................................................................................... 9 

Trends in the United States ................................................................................... 9 
World Trends ...................................................................................................... 13 

Reliability of Maternal Mortality Calculations ....................................................... 14 
Calculation Methods ........................................................................................... 14 
Moving Forward ................................................................................................. 15 

Chapter 3: Trends in Obstetrics .................................................................................. 16 
What is the Status Quo? .......................................................................................... 16 

1920-2019 Women, Childbirth, and the Medical Profession ............................. 16 
Understanding Alternative and Supplemental Care ................................................ 22 

Why seek Alternative or Supplemental Care? .................................................... 22 
Midwives............................................................................................................. 24 
Doulas ................................................................................................................. 25 
Sanhujori ............................................................................................................. 26 

Chapter 4: Postpartum Depression .............................................................................. 30 
What is Postpartum Depression? ............................................................................ 30 
Understanding Culture and PPD ............................................................................. 33 

Chapter 5: Architectural Precedents ........................................................................... 34 
Understanding Process ............................................................................................ 35 

Inspiration vs Analysis ........................................................................................ 35 
Reverse Engineering Program ............................................................................ 35 
Program Conclusions .......................................................................................... 40 

Hospitals and Healthcare ........................................................................................ 42 
Community Buildings and Spaces .......................................................................... 46 

Chapter 6:  Understanding Newark, NJ ...................................................................... 51 
Newark’s History .................................................................................................... 51 
The Demographics of Newark ................................................................................ 56 



 

 

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Chapter 7: Site Analysis.............................................................................................. 58 
Site Selection and Existing Conditions ................................................................... 58 

Site Selection ...................................................................................................... 58 
Preliminary Analysis and Documentation .......................................................... 63 

Chapter 8: Research Conclusions ............................................................................... 64 
Bibliography ............................................................................................................... 66 
 
 
 
 



 

 

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List of Figures  

Figure 1, Marble plaque showing parturition scene, Ostia, Italy, 400 B (Source: 
Science Museum, London) ........................................................................................... 3 
Figure 2, Health VS Wellness (Source: Author) .......................................................... 8 
Figure 3, Trends in pregnancy-related mortality in the United States: 1987-2015 
(Centers for Disease Control and Prevention) ............................................................ 10 
Figure 4, Causes of pregnancy-related death in the United States: 2011-2015 (Centers 
for Disease Control and Prevention) ........................................................................... 11 
Figure 5, Maternal mortality rates by state (Source: Ungar/Simon, USA Today, 
10/26) .......................................................................................................................... 12 
Figure 6, Maternal mortality ratio (MMR, maternal deaths per 100 000 live births), 
2017 (World Health Organization 2019) .................................................................... 13 
Figure 7, A patient in twilight sleep ready for examination, (Scopolamine-Morphine 
Anesthesia/Public Domain) ........................................................................................ 17 
Figure 8, A woman thrashing on a hospital bed during childbirth in 1944, (Alfred 
Eisenstaedt/The Life Picture Collection/Getty Images) ............................................. 18 
Figure 9, A patient prepared for twilight sleep, (Scopolamine-Morphine 
Anesthesia/Public Domain) ........................................................................................ 19 
Figure 10, Maternal morbidity, by method of delivery and previous cesarean history: 
41-state and District of Columbia reporting area, 2013, (Centers for Disease Control 
and Prevention) ........................................................................................................... 20 
Figure 11, Overall cesarean delivery and low risk cesarean delivery: United States, 
Final 1990-2012 and preliminary 2013, (Centers for Disease Control and Prevention)
..................................................................................................................................... 21 
Figure 12, Gateshead Health Midwives, (NHS, Gateshead Health) ........................... 24 
Figure 13, Midwife and new Mom, (NHS, University Hospitals Birmingham, NHS 
Foundation Trust Midwifery Awards) ........................................................................ 25 
Figure 14, Doulas offer support through the end of pregnancy, in the delivery room, 
and beyond. May is National Doula Month, (www.sheknows.com) .......................... 26 
Figure 15, Cultural ideas of balance and comfort can impact a women’s health and 
healing process, (Author) ............................................................................................ 28 
Figure 16, 11/21/2018 – Masterful handling of babies (and delicious steamed Korean 
sweet potato snack), (Joy Lee) .................................................................................... 29 
Figure 17, Depressed Mother, (Photo by napatcha/ Adobe Stock) ............................. 30 
Figure 18, Emotional Distress and Postpartum Depression in Women, (Author with 
use of Meta-Chart) ...................................................................................................... 31 
Figure 19, Mother and baby, (NeuroscienceNews.com, image is adapted from the 
Harvard press release.) ................................................................................................ 32 
Figure 20, Sibley Memorial Labor and Delivery Floor, (Wilmot Sanz) .................... 36 
Figure 21, Sibley Memorial Post-Partum Floor, (Wilmot Sanz) ................................ 37 
Figure 22, Sibley Memorial Maternity Program, (Author) ......................................... 38 
Figure 23, Breal-Sous Vitre Public Center, (Arch Daily from Atelier 56S) ............... 39 
Figure 24, Breal-Sous Vitre Public Center Program, (Author) .................................. 40 



 

 

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Figure 25, Minimum Proposed Program, (Author) .................................................... 41 
Figure 26, Minimum Proposed Program Graphic, (Author) ....................................... 42 
Figure 27, Wuxi Women’s and Children’s Hospital, (Perkins Eastman) ................... 43 
Figure 28, Inova Women’s Hospital, (Wilmot Sanz) ................................................. 44 
Figure 29, VCU Medical Center, Virginia Treatment Center for Children, (Cannon 
Design) ........................................................................................................................ 45 
Figure 30, VCU Medical Center, Virginia Treatment Center for Children, (Cannon 
Design) ........................................................................................................................ 45 
Figure 31, LocHal Library, (Civic Architecture) ........................................................ 46 
Figure 32, LocHal Library, (Civic Architecture) ........................................................ 47 
Figure 33, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo 
Architects) ................................................................................................................... 48 
Figure 34, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo 
Architects) ................................................................................................................... 48 
Figure 35, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo 
Architects) ................................................................................................................... 49 
Figure 36, Our Town on Passaick River, (“The History of Newark, New Jersey : 
Being a Narrative of Its Rise and Progress, from the Settlement in May, 1666, by 
Emigrants from Connecticut, to the Present Time, Including a Sketch of the Press of 
Newark, from 1791 to 1878”) ..................................................................................... 51 
Figure 37, Newark, NJ, (Author with use of Google Earth) ....................................... 53 
Figure 38, The National Guard on Springfield Avenue in Newark on July 14, 1967, 
(Don Hogan Charles/The New York Times) .............................................................. 54 
Figure 39, An injured rioter with the police, (Hulton Archive, via Getty Images) .... 55 
Figure 40, Race Distribution of Newark, NJ, (Author with use of Meta-Chart) ........ 57 
Figure 41, Initial Site Evaluations and Scoring (Author) ........................................... 59 
Figure 42, All Potential sites in Newark, NJ, (Author with use of Google Earth) ..... 60 
Figure 43, Rutgers University Hospital, (Author with use of Google Earth) ............. 61 
Figure 44, Final Site, (Author with use of Google Earth) .......................................... 62 
Figure 45, Zoning Diagram, (Author with use of Google Earth) ............................... 63 
Figure 46, Street Hierarchy, (Author with use of Google Earth) ................................ 64 

  



 

 

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Chapter 1: Healthcare and Women 

 

Women and Medical History 

Ancient Times 

 From ancient times women have played an important role in medicine and 

especially with the process of childbirth. The extent to which women were formally 

involved with the process of healing, however, varied greatly depending on culture 

and historic era. 1 

 In ancient Egypt one of the key Egyptian goddesses, Isis, was associated with 

healing. As a result, during the Dynastic period of Egyptian history (3100-2686 BC) 

the priestesses of Isis were also formal healers.2 As Egyptian culture changed, 

however, medicine became less associated with religion and women lost their formal 

roles as healers. Additionally, with the rise of embalming (a field that was exclusive 

to men) knowledge of anatomy expanded, although that knowledge was limited to 

men only.3 Thus, further excluding women from formal knowledge and involvement 

in the medical field.  

 In ancient Greece schools of medicine and healing were also limited to men, 

although evidence suggests that women were not excluded from practicing healing 

and midwifery.4 In Greek society women typically had fewer rights then men, this 

 
1 Bourdillon, Hilary. 1988. Women As Healers : A History of Women and Medicine. Women in 
History. Cambridge England: Cambridge University Press. 
2 Bourdillon, Hilary 
3 Bourdillon, Hilary 
4 Bourdillon, Hilary 



 

 

2 
 

prevented them from attending formal Greek schooling. Evidence shows, on the other 

hand, that women did partake in healing and midwifery and were respected for those 

skills.5 Although likely a women’s education in healing was orally passed down from 

one woman to another. The nature of women healers was similar in Roman times 

where we know that there were midwifes and some female healers, but that women 

were not considered to be physicians (a male role). 6 

 Into the 14th century women typically managed the healing of ailments within 

the home as well as practicing midwifery. With some midwives from the middle ages, 

like Margery Cobbe, being famous for their skills among royalty.7 During this period 

some women even wrote guides to help in the teaching of midwifery. One woman, 

Trotula of Salerno Italy wrote a book title the Diseases of Women, which survives to 

this day.8 In fact, during the middle ages Salerno Italy was site of a famous medical 

school which did admit both men and women, although there were fewer women than 

men studying.9 The women which had access to this kind of education were noble 

women of a high societal and economic class. This freedom of women to study and 

even be licensed to practice medicine in the middle ages did not extend to northern 

Europe, France or England where women were not permitted into Universities.10 

Although this does not mean that no women practiced medicine or healing in northern 

Europe, England or France. Monastic and parliamentary records from the time period 

show the employment of “wise women” and women healers.  

 
5 Bourdillon, Hilary 
6 Bourdillon, Hilary 
7 Bourdillon, Hilary 
8 Bourdillon, Hilary 
9 Bourdillon, Hilary 
10 Bourdillon, Hilary 



 

 

3 
 

 From the 14th century and onward the idea of women as doctors, surgeons, 

medical professionals, or licensed healers became increasingly unpopular and even 

criminalized.  Women continued to heal their families and act as midwives but were 

generally not permitted to practice healing formally or professionally.11 Eventually 

the fear of witches took over Europe and England and this put women and women 

healers in danger of accusation. The vast majority of people accused and tried of 

witchcraft were women. Healers were particularly vulnerable to accusation because 

as unlicensed healers it was believed that they could only have gotten their healing 

powers and knowledge from the devil himself. 12 

 

Figure 1, Marble plaque showing parturition scene, Ostia, Italy, 400 B (Source: Science Museum, London) 

 
11 Bourdillon, Hilary 
12 Bourdillon, Hilary 



 

 

4 
 

 Despite the significant passage of time the gradual exclusion of women from 

the formal medical profession in the past echoes in the present. Medical bias against 

women is still struggled with today and women still are underrepresented in the 

medical field. Ultimately, the wrongs of the past formed a strong bedrock for 

discrimination and mistreatment of women in the present day. Following chapters 

will explore medical bias as well as more recent examples of modern day injustices 

against mothers that have contributed to a feeling of distrust that is driving many 

women to seek alternative health care and support. 

Medical Bias 

Overview of Bias 

 Bias effects how we interpret information. Our subjective perception of 

information, how we seek information out, or what information we ignore all 

constitutes bias. There are many ways that bias can be manifested and when 

subjective interpretation of information occurs it is hard to rule out bias as a factor in 

the conclusions drawn from information. In fact, searching for specific information in 

and of itself is a form of bias.13 However, biased information is not inherently 

incorrect and what is most important is to understand what bias is affecting the 

information, rather than ignoring the information all together. It is important to note 

that bias can be, and is often, completely subconscious. 

In the medical profession the foundation of medical study and information has 

been focused on the male body. The focus on the male body and comparative 

 
13 Kaptchuk, Ted J. "Effect Of Interpretive Bias On Research Evidence." BMJ: British Medical Journal 
326, no. 7404 (2003): 1453-455. http://www.jstor.org/stable/25454853. 



 

 

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disregard for the study of the female body reflects the commonly held belief that 

women’s bodies are essentially the same as men’s bodies but disrupted by hormones 

and female sex organs. The belief being that the female body is the same as the male 

body, just with different sex organs. Therefore, it is unnecessary to study the female 

body because understanding the male body will provide sufficient information. On 

the other hand, it is also believed that the differences in women’s bodies make them 

less suitable to medical study (i.e. drug trials). That because women have different 

hormones and sex organs, they would disrupt proper study of illnesses, procedures, or 

medication. Both assuming equality or assuming differences when that is not always 

the case is a form of bias that colors the medical profession and effects diagnoses, 

treatment, and health outcomes for both men and women.14 

Bias Against Women 

Bias against women in the medical profession appears in many different 

forms. From bias inherent in how the medical profession has historically studied and 

practiced medicine to the extent to which women are represented in the body of 

health care providers. For example, in medical textbooks there tends to be an 

inclination to prefer to study the male body rather than the female body, the exception 

being when the focus of the images is the female sexual organs. This bias against 

women in the foundational element of medical education and could be indicative of, 

and perpetuate, a larger problem.15 

 
14 Ruiz, M. Teresa, and Lois M. Verbrugge. "A Two Way View of Gender Bias in Medicine." Journal 
of Epidemiology and Community Health (1979-) 51, no. 2 (1997): 106-09. 
http://www.jstor.org/stable/25568422. 
15 "Sex and Gender Bias in Medical Textbooks." Reproductive Health Matters 3, no. 5 (1995): 144-45. 
http://www.jstor.org/stable/3775451. 



 

 

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As far as bias among medical professionals, women and especially women of 

color represent only a small portion of medical community which still tends to be 

primarily white and male. Additionally, women that are as equally qualified as their 

male counterparts tend to receive fewer opportunities or honors in the field. These 

unfortunate facts support the presence of bias against women, and women in color in 

medicine and healthcare.16 

Racial Bias 

Medical bias is also rampant against people of color, who tend not to be 

believed and who are, shockingly, also still perceived to have distinct anatomical 

characteristics that separate them from white people. In explanation, some medical 

practitioners still believe that black people have thicker skin than their white 

counterparts. This misconception is not true and the fact that such information is 

believed by anyone in healthcare services is concerning. Additionally, people of color 

tend not to be believed by medical professionals, mistrust between doctors and 

patients prevents the open dialogue that is necessary to receive quality care. This 

breakdown ends up putting patients at risk and making it harder for them to receive 

care.17 

Medical bias is a reality that effects who can enter the medical profession, 

what is studied, and what quality of care a person receives. These factors stack the 

 
16 BHATT, WASUDHA. "THE LITTLE BROWN WOMAN: Gender Discrimination in American 
Medicine." Gender and Society 27, no. 5 (2013): 659-80. http://www.jstor.org/stable/43669822. 
17 Hoffman, Kelly M., Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver. "Racial Bias in Pain 
Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between 
Blacks and Whites." Proceedings of the National Academy of Sciences of the United States of America 
113, no. 16 (2016): 4296-301. https://www.jstor.org/stable/26469319. 



 

 

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cards against women being properly represented in the field as well as in medical 

study. This directly effects the quality of care any woman can receive. Particularly in 

the case of women of color where racial bias isolates women of color and creates 

obstacles to receiving quality care, the consequences of which can be fatal. 

Understanding the existence of the biases is crucial to being able to combat them 

through proper education of women and healthcare practitioners.  

Health and Wellness 

Differentiating Health from Wellness 

 It is important for the purpose of this thesis to make a distinction between 

health and wellness. Simply put, health deals with the physical body being free from 

illness or injury. Wellness on the other hand is a wholistic term to describe the state 

of complete physical, mental and social wellbeing. The term wellness does not just 

look inward on the state of the body, mind and emotional wellbeing, but 

simultaneously looks outward at a person’s interactions with others and the world.  

This definition of wellness is supported by the World Health Organization and is the 

basis for how they define health and differentiate true health from simply being free 

of illness or injury.18 Therefore, it is possible to be healthy but not “well”. People can 

be free of illness or injury but suffering from depression or isolation.  

 
18 “Frequently Asked Questions.” World Health Organization. World Health Organization. Accessed 
October 18, 2019. https://www.who.int/about/who-we-are/frequently-asked-questions. 



 

 

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Figure 2, Health VS Wellness (Source: Author) 

 This thesis seeks to explore the concept of wellness as it applies to Maternal 

Mortality, therefore the issue is not to just provide a space in which a doctor or 

healthcare practitioner can safely perform their duties related to the health of women 

but that the environment, services, and programing of the building facilitate a 

women’s journey to achieve wellness. Ultimately, striving for wellness is a goal that 

transcends race, and socio-economic status. This thesis prioritizes total wellness for 

all women in the face of rising maternal mortality.  



 

 

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Chapter 2: Maternal Mortality 

 

What is Maternal Mortality 

Trends in the United States 

 Since the Centers for Disease Control and Prevention (CDC) began collecting 

data on maternal mortality in 1986-1987 there has been a steady rise in maternal 

deaths from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births 

in 2015.19 The CDC reports that it cannot, or has not yet, determined why the 

Maternal Mortality rate has been steadily rising. Thanks to the Pregnancy Mortality 

Surveillance System which yearly collects information from all fifty states as well as 

the District of Columbia and New York City, it has been possible to track the deaths 

of all women who died during pregnancy or up to one year after pregnancy. The death 

certificates of these women as well as the connected birth certificates or fetal death 

certificates are then used to calculate the national average.20  

 
19 “Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.” Centers for Disease 
Control and Prevention. Centers for Disease Control and Prevention. Accessed October 18, 2019. 
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-
system.htm. 
20 “Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.”  



 

 

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Figure 3, Trends in pregnancy-related mortality in the United States: 1987-2015 (Centers for Disease Control and 
Prevention) 

In recent years, the most common causes of death for mothers and pregnant 

women are infection, hemorrhage, cardiomyopathy, thrombotic pulmonary embolism, 

cardiovascular accident, hypertensive disorder of pregnancy, and amniotic fluid 

embolism. It is important to note, however, that in nearly seven percent of maternal 

deaths the cause of death is unknown. Anesthesia complications make up only .3 

percent of maternal deaths. Additionally, other undescribed cardiovascular and non-

cardiovascular conditions that are not further specified by the CDC are the two 

leading causes of death. Women with preexisting conditions like hypertension, 



 

 

11 
 

diabetes or heart problems are even more likely to die than their otherwise healthy 

counterparts.21  

Figure 4, Causes of pregnancy-related death in the United States: 2011-2015 (Centers for Disease Control and 
Prevention) 

 It’s also important to note that in the US a distinct racial disparity in maternal 

mortality exists with minorities typically dying at far greater rates then white women. 

For black women the maternal mortality rate is 42.8 deaths per 100,000 live births, 

followed by 32.5 deaths per 100,000 live births for Native American populations, and 

14.2 deaths per 100,000 live births for Asian/Pacific Islander. White women have a 

rate of 13.0 deaths per 100,000 live births while Hispanic women have a rate of 11.4 

deaths per 100,000 live births.22 These statistics suggest that racial bias plays a role in 

the quality of care and health outcomes experienced by people of color. 

 
21 “Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.” 
22 “Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.” 



 

 

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 Maternal mortality in the United States varies greatly from state to state. 

California has a maternal mortality rate of 4 per 100,000 live births, significantly 

lower than the national average. Following California, the states with the lowest 

maternal mortality are Massachusetts, Nevada, Connecticut and Colorado. On the 

other hand, Louisiana has the highest Maternal mortality with a rate of 58.1 deaths 

per 100,000 live births, shockingly higher than the national average. Following 

Louisiana, the states with the highest maternal mortality are Georgia, Indiana, 

Arkansas, and New Jersey. 23 

 

 

Figure 5, Maternal mortality rates by state (Source: Ungar/Simon, USA Today, 10/26) 

 
23 “The States with the Highest (and Lowest) Maternal Mortality, Mapped.” Advisory Board Daily 
Briefing. Advisory Board, November 9, 2018. https://www.advisory.com/daily-
briefing/2018/11/09/maternal-mortality. 



 

 

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World Trends 

 While on average maternal mortality across the globe has been gradually 

decreasing, the United States is the only developed country in the world that instead 

of a stable or decreasing maternal mortality rate, have been experiencing a steady 

increase in maternal mortality.24 

Figure 6, Maternal mortality ratio (MMR, maternal deaths per 100 000 live births), 2017 (World Health 
Organization 2019) 

 Globally in 2017 there were roughly 295,000 maternal deaths, a thirty five 

percent decrease compared to the roughly 451,000 maternal deaths that occurred in 

2000.25 This is an encouraging global trend, however, in the worlds least developed 

countries the maternal mortality rate averages at about 415 deaths per 100,000 live 

births. Comparatively, the average maternal mortality rate for Europe is 10 deaths per 

 
24 Delbanco, Suzanne, Maclaine Lehan, Thi Montalvo, and Jeffery Levin-Scherz. “The Rising U.S. 
Maternal Mortality Rate Demands Action from Employers.” Harvard Business Review. Harvard 
Business Review, June 28, 2019. https://hbr.org/2019/06/the-rising-u-s-maternal-mortality-rate-
demands-action-from-employers. 
25 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division. “PDF,” 
2019. 



 

 

14 
 

100,000 live births while places like Australia and New Zealand have maternal 

mortality rates of 7 deaths per 100,000 live births.26  This places the average maternal 

mortality rate in the United States at about double the rate of comparable developed 

countries. The World Health Organization makes a point that outside of factors such 

as migration or displacement, climate change consequences, and humanitarian crisis 

the key factor to reducing Maternal mortality is in providing competent care to 

women before, during, and after childbirth. 27 

Reliability of Maternal Mortality Calculations 

Calculation Methods 

 Maternal mortality is a ratio created by determining the number of maternal 

deaths per 100,000 live births. It’s important to note that maternal deaths are counted 

as deaths that occur during pregnancy or up to one hundred days after delivery.28 

However, some places only count maternal deaths as occurring up to forty-two days 

after delivery.29 Maternal deaths determined not to be due to pregnancy related causes 

can be excluded from data. It is important to note that the accuracy of the death 

certificates in determining and recording the cause of death is paramount to accurate 

data. Additionally, cases in which the mother is seriously injured or suffers permanent 

or long-lasting injuries related to their pregnancy or birth would not be accounted for.   

 
26 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division 
27 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division 
28 “Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC.” 
29 Delbanco, Suzanne, Maclain Lehan, Thi Montalvo, and Jeffery Levin-Scherz 



 

 

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Moving Forward 

 While on the global scale the maternal mortality of the United States may be 

low, the maternal mortality rate of the US is rising, while across much of the globe it 

is steadily decreasing. Additionally, in comparison to other developed countries, the 

United states has an unusually high maternal mortality rate. Ultimately, there is no 

clear reason why the united states is experiencing this strange increase, unlike in other 

parts of the world there are no mass migrations and displacements of people, no 

severe climate change consequences that effect daily life, and no large scale 

humanitarian crisis that are problems in other countries with high maternal mortality 

rates. This suggests that there is a failing of care before, during, and/or after 

childbirth, or that some women in the united states, despite being in an otherwise 

advanced and prosperous country, are struggling to get the care they need. As such, 

this thesis seeks to investigate ways in which architecture can facilitate both better 

access to care and better quality of care, particularly for minorities who are 

disproportionately affected.  

   



 

 

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Chapter 3: Trends in Obstetrics 
 
 
 

What is the Status Quo? 

1920-2019 Women, Childbirth, and the Medical Profession 

 As outlined earlier, practices and attitudes surrounding childbirth have 

changed a great deal over time and depending on cultural values. In developed 

countries that tend to value and follow western medical standards and practices there 

have been new thoughts and concerns raised around how women are giving birth. 

There is a tension between mothers, western medicine, doulas, and midwifes. 

Therefore, in the context of understanding and rethinking the medical care of 

expectant mothers, and expanding the idea of mothers health to the mothers total 

wellbeing, it is important to understand how the points of views of these various care 

givers and the hopes and concerns of prospective mothers.  

 During the industrial revolution in the united states home births and midwives 

became associated with the old and dirty practices of the past. Technology, hospitals, 

and doctors became associated with the future, and became the accepted place for 

births.30 Access to technology, however, does not necessarily equate to a better 

standard of care, and during this transitionary period untested medical interventions 

resulted in many complications and deaths.31 From the 1920’s to the 1960’s the 

hospital birth utilized scopolamine. Scopolamine is memory eliminating drug that 

 
30 Panazzolo, Michelle, and Ritchlyn Mohammed. "Birthing Trends in American Society and Women's 
Choices." Race, Gender & Class 18, no. 3/4 (2011): 268-83. www.jstor.org/stable/43496848. 
31 "Birthing Trends in American Society and Women's Choices." 



 

 

17 
 

takes away a person’s awareness and self-control. The use of scopolamine in births 

put women into a “twilight sleep” where women fully experienced the pain of 

childbirth while being robbed of their autonomy.32 During a scopolamine birth 

women were strapped into “twilight sleep cribs” delivery beds complete with padding 

and restraints in order to limit the damage that a women could do to themselves 

through violent thrashing, a side effect of the drug induced haze the women were 

experiencing.33 Eventually, the danger and harm of scopolamine became recognized, 

aided by the public outcry of women, and it became illegal to administer scopolamine 

to a pregnant woman.34 

 

Figure 7, A patient in twilight sleep ready for examination, (Scopolamine-Morphine Anesthesia/Public Domain) 

 

 
32 "Birthing Trends in American Society and Women's Choices." 
33 Aron, Nina Renata. “Restraints, Hallucinations, and Forgotten Pain Were the Norm on Midcentury 
Maternity Wards.” Medium. Timeline, January 17, 2018. https://timeline.com/restraints-hallucinations-
and-forgotten-pain-were-the-norm-on-midcentury-maternity-wards-46909123c4f7. 
34 “Restraints, Hallucinations, and Forgotten Pain Were the Norm on Midcentury Maternity Wards.” 



 

 

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Figure 8, A woman thrashing on a hospital bed during childbirth in 1944, (Alfred Eisenstaedt/The Life Picture 
Collection/Getty Images) 

 



 

 

19 
 

 

Figure 9, A patient prepared for twilight sleep, (Scopolamine-Morphine Anesthesia/Public Domain) 

 As a strong reaction against the birthing practices of the 1920-1960’s between 

the 1960’s and 70’s there came a resurgence in the popularity of home births and a 



 

 

20 
 

change in how medical births are performed.35 Ultimately, however, most American 

women still give birth in hospitals to this day.  

According to the CDC there were 2,621,010 vaginal deliveries in the United 

States in 2017 while caesarian deliveries accounted for 1,232,339 births, meaning that 

32% of all births in the united states were c-sections.36 Statistics show that the risk of 

needing a transfusion, having a ruptured uterus, unplanned hysterectomy (surgical 

removal of the uterus), or being admitted to the intensive care unit drastically 

increases when a woman has a c-section.37  

Figure 10, Maternal morbidity, by method of delivery and previous cesarean history: 41-state and District of 
Columbia reporting area, 2013, (Centers for Disease Control and Prevention) 

 
35 "Birthing Trends in American Society and Women's Choices." 
36 Martin, Joyce A, Brady E Hamilton, Michelle JK Osterman, Anne K Driscoll, and Patrick Drake. 
“PDF,” November 7, 2018. 
37 Curtin, Sally C, Kimberly D Gregory, Lisa M Korst, and Sayeedha F.G. Uddin. “PDF,” May 20, 
2015. 



 

 

21 
 

While some c-sections are medically necessary, the rate of c-sections in the United 

States suggest that some c-sections performed on women are medically 

unnecessary.38  

 

Figure 11, Overall cesarean delivery and low risk cesarean delivery: United States, Final 1990-2012 and 
preliminary 2013, (Centers for Disease Control and Prevention) 

 

When coupled with the facts that c-sections pose greater risks to women, are harder to 

recover from, and make successive pregnancies more dangerous as well, when 

possible low risk and healthy mothers should strive for vaginal delivers. Vaginal 

 
38 Osterman, Michelle JK, and Joyce A Martin. “PDF,” November 5, 2014. 



 

 

22 
 

deliveries can be natural or aided with the help of contraction causing medicine and 

pain relief.  

While things have come a long way in terms of women’s overall health and 

wellbeing in birthing practices since the days of scopolamine, an event that was 

traumatizing for many and robbed all women of their autonomy during birth, the rise 

in maternal mortality in the United States and the high rate c-sections shows that the 

system is still failing to provide women with healthcare that supports a mothers total 

wellbeing. Ultimately, in recent years the popularity of midwifes, doulas, and home 

births have increased as women seek a more holistic form of care.  

 

Understanding Alternative and Supplemental Care 

Why seek Alternative or Supplemental Care? 

 Increased interest in and use of alternative or supplemental care for births such 

as; home births, use of birth centers, the use of a doula, and/or the use of a midwife 

have been on the rise in many developed countries that otherwise utilize modern 

western medicine like the United States, The United Kingdom, and Australia.  

Overall, many women seem to be motivated by the desire to be more comfortable and 

have more control over their birth experience.39 Other women are motivated by 

personal traumatic experiences or wanting to avoid “unnecessary intervention” by 

doctors.40 The danger with women fearing or avoiding medical intervention is that a 

woman could find herself in a dangerous labor and not be able to get the medical 

 
39 Dannaway, Jasan, and Hans Peter Dietz. "Unassisted Childbirth: Why Mothers Are Leaving the 
System." Journal of Medical Ethics 40, no. 12 (2014): 817-20. www.jstor.org/stable/43283198. 
40 "Unassisted Childbirth: Why Mothers Are Leaving the System." 



 

 

23 
 

attention she needs when it is necessary. Better education of pregnant women is 

necessary to make sure they can make the best decisions for their health.41 On the side 

of the medical profession, greater education and understanding of women’s fears are 

needed, along with outreach to help improve women’s relationships with doctors and 

hospitals.  

 Women’s need for more personalized care has been recognized by the United 

Kingdom’s National Health Service. The NHS determined that women need to be 

offered more personalized pregnancies and concluded that in low risk pregnancies the 

best qualified professional to provide that personalized care was a midwife.42 

Additionally, the United Kingdom has in place the Patients Charter, which 

emphasizes the rights of patients and establishes a clear standard of care.43 

Ultimately, the patient centered care offered by midwives has become increasingly 

interesting to American patients who are used to the physician centered care offered 

by western hospitals.44 

 
41 "Unassisted Childbirth: Why Mothers Are Leaving the System." 
42 Mejia, A., R. Shirazi, R. Beech, and D. Balmer. "Planning Midwifery Services to Deliver Continuity 
of Care." The Journal of the Operational Research Society 49, no. 1 (1998): 33-41. 
doi:10.2307/3010651. 
43 "Planning Midwifery Services to Deliver Continuity of Care." 
44 KANG-WANG, JANET F. "The Midwife in Taiwan: An Alternative Model for Maternity Care." 
Human Organization 39, no. 1 (1980): 70-79. www.jstor.org/stable/44125571. 



 

 

24 
 

 

Figure 12, Gateshead Health Midwives, (NHS, Gateshead Health) 

Midwives 

 Midwives are defined as “a person who assists women in childbirth”.45 

Midwives focus on vaginal childbirth and typically have formal medical training. 

Births lead or attended to by midwives can occur in a hospital, clinical 

setting/birthing center, or at the home. Midwifery is regulated on a state by state basis 

across the US. There are organizations, however, that operate internationally like the 

International Confederation of Midwives or at the national level like the United States 

Midwifery Education, Regulation Association that try to create standards of care, 

conduct and ethics for midwives.46  

 
45 “Midwife.” Merriam-Webster. Merriam-Webster. Accessed December 13, 2019. 
https://www.merriam-webster.com/dictionary/midwife. 
46 Kennedy, Holly Powell, Jo Anne Myers‐Ciecko, Katherine Camacho Carr, Ginger Breedlove, Tanya 
Bailey, Marinah V. Farrell, Mary Lawlor, and Ida Darragh. “United States Model Midwifery 
Legislation and Regulation: Development of a Consensus Document.” Wiley Online Library. John 



 

 

25 
 

 

Figure 13, Midwife and new Mom, (NHS, University Hospitals Birmingham, NHS Foundation Trust Midwifery 
Awards) 

Modern midwifery is an extension of ancient practice and time-honored 

tradition; however, formal medical training is now essential to the profession. Formal 

medical training, in tandem with the personalized relationship and patient centered 

care provided by midwifes are being recognized for the quality of care and support 

midwives can provide to women with low risk pregnancies. The benefits of trained 

midwifes, both to patients and healthcare systems, have been recognized in places 

like the United Kingdom. It is important to note, however, that adopting and 

enforcing clear standards of education and care is key to making midwifes a safe and 

reliable option for women.  

Doulas 

 Doulas are generally defined as “a person trained to provide advice, 

information, emotional support, and physical comfort to a mother before, during, and 

 
Wiley & Sons, Ltd (10.1111), February 20, 2018. 
https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.12727. 



 

 

26 
 

just after childbirth”.47 A doula’s main role is in providing emotional, physical, and 

educational support to a mother.  

 

Figure 14, Doulas offer support through the end of pregnancy, in the delivery room, and beyond. May is National 
Doula Month, (www.sheknows.com) 

Doulas are not required to have formal medical training and are therefore 

prohibited from giving medical advice to the women they help.48 In the case of doulas 

particularly, the need to establish standards of communication between doulas, 

midwives, doctors and nurses is key to providing the best emotional and physical care 

for a mother. 

Sanhujori 

 While midwives and doulas are becoming more mainstream in western culture 

the physician centered paradigm of western medicine is gradually moving toward a 

more holistic and patient centered approach. Other places around the world, however, 

 
47 “Doula.” Merriam-Webster. Merriam-Webster. Accessed December 13, 2019. https://www.merriam-
webster.com/dictionary/doula. 
48 “PDF,” March 29, 2017. 



 

 

27 
 

have their own ways of approaching wholistic maternal health. The Korean practice 

of Sanhujori (literally referring to postnatal care) is a cultural tradition that takes 

place after a woman has been discharged from the hospital and before her first 

postnatal doctors’ appointment up to six weeks later.49  

Following delivery women can feel overwhelmed by the experience of birth, 

motherhood, and the changes their body has gone through (as well as the recovery it 

must go through now). Sanhujori practices provide a cultural framework to attend to a 

mother’s needs. Sanhujori focuses on fostering good mental, emotional, and physical 

health through treating the body with heat (and avoiding cold), resting, eating well, 

avoiding any potentially harmful strain, keeping clean, and being provided with 

support and attention.50 These ideals and practices reflect the Korean culture/mindset 

of Korean women as well as some objectively beneficial health practices. For 

example, while avoiding cold and keeping the body warm is good for preventing 

blood clots, increasing circulation, as well as soothing muscle pain that a woman 

might be experiencing postpartum, there is a cultural element to the belief in warming 

the body as well.  

 
49 Yoo Eunkwang. "Reflections on Sanhujori: A Korean Postnatal Care Paradigm for Women’s 
Health." Asian Journal of Women's Studies 4, no. 4 (1998): 110-28. 
50 "Reflections on Sanhujori: A Korean Postnatal Care Paradigm for Women’s Health." 



 

 

28 
 

 

Figure 15, Cultural ideas of balance and comfort can impact a women’s health and healing process, (Author) 

The theory of yin and yang, simplified the belief that opposite entities create 

or maintain balance and harmony, is an overarching belief that also applies to health. 

In Sanhujori, the belief is that yin which represents cold and yang which represents 

heat must be in balance for a woman to heal and that the experience of birth throws 

off the balance in the body.51 Therefore, recovering mothers must overcompensate 

with warmth in order to recover and achieve harmony in their own bodies. As such, 

the practice of warming the body is beneficial to a woman’s health as well as relates 

to cultural ideal of balance and comfort. While there are many ways to recover from 

childbirth that would be medically appropriate (or at the very least not damaging to a 

 
51 "Reflections on Sanhujori: A Korean Postnatal Care Paradigm for Women’s Health." 



 

 

29 
 

woman’s physical recovery) for Korean women, Sanhujori is necessary to give 

themselves peace of mind and help them through their unique recovery experience.52  

 

Figure 16, 11/21/2018 – Masterful handling of babies (and delicious steamed Korean sweet potato snack), (Joy 
Lee) 

Sanhujori can take place in a special facility, in home with family, or in the 

home with a hired caregiver.53 The goal of Sanhujori is to restore women to their full 

 
52 "Reflections on Sanhujori: A Korean Postnatal Care Paradigm for Women’s Health." 
53 "Reflections on Sanhujori : A Korean Postnatal Care Paradigm for Women’s Health." 



 

 

30 
 

physical, mental, and emotional health after childbirth and ensure healthy future 

pregnancies and a long life. Continued support after birth and cultural acceptance of 

the importance of helping a woman heal and recover (mentally and physically) after 

birth gives peace of mind to the women who practice Sanhujori.54 Sanhujori provides 

an interesting cultural counterpoint to the prenatal care focused on in the west, as well 

as the fact that many women in the US do not have this framework of support and 

understanding to help them through their postpartum recovery.  

 

Chapter 4: Postpartum Depression 

 

What is Postpartum Depression? 

 

Figure 17, Depressed Mother, (Photo by napatcha/ Adobe Stock) 

 
54 "Reflections on Sanhujori: A Korean Postnatal Care Paradigm for Women’s Health." 



 

 

31 
 

Postpartum depression, also known as PPD, consists of the development of a 

depressive disorder or similar symptoms within the first year after giving birth. 

Including the typical symptoms associated with depression, PPD includes irrational 

fears for the baby and the baby’s health along with the potential to have both suicidal 

and infanticidal thoughts.55 As such, PPD is a condition that must be taken seriously 

for the sake of both mother and child.  

 

 

Figure 18, Emotional Distress and Postpartum Depression in Women, (Author with use of Meta-Chart) 

While up to 85% of women will experience some sort of emotional distress 

after birth, 10-20% of those women will experience postpartum depression. Its 

 
55 Evagorou, Olympia, Aikaterini Arvaniti, and Maria Samakouri. "Cross-Cultural Approach of 
Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions." 
Psychiatric Quarterly 87, no. 1 (2016): 129-54. doi:10.1007/s11126-015-9367-1. 



 

 

32 
 

estimated that 80% of cases of PPD will go undiagnosed and untreated.56 Leaving 

PPD undiagnosed and untreated not only puts mother and child at risk but also puts a 

huge strain on the family. A mother’s mental health and the support structure 

surrounding her are also two factors that affect how sensitive a mother will be toward 

the needs of the baby. Maternal Sensitivity describes the ability of a mother to 

correctly interpret her baby’s communication signals and respond to them 

appropriately.57 This ability to understand and respond to a child’s needs directly 

influences the ability for the mother and child to bond appropriately with one 

another.58 In other words, the mental health of the mother has a direct impact on a 

woman’s ability to correctly interpret her child’s needs.59  

Figure 19, Mother and baby, (NeuroscienceNews.com, image is adapted from the Harvard press release.) 

 
56 "Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors 
and Therapeutic Interventions." 
57 Shin, Hyunjeong, Young-Joo Park, and Mi Ja Kim. "Predictors of Maternal Sensitivity during the 
Early Postpartum Period." Journal of Advanced Nursing 55, no. 4 (2006): 425-34. doi:10.1111/j.1365-
2648.2006.03943.x. 
58 "Predictors of Maternal Sensitivity during the Early Postpartum Period." 
59 "Predictors of Maternal Sensitivity during the Early Postpartum Period." 



 

 

33 
 

The causes of PPD, however, are hard to pin down. Studies are able to point to 

some risk factors that increase a woman’s likelihood to be affected by postpartum 

depression such as a family or personal history of depression before pregnancy, lack 

of social support systems, stress when caring for the new child, having an unwanted 

or unplanned pregnancy, stressful life events, being from a lower income bracket, and 

poor relationships with one’s family.60 In the case of poor familial relationships, lack 

of a support system, and being low income, the potential causes of postpartum 

depression also stand as obstacles to getting the help necessary to deal with PPD. It is 

also important to note that being apart of a lower socio-economic class both makes a 

woman more likely to experience PPD as well as being affected by maternal 

mortality. This overlapping risk factor identifies that women of a lower socio-

economic class are a particularly vulnerable classification of women who should be in 

heavily considered in the design processes of a women’s health facility. 

 

Understanding Culture and PPD 

 
 As discussed with Sanhujori practices, cultural ideas of comfort and pain, 

right and wrong, normal and abnormal effect how an individual interprets their world 

and experiences as well as how they express those feelings to others. For example, the 

symptoms of postpartum depression and how they are described by women vary from 

country to country and culture to culture. While some women experience or describe 

 
60   "Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk 
Factors and Therapeutic Interventions." 



 

 

34 
 

more physical fatigue, others describe numbness in the head, or think that they hear 

their baby crying when it is not. This is echoed in the difference in cultural beliefs 

and practices surrounding childbirth and postpartum care. For example, the belief in 

whether or not a mother should stay home for a certain amount of time, eating a 

specific diet, or avoiding certain activities postpartum all differ greatly depending on 

where you are. In the United States women tend to describe physical symptoms of 

PPD, like fatigue, rather than admit to feelings associated with depression and mental 

illness (for fear of being stigmatized). Additionally, women in the US tend to go back 

to work as soon as possible after birth both because paid maternity leave is rare, hard 

to get, and/or that women are socially pressured to get back on their feet as soon as 

possible.  

 Despite all the different symptoms and beliefs across cultures the unifying 

factor is that women should have access to support and mental health care in a way 

that makes them feel comfortable being honest about their experience. That women 

should be able to seek help without being stigmatized.  

 While every woman would not be comfortable with or get piece of mind from 

Sanhujori practices or the special Sanhujori diets, every woman should be able to get 

the mental health support that they personally need in order to successfully recover 

from childbirth, and especially from postpartum depression.  

 

Chapter 5: Architectural Precedents 

 



 

 

35 
 

Understanding Process 

Inspiration vs Analysis 

 In order to set a framework for designing a building which takes the 

functionality of a hospital and softens it to create something more evocative of a 

community center, both hospitals and community centers needed to be studied. Some 

architectural precedents were used as a basis to establish program while others are 

inspirational precedents that are more important visually and thematically. Below is 

outlined which architectural precedents aided in developing program understanding 

while others act as a source of inspiration.  

Reverse Engineering Program 

 The process of reverse engineering a program begins with identifying a 

building or buildings that are programmatically similar to the proposed project. Then 

with the use of project documentation like building plans, the spaces of the building 

can then be categorized by their program type and the square footages can be 

determined for each program element. Analyzing the plans of an applicable precedent 

can not only determine what kind of program elements are necessary but also what 

square footages are necessary to support those program elements. For this thesis the 

maternity floors of Sibley Memorial Hospital in DC, by Wilmot Sanz were analyzed 

for hospital programing while Breal-Sous Vitre Public Center in France, by Atelier 

56S was studied to determine the program elements of a public library and 

community center.  



 

 

36 
 

 Sibley Memorial Hospital is a Leed Gold certified building of 486,000 square 

feet and 200 beds total. This hospital serves not only mothers but also cancer and 

other patient groups. As such, it is only necessary to look at the maternity ward and 

related program areas. This focused the program analysis on only two floors of Sibley 

Memorial.  

 

Figure 20, Sibley Memorial Labor and Delivery Floor, (Wilmot Sanz) 

 



 

 

37 
 

 

Figure 21, Sibley Memorial Post-Partum Floor, (Wilmot Sanz) 

The analysis of the two floors identified the program types, the total square 

footages and in the case of a program that was split between similar rooms the total 

square footages were divided by the number of rooms to give the square footage 

necessary for one room. For example, postpartum rooms took up 13,997 square feet 

divided among 46 rooms of roughly equal size which illustrates that in order to 

accommodate equipment, furniture, and staff in a typical postpartum room roughly 

304 square feet is necessary. This information can then be used to scale a maternity 

ward based on the number of certain room types needed so that program can be 

adjusted and expanded later in the design process to accommodate a certain number 

of patients.  



 

 

38 
 

 

Figure 22, Sibley Memorial Maternity Program, (Author) 

 Breal-Sous Vitre Public Center is a 7,534 square foot facility that includes a 

public center, library, recreational center, after-school activities center as well as 

outdoor spaces. Since analysis of program began before a final site was determined a 

smaller facility was used to establish base line program elements and square footages.  

  SF  #  PER 

Post‐Partum  13997  46  304 

Post‐Partum Iso  1803  4  450 

Staff and Service  19693     

Circulation  25643     

Labor and Delivery  7202  16  450 

Labor and Delivery Iso  1196  2  598 

C‐Section  2734  3  911 

Triage Recovery  2545  8  318 

Special care Nursery  3050  18  169 

Sleep Rooms  967  8  120 

Total Building  78830     

Net   53187     

       

Grossing Factor :1.48       



 

 

39 
 

 

Figure 23, Breal-Sous Vitre Public Center, (Arch Daily from Atelier 56S) 

 



 

 

40 
 

 

Figure 24, Breal-Sous Vitre Public Center Program, (Author) 

Program Conclusions 

 Based on the analysis of Sibley Memorial Hospital and Breal-Sous Vitre 

Public Center a list of minimum program elements and square footages was 

developed. The resulting information was then translated and labeled graphically to 

aid in preliminary design. 

Community  ‐  ‐  5000 

Community 
Administration 

‐  ‐  410 

Community Service  ‐  ‐  1110 

Community Restrooms  ‐  ‐  610 

Community Circulation  ‐  ‐  2000 

Outdoor Community 
Space 

‐  ‐  1430 

Family Support   ‐  ‐  1000 

Research Residency 
Apartment 

2  600  1200 

Temporary Housing for 
Women 

4  800  3200 

Cafe  1  ‐  1000‐1500 

Cafeteria  1  ‐  1000‐1500 

Child Care  1  ‐  2000 

Counseling  ‐  ‐  1000 

Legal Aid  ‐  ‐  1000 

Total Community      23000 

Total Building      53000 



 

 

41 
 

 

Figure 25, Minimum Proposed Program, (Author) 

  # Units  Per  Total SF 

Postpartum  16  300  4800 

Postpartum Iso  2  450  900 

Labor and Delivery  6  450  2700 

Labor and Delivery Iso  1  600  600 

C‐Section  1  950  950 

Triage Recovery  3  320  960 

Special Care Nursery  6  170  1020 

Sleep Rooms  3  120  360 

Health Staff and 
Service 

‐  ‐  6600 

Pharmacy  1  800  800 

Health Circulation  ‐  ‐  8550 

Exam  10  100  1000 

Total Health      30000 

Community  ‐  ‐  5000 

Community 
Administration 

‐  ‐  410 

Community Service  ‐  ‐  1110 

Community Restrooms  ‐  ‐  610 

Community Circulation  ‐  ‐  2000 

Outdoor Community 
Space 

‐  ‐  1430 

Family Support   ‐  ‐  1000 

Research Residency 
Apartment 

2  600  1200 

Temporary Housing for 
Women 

4  800  3200 

Cafe  1  ‐  1000‐1500 

Cafeteria  1  ‐  1000‐1500 

Child Care  1  ‐  2000 

Counseling  ‐  ‐  1000 

Legal Aid  ‐  ‐  1000 

Total Community      23000 

Total Building      53000 

 



 

 

42 
 

 

Figure 26, Minimum Proposed Program Graphic, (Author) 

 

Hospitals and Healthcare 

 In addition to Sibley memorial hospital, other hospitals were found that serve 

as aesthetic or thematic precedents and architectural inspiration. Wuxi Women’s and 

Children’s Hospital in Wuxi China, Inova Women’s Hospital in Falls Church 

Virginia, as well as VCU Medical Center, Virginia Treatment Center for Children, 

Replacement Facility in Richmond Virginia were all precedents that were visually 

and thematically of interest.  



 

 

43 
 

 

Figure 27, Wuxi Women’s and Children’s Hospital, (Perkins Eastman) 

 The natural campus and green roofs of the Wuxi Women’s and Children’s 

Hospital by Perkins and Eastman is thematically interesting for its use of green space. 

Views of nature and green space are shown to promote health and wellbeing for 

hospital patients.61 This hospital design seeks to provide all patients with a natural 

landscape view. The scale of the project, however, is too large to be a programmatic 

precedent for a women’s health and wellness center in Newark, NJ. 

 
61 United States. Forest Service. Urban Nature for Human Health and Well-Being : A Research 
Summary for Communicating the Health Benefits of Urban Trees and Green Space. Washington, D.C.: 
United States Department of Agriculture, Forest Service, 2018. 2018. Accessed December 14, 2019. 
INSERT-MISSING-URL. 



 

 

44 
 

 

Figure 28, Inova Women’s Hospital, (Wilmot Sanz) 

 The warm and spacious patient rooms of Inova Women’s Hospital by Wilmot 

Sanz represent an attitude toward patient experience where the goal is not only to 

provide a functional facility but a facility that also makes the patients feel at home. 

Warm colors and homey interior design details helps take away from the clinical 

feeling of the typical hospital room. In a building that seeks change the patient’s 

impression of hospitals, creating comfortable and beautify interior spaces is key.  



 

 

45 
 

 

Figure 29, VCU Medical Center, Virginia Treatment Center for Children, (Cannon Design) 

 

Figure 30, VCU Medical Center, Virginia Treatment Center for Children, (Cannon Design) 



 

 

46 
 

 Finally, the VCU Treatment Center for Children does an excellent job of 

making the facility approachable and inviting. The broken-up massing of the building 

makes the facility more approachable; this impression is aided by the landscaped 

approach and the warm wood used in both the exterior and interior. Natural light 

makes the lobby bright, inviting, and visually interesting. A health facility that is also 

a community center must be approachable and inviting for both patients and 

community members. 

Community Buildings and Spaces 

In addition to Breal-Sous Vitre Public Center, other community buildings and 

spaces were found that serve as aesthetic or thematic precedents and architectural 

inspiration. The Asia Culture Center in Gwangju, South Korea as well as the LocHal 

library in Tilburg, Netherlands were both precedents that were visually and 

thematically of interest for the community center portion of this thesis.  

 

Figure 31, LocHal Library, (Civic Architecture) 



 

 

47 
 

 

Figure 32, LocHal Library, (Civic Architecture) 

 The LocHal Library by Civic Architecture was particularly interesting for its 

central multistory space. This central community space provides vertical circulation, 

flexible seating for individuals or groups, as well as the potential to use as a gathering 

space with stadium seating. This multistory space largely lit by natural light contrasts 

industrial structure with warm wood and green hanging plants. The result is a space 

that gives priority to community space while also providing the opportunity for 

multiple space uses. Creating a double height or multistory space for important 

community spaces within the combined health and community center would help to 

promote interesting architecture and reinforce the importance of community. 

Flexibility of the community space is also key so that the community that uses the 

space can get the most use out of it as possible.  



 

 

48 
 

 

Figure 33, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo Architects) 

 

Figure 34, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo Architects) 



 

 

49 
 

 

Figure 35, The Asia Culture Center in Gwangju, South Korea, (Kyu Sung Woo Architects) 

 Finally, the Asia Culture Center in Gwangju, South Korea by Kyu Sung Woo 

Architects is a great example of harnessing nature in flexible outdoor community 

spaces. The pockets of green space help break up the huge campus of buildings while 



 

 

50 
 

providing spaces where people can sit and enjoy nature alone or in groups. Here 

landscaping is used to create space alongside architecture so that both the architecture 

and landscaping interact. Additionally, the green space provides a beautiful backdrop 

that can be framed by the architecture on the inside, creating beautiful views for 

users. Creating a variety of flexible green space will help to make the health and 

community center approachable as well as providing extra amenities for the 

community.  

 



 

 

51 
 

Chapter 6:  Understanding Newark, NJ 
 
 
 

Newark’s History 

  

 

Figure 36, Our Town on Passaick River, (“The History of Newark, New Jersey : Being a Narrative of Its Rise and 
Progress, from the Settlement in May, 1666, by Emigrants from Connecticut, to the Present Time, Including a 
Sketch of the Press of Newark, from 1791 to 1878”) 

Newark, New Jersey was first settled in May of 1666 by Puritan along the 

Passaic River.62 These conservative puritans came primarily from the Connecticut 

settlements of Branford, Guilford, and Milford of the New Haven Colony, where 

 
62 Atkinson, Joseph, and Thomas Moran. The History of Newark, New Jersey : Being a Narrative of Its 
Rise and Progress, from the Settlement in May, 1666, by Emigrants from Connecticut, to the Present 
Time, Including a Sketch of the Press of Newark, from 1791 to 1878. Newark, NJ: William B Guild, 
1878. 



 

 

52 
 

religious tolerance was increasing. The increased tolerance, especially of Quakerism, 

drove the desire of these conservatives and intolerant puritans to seek out a new home 

untainted by beliefs they were against. The establishment of the settlement by Captain 

Robert Treat, while approved of by the local Governor, was disputed be the native 

Hackensack tribe. Early Newark was a theocracy in which church rule was law and 

only church members could hold office, inherit land, or have any other civil 

liberties.63 After the American revolution the key industries in Newark were leather 

tanning, as well as shoe and jewelry manufacturing.64 Its proximity to New York and 

location on the Passaic River made it a great location for industry, which can still be 

seen along the river’s edge today.  

 
63 “1666 – The Founding of Newark.” Descendants of Founders of New Jersey. Descendants of 
Founders of New Jersey. Accessed November 16, 2019. http://www.njfounders.org/history/1666-
founding-newark. 
64 The Editors of Encyclopaedia Britannica. “Newark.” Encyclopædia Britannica. Encyclopædia 
Britannica, inc., May 15, 2019. https://www.britannica.com/place/Newark-New-Jersey. 



 

 

53 
 

 

Figure 37, Newark, NJ, (Author with use of Google Earth) 

From the 1950’s to the 1970’s the white middle class which occupied Newark 

moved further out into the suburbs, a trend happing across the United States. 

Eventually, the proportions of African Americans in Newark rose from one fifth to 

three fifths of the population in 1990.65 In 1967 riots took over Newark but progress 

was made in 1970 when Newark elected its first African American mayor.  

 
65 “Newark.” 



 

 

54 
 

 

Figure 38, The National Guard on Springfield Avenue in Newark on July 14, 1967, (Don Hogan Charles/The New 
York Times) 



 

 

55 
 

 

Figure 39, An injured rioter with the police, (Hulton Archive, via Getty Images) 

The events of the riots are remembered to this day, and it’s important to note that 

Newark still has significant poverty and health problems.6667 Newark of today is the 

 
66 “Newark.” 
67 Rojas, Rick, and Khorri Atkinson. “Five Days of Unrest That Shaped, and Haunted, Newark.” The 
New York Times. The New York Times, July 11, 2017. 
https://www.nytimes.com/2017/07/11/nyregion/newark-riots-50-years.html. 



 

 

56 
 

largest city in New Jersey, a highly industrial city with a diverse group of industries, 

Newark benefits from its proximity to New York City.  

The Demographics of Newark 

 Newark, NJ has a population around 277,000 people. Currently around 58 

percent of the population are between the ages of 18 and 65.68 With 7.5 percent of the 

population under the age of five and 24.8 percent under the age of 18.69 Only 9.7 

percent of the population 65 or older.70 The gender split is almost 50/50 with 50.6 

percent of the population being women.71 This suggests that a good amount of the 

population of Newark are women in their childbearing years. As such it is reasonable 

to say that women health services are needed in the area. Additionally, the vast 

majority of the population of Newark are minorities. Currently, 50.1 percent of the 

population is Black or African American, 36.4 percent of the population are Hispanic 

or Latino.72 Other minorities include mixed race people at 2.7 percent, Asian people 

at 1.7 percent, and native American at .6 percent.73 Only about 36 percent of 

Newark’s population is white. 74 

 
68 “U.S. Census Bureau QuickFacts.” Census Bureau QuickFacts. United States Census Bureau . 
Accessed November 16, 2019. 
https://www.census.gov/quickfacts/fact/table/newarkcitynewjersey,US/PST045218. 
69 “U.S. Census Bureau QuickFacts.” 
70 “U.S. Census Bureau QuickFacts.” 
71 “U.S. Census Bureau QuickFacts.” 
72 “U.S. Census Bureau QuickFacts.” 
73 “U.S. Census Bureau QuickFacts.” 
74 “U.S. Census Bureau QuickFacts.” 



 

 

57 
 

 

Figure 40, Race Distribution of Newark, NJ, (Author with use of Meta-Chart) 

 
As established earlier, Maternal mortality tends to be worse for women of color and 

minorities, further establishing that Newark is home to a vulnerable population of 

women. Additionally, about 28.3 percent of Newark’s population lives in poverty 

(compared to the national average of 11.8).75 Compounding that fact, while 74 

percent of Newark’s population has at least a high school degree (the national average 

being 87.3) only 14.4 percent of the population have a bachelor’s degree or higher 

(compared to 30.9 percent at the national average).76 Since women of a lower socio-

economic status are also at a greater risk of maternal death Newark is the perfect 

storm of poor Maternal mortality, compounded by a having a sizable population of 

women in their childbearing years, a high representation of minorities, as well as high 

 
75 “U.S. Census Bureau QuickFacts.” 
76 “U.S. Census Bureau QuickFacts.” 



 

 

58 
 

poverty and lower education rates. Finally, around 23.3 percent of the population is 

without health insurance, whereas the national average is less than half that at 10 

percent.77 The demographics of Newark suggest a population that is highly vulnerable 

to the problem of Maternal Mortality in the state of New Jersey. 

 
 

Chapter 7: Site Analysis 

 

Site Selection and Existing Conditions 

Site Selection 

 Between the high maternal mortality rate of New Jersey, and the high-risk 

demographic population of Newark, supported by a public transit system and 

proximity to education and large-scale health institutions, as well as an apparent need 

for community building and social architecture, Newark New Jersey would be an 

ideal location for a women’s health and wellness center. Initially, vacant or largely 

vacant, and underused lots at different scales were selected and then ranked by the 

sites in three weighted tiers. The most heavily weighted tier calculated by giving the 

site a score one through ten, ten being the best and then multiplied the score by three. 

The highest tier selection criteria were the sites proximity to transit, the walkability of 

the surrounding area, whether the site had any access to green space, and the sites 

proximity to additional amenities. The second tier, which took the scores out of ten 

and multiplied them by two consisted of how large the site was (larger being better 

 
77 “U.S. Census Bureau QuickFacts.” 



 

 

59 
 

for program scaling and flexibility), how active or urban the surrounding area is, and 

whether the site was close to medical and educational facilities that would help 

support the programing of a women’s health center. The baseline criteria, for any site 

selection was based on the maternal mortality rate of the area (higher equating to 

greater need), whether or not the demographics of the area reflected the demographics 

of a population that was particularly vulnerable to maternal mortality, as well as on 

how well the area dealt with the health of its population (worse health outcomes 

demonstrating greater need for intervention).  

 

Figure 41, Initial Site Evaluations and Scoring (Author) 



 

 

60 
 

 The potential sites consisted of blocks located at Prudential Dr and Broad St 

(site #1), North 5th St and Park Ave (site #2), Orange and Nesbitt (site #3), and 

Central Ave and Market St (site #4).  

 

Figure 42, All Potential sites in Newark, NJ, (Author with use of Google Earth) 

 

Once the design process began, however, the programmatic decision to 

exclude C-section rooms from the design (as a way to de-incentivize medically 

unnecessary c-sections) made the necessity for quick access to emergency care from 

the site the most significant driver for determining site location. As a result, the 

immediate area surrounding Rutgers University Hospital became the focus of the 

search.  



 

 

61 
 

 

 

Figure 43, Rutgers University Hospital, (Author with use of Google Earth) 

 

Immediately, a site directly across the street from the hospital entry (on 

Bergen St.) became the clear choice. Bounded by Bergen Street, 13th Ave, Camden 

St, and 12th Ave the site is currently only home to a Rite Aid, a KFC, and an IHop. 

This site creates immediate access too, and an association with Rutgers University 

Hospital. Additionally, because of the hospital’s connection to higher medical 



 

 

62 
 

education through Rutgers University, the site of the women’s health and wellness 

center can also be an educational testing ground for new practices.  

 

Figure 44, Final Site, (Author with use of Google Earth) 

 

 



 

 

63 
 

 

Preliminary Analysis and Documentation  

 As can be seen in the figure below, in addition to the Hospital and related 

buildings (shown in blue) the Bergen St and 12th Ave stie is surrounded by primarily 

residential buildings (in dark orange) with some commercial buildings (light orange) 

and civic/public buildings (yellow).  

 

Figure 45, Zoning Diagram, (Author with use of Google Earth) 

 

The busiest street that borders the site is Bergen St (indicated below in the 

darkest blue), followed by 12 Ave, then Camden St., and finally 13th Ave.  



 

 

64 
 

 

Figure 46, Street Hierarchy, (Author with use of Google Earth) 

 

Chapter 8: Research Conclusions 

 
 Maternal mortality is a serious problem in the united states. There is no clear-

cut reason why maternal mortality has been rising and congress had taken action 

recently to try and figure out this complex problem. Overly high rates of c-sections 

(which increase the risk of complications), medical bias against women and 

minorities, difficulty of accessing care, fear or distrust of medical professionals are all 

things that contribute to this problem. Additionally, the current physician healthcare 

system leaves women feeling left behind, and more and more women are seeking out 

more personalized and compassionate care. Providing personalized care is not only 

makes women feel better about their care but can also help provide a framework for 

better taking care of women, before, during, and after childbirth. Ultimately, 



 

 

65 
 

personalized care and better support networks (particularly postpartum) would help to 

identify and address not only the physical needs of women, but also their mental and 

emotional needs as well.  

 Newark, NJ is an ideal location to explore these systematic problems and how 

architecture can foster better and more holistic care, while also providing women with 

a space that does not isolate them but rather provides them with a place in which they 

can find support and community. Integrating these two program types, health and 

community, will get to the root of this exploration.  

 The history of women and childbirth is a rollercoaster, and while medical 

technology has drastically and quickly improved in recent memory, inhumane 

birthing practices were the standard in the US from 1920-1960. When made aware of 

this history, its unsurprising that there still seems to be a pervasive disconnect 

between healthcare practitioners and patients. Therefore, it is a key part of the 

program for the proposed building type that education of staff and patients, as well as 

advocacy services be provided within the same building as the community spaces and 

healthcare spaces. Thus, this thesis seeks to explore what happens and what is 

possible when health, community, and educational programs are brought together in 

one accessible space.  



 

 

66 
 

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