Why is Birth a Design Problem with Kim Holden
Can rethinking and redesigning the ways birth is approached shift the outcomes of labor and birth experiences? Can it be instrumental in improving our qualities of life--in our environments, in cities, and beyond? Architect and founder of Doula x Design Kim Holden join Design and the City to explore how she sees birth as a design problem. Photo by Kate Carlton Photography
"Your hormones and your are directly affected by your surroundings and about how you're feeling physically, emotionally—all of those things. So that's why environment is so critical. You know, and thinking about what that looks like. And again, it's different for everybody, but there's so much that you can do, just as a birthing person and a partner with that, but then there's a lot that I can do as an architect"
We are asking—is birth a design problem? Can rethinking and redesigning the ways birth is approached shift the outcomes of labor and birth experiences? Can it be instrumental in improving our qualities of life--in our environments, in cities, and beyond? And, as we explore how to create better cities for the next generation to work, live and play in, should we also consider the spaces in which that generation comes into this world?
It’s these questions we will explore today with Kim Holden, one of the founders of SHoP Architects, whose own birth experience led her to becoming a doula herself, and is that background in architecture that has become a lens through which she views her new practice, Doula x Design.
She is using a unique application of design to solve something not typically seen as a design problem,to help facilitate better birthing experiences for her clients by advocating for creating positive environments that support labor rather than inhibit it.
Her designer’s approach to birth focuses on everything from the scale of the individual—anatomically and physiologically—to the scale of the environment, to the archaic design of the tools and instruments that play roles in a delivery room, to the triage and post-partum hospital flows, and what those impacts look like for the person bringing new life into the world. She is here to remind us that women, and birthing people, are designed for this.
I had the honor of speaking with Kim about how she got her start in architecture, her transition away from a successful studio, what her journey into doulaship has looked like plus all the ins and outs of how we’ve gotten birth wrong for so long, and how she is applying her expertise as an architect to rethink our society’s relationship with where and how new life makes an entrance into our world.
Alexandra Siebenthal, reSITE: Hi, everyone. We're back with Design and the City. Today, we have with us, Kim Holden. Kim, thank you so much for joining. We're really excited to have you.
Kim Holden, Doula x Design: Oh, thank you. Thank you, Alexandra. Thanks for having me. I'm excited as well.
Alexandra: So before you made this transition to a Doula x Design, can you tell us what brought you to architecture and how SHoP got started?
Kim: Yeah sure, I majored in art history and studio art in college. And I wasn't really sure what I wanted to do, but I knew what I wanted it to be in a creative field. So after college, I took a job with an advertising agency, I worked for a real estate developer who had an architecture firm. And then I took classes at night in architectural design, graphic design, rendering, interior design.
And then I took the career discovery Summer Program at the GSD, the Graduate School of Design at Harvard, which simulates what first year of architecture school would be, but just in six weeks, and I loved it. And so that was the experience that led me to applying to school. And so I ended up going to Columbia in the early 90s. And that was where I met my future partners, and we started SHoP together. So we started SHoP in 1996. And so the firm was two married couples and the identical twin of one of the brothers. And it started with the five of us.
Alexandra: And, what did the evolution of SHoP look like?
Kim: Yeah, yeah, we started, like I said, tiny, it was just the five of us. I mean, we did competitions, until we landed our first project, which was Mitchell Park in Greenport, Long Island, and it was a public project. So that was sort of a crash course in how to navigate public agencies at the, you know, the local and the state levels. And at the time, we all had other jobs that we were working, to actually have an income. And then once we won that project, we realized that, if we wanted to get lift off, we needed to come together and commit to the firm, which is what we did.
And so that was 1996. And we had come together in school, and we all really respected each other, each other's work ethic. And we also had this shared idea that there was no model for the profession that was very enticing to us. We didn't really want to go the corporate direction, we didn't really want to do the whole ‘Howard Roark starving-architect’ thing. And we came out of architecture school at the tail end of the recession, so there wasn't really a lot of building going on and most of the architecture that was happening was theoretical.
It was also the beginning of digital technology, starting to be used in industries other than aerospace, and we saw that as an opportunity. And we all really just wanted to build. So the name SHoP came out of—it's an acronym for our, our names: Sharples, Holden and Pasquarelli. But it also alluded to the fact that half of the office in the beginning was a model shop, and we really wanted to figure out how to build.
So then we just started, you know, landing more projects, and we landed a project for the School of the Arts at Columbia University. And then we did the Porter House. The School of the Arts was never built, or at least not by us. But it was amazing that institution of that as our institution where we had gone with select us to be their architect. So that was really that kind of elevated us and made us think, 'okay, what we're doing is really working'.
PS1 is another project that I think most people may be familiar with, which we won the Young Architects Competition for PS1 and the Museum of Modern Art to build a temporary installation in the courtyard at PS1, which is the contemporary branch of the Museum of Modern Art. And that was where we were able to apply these concepts of digital technology in a very real way. And that also helped to put us on the map, and then that led to other things. So you look at PS1, and then you look at a project, like Barclays, and there's, there's the DNA is right there.
And so, yeah, and so then we just kept hiring people and realizing like, ‘Oh, my gosh, this is a thing, this is happening’. We all came from different backgrounds, which I think is significant in the evolution of the firm and how we approach problem solving. We all came at it from a different angle with different experiences. And that was always important. So when we were growing the firm and looking for people to hire, that was important to us that people came from all sorts of different backgrounds. We just thought that made for a much more rich and enriching and collaborative environment.
Alexandra: What are some of those major lessons that you learned from navigating that, or just biggest takeaways?
Kim: Yeah, I think that was definitely the way to go. I think that really made for SHoP's 'special sauce', if you will. You know, really seeking out each person's passion in addition to architecture, and harnessing that. But, it became more challenging to continue with that as the firm grew. It really started as a family business. And in the early years, it felt very, it felt very much like a family. But once you reach a certain point or go over a certain amount of employees, it's much harder to maintain that, and that was a real struggle.
As we started to get even larger projects like the East River Waterfront Park project, Barclays and then other towers. It was fast and furious to try to keep the DNA of the firm while also building and making sure that we had policies, and having timesheets, you know, those kinds of things. So those are very real, and human resources. We always from the very beginning, it was very important to us that we, that every employee had health insurance, that we never had an unpaid intern. And we continued with that as we grew, but it's very different, you know, with five or 10 people versus 200. And that was a big difference.
Alexandra: Yeah, I love how you say this, this DNA, what would you describe that, as that was special to your firm? What was the DNA that you guys had?
Kim Holden: I think it was… Well, we were all about performance based design. And, we sort of started when Frank Gehry was, you know, all the rage. And, you know, from our perspective, he would may be, and no disrespect to Frank Gehry and what he's created, but it was more about creating a form and then figuring out how to build it. What we tried to do was, figure out the, you know, understand the parameters, and then merge the two together. So how the structure or the space or the environment needed to perform and formed the design and the aesthetics and what it looked like.
And so that's why, you know, in the beginning, our projects all look very different. Because it wasn't about a style. We came out of Columbia at a time when Bernard Schumi was the Dean. And one of the things that was fantastic about him was that he didn't, you know, he was a deconstructivist himself, but not the doctrine that he wanted everyone to follow. He had a wide range of studio instructors and a wide range of styles, if you will, Bob Stern, Hani Rashid, Laurie Hawkinson, and Henry Smith-Miller. So it really ran the gamut.
So I think that also informed the way we approach things and about it not being about a style, but really about it being performance based. And then using technology to help us get there, to help us build that. And to help us also not only construct these things, but fabricate them, and then using that technology in the design process as well. So using that technology all throughout the process was really important to us, figuring out how to do that. And then also creating buildings that looked interesting, but that didn't cost so much more than buildings that were just kind of like rectilinear and normal. How do you do that? How do you optimize that process? I guess, early on, be economic, or maybe... efficient!
Alexandra: Yeah, it seems like you've been a trailblazer on many fronts. What ultimately made you decided to take the step of leaving your very successful firm to becoming a doula?
Kim: Yeah, sure. Great question. I have two daughters, who are teenagers now 13 and 18. My first daughter was born in 2003. And when I got pregnant, I just thought, ‘Oh, you know, I'll find an obstetrician and go to the hospital, have a baby. And that's how it's done’. Until a friend of mine said, ‘well know there are other options. You could hire a midwife, and you can have a doula’. And I you know, at that point, I thought, ‘Well, midwives isn't like for hippies?’ And, you know, ‘What's a doula?’
And so it opened up this whole world to me of other options and understanding what those options were. And realizing that I had, I had the ability to be supported in a way that would allow me to have a voice during my birth, and feel respected, and be supported and have the birth that I wanted to have. So I had a midwife and doula—and a doula is someone who supports a birthing person during pregnancy and birth and postpartum, in every way, except for medically. So physical support in terms of massage, emotional support, educational support, resources. And really, the role is to mother the mother. So I wanted to define what a doula is.
Kim: So I had a midwife, I had a doula, I went to a birth center that was affiliated with the hospital, I had my sister, and my husband was there. And I had a crazy birth experience, as birth can be. But because I had this team, surrounding me and telling me that I was amazing, and I was a superhero, and I could do it, and making me feel calm and making me feel relaxed, I had an incredibly positive birth experience. And it could have gone a number of other ways had I not had that team.
I came out of that experience with my mind blown, just completely, like, 'Wow'. It just opened my eyes to this whole other world, so much so that I briefly said to myself, 'I think I'm in the wrong profession, I should become a midwife'. And so I went down the road of like research, and I got the books, and I figured out what it would take for me to go back to school, until I snapped out of it and realize that, you know, you've got this burgeoning firm, and this, you know, amazing thing, and went to school for architecture, like, just, 'okay, get a grip'.
So then four and a half years later, I had the same dream team, very different birth experience. But again, I came out of it just so positive, and your birth experience, one's birth experience stays with you forever. And you know, it can either be positive, it can be negative, or it can be somewhere in between. So why not do whatever you can to make it as positive as you can?
I think from 2012 on,t I took on more of the role of managing partner of the firm as the firm grew, because it was important to us that one of the five original partners did that. And that was a big job, and challenging. And ultimately, that led to a whole host of other, you know, issues within the firm, and also personally. So I was married to one of the partners—Greg Pasquarelli and I were married. And that also took a toll on that relationship as well. So that was challenging.
So ultimately, I left the firm, and had no idea what I was going to do. I had no idea, but I figured it would be something in design. I left the firm at a time when, you know, the world was in a state of disarray—politically, issues with women's health care, families—there was just so much injustice, and I felt very helpless. I felt like there wasn't really anything that I could do, but I wanted to be able to do something.
So I took some time to really, you know, and I was just exhausted, I was exhausted from, you know, 20 years of just doing what I have been doing, and the juggling act, and you know, parenting and all of those things that you know, people struggle with, with personal and professional. I was just completely depleted. So I did give myself some time to remind myself who I was and reconnect with family and friends. Because I had forgotten, really, you know, what made me, me. I had just become so absorbed in the firm, and what it took to run the firm and all of that. And then that so I'm going on and on but then to a to a to a trip to Nepal, which came at the right time. So I left SHoP in November of 2017.
Kim: In January 2018, I had an opportunity to travel to Nepal. And that opportunity came about because SHoP had been working with an organization called Kids of Kathmandu, and that organization supported orphanages, or one in particular in Kathmandu. After the earthquake in April 2015, they sort of expanded their mission to include rebuilding of schools that had been destroyed by that earthquake. And just a series of coincidences led them to SHoP, and I ended up running the project, but I had never been there.
Ultimately, they asked me to be on the board. So I traveled there in the capacity as a board member. And the trip, the goals of the trip are twofold. One was to visit the schools under construction, and also the school that had been completed. And the other was to visit the orphanage and to set up health and hygiene workshops for the kids, because they had no access to anything about health, hygiene, how their bodies work, puberty—those kinds of things. And that was very impactful.
Architecture is a long game, you know, it can take months to years to see your idea become reality. What I saw in Nepal was, we set up these workshops, and then I interacted, I was there before the workshops, and then interacting with the kids. And hearing them talk about, [hearing] the boys talk about—I had no idea what a period was, I had no idea that my sisters—which is what they call each other in the orphanage, the brothers and sisters—that's what they do every month. And I saw them having a renewed understanding and respect for these girls, and for these women.
And for these girls who were like soaking up the information about how babies are made. And there was no like, you know, we're just riveted. And they, I could see them just being like, 'Wow, I can do that'. So the kind of like immediate reward of that had an impact. Again, I didn't know where this was going, but it was life altering.
Then I had this checklist of things that I wanted to be part of my next chapter and the checklist included. I want to be my own boss—because after 20 years of being my own boss, I can't, I know that I'm unemployable andI can't work for anybody else. I wanted to do something that had an impact, particularly an empowering impact for women and girls. And I wanted to be able to do something that gave me flexibility, so that I could be present for my daughters, and be able to co-parent them in that way, logistically. So that was it. And then something that involves design, ideally, you know. I kept saying, I'm going to know, when I know, I'm going to know, and I know I'm not going to force it. And then one day, the light bulb went off.
And I also had a mentor and the woman who was my doula, who I've had many conversations with, you know, after leaving SHoP. But it still never occurred to me that this is what I could do until one day all the pieces came together, and then I was off and running. Oh, sorry, and then I also thought it'd be great if I could do something that would eventually create a platform for greater advocacy, right? That would be amazing. And so you know, being able to use my kind of unique skill set, to further an idea, or a concept was very appealing to me. I just didn't know what that idea or concept was.
Alexandra: Well it really seems like you're doing just that. I think this is arguably one of the most important applications of design, being more than just pretty buildings and consumerism, but really, for creating change and impact, was there a particular an aha, moment that led you to where you are now.
Kim: So it was about the summer of 2018. And August was when the light bulb went off. So by September, I was September, October, I was doing all the research, I was taking workshops, I was reading books, I was networking, I was reaching out to try to understand as much as I could about birthwork, about what a doula is, about all of that. I knew that I could set up the business because that's, you know, my wheelhouse. And I felt very strongly that I wanted to do it, I wanted to be very professional about it, I was not going to fly by the seat of my pants. I was going to have liability insurance and I was going to make sure I set up the structure of the business properly, things like that.
So I was kind of parallel tracking the training, setting up the business, but then also trying to figure out 'Who am I? What's my brand? And what's that going to be?' and also 'What's my mission?' And then 'What's it gonna look like?' So I did all those things throughout the fall, and then into the early winter. And then in January of 2019, I launched. and then I was like, 'I've launched oh no, now I need to get clients'. And then I, so my, my first couple of clients were people who I knew, a couple of them were SHoPers.
But at the same time, then I was going to, I joined a couple of birth doula collectives, and we had speed dating events. And that was a great opportunity for me to kind of hone my pitch and figure out who I am and how I want to present myself, and what's my special sauce as a doula. And then that led me to my first client who didn't know me from before. And it was a lovely couple, Canadian, she is an architect, and he's a vet. And they took a chance on me. I had really, you know, no experience. And they took a chance on me. And they were my first real kind of clients who didn't know me from before. I had three births under my belt, and then I was off and running.
My first birth that I attended, it was just completely mind-blowing, and affirming that this is what I should be doing. So yeah, by the time COVID hit, I was literally turning clients away. And just getting more and more excited about the possibilities, and then the world shut down. And I had to take my clients, through my existing clients who were panicking, understandably. What is gonna look like? I mean, it was really scary. And it was just so anxiety-provoking for everybody, right?
But then I figured it out. I figured out how to pivot to virtual and I had this incredible support network in the doula community, the birth work community is amazing and so strong, and so like nurturing as you can imagine, because we're all nurturers and helpful. Just about how do we do this? Right? What are the policies? And what do you mean, there's a new policy that birth partners can't go into the hospitals, that's insane. You're making a birthing person go in and give birth alone? I mean, there's so much more risk in that than allowing the person to bring a support person in with them. So there was a lot to navigate.
We ultimately formed a group called Metro Doula Group COVID Response Team. And we were sourced and distributed PPE to birth communities, as well as birth workers in underserved communities who did not have access to anything. So these hospitals didn't have they didn't have PPE for their workers. And so that helped, not only those communities, but also help forge my relationships with these other doulas. And we feel not so helpless, like I was actually doing something, you know, and, and that continues to this day. So just this morning, I was out in Brooklyn, and I was picking up PPE and dropping off PPE. The need is still there. It's not as great as it was, but it's definitely still there. So I was driving all over Brooklyn this morning doing that.
And COVID has also allowed me to get a little further in terms of bringing together my birth and my design backgrounds. And so I've, you know, I've sort of teamed up with a woman who was a nurse, and now she's an architect. And so we're, you know, we have some couple projects in the works with that. Speaking to people about postpartum centers, and what that might look like, so that has kind of taken off in a way that I think that that it wouldn't have. If I [had] continued to do all these births in person, because that is real—it's not only a time commitment, but it's very draining. You know, births can go on for 36 hours, right? And then you could come sleep for six, and then you have to go off to another one. You never know when the moms are going to go into labor. So that's a silver lining, I think. So there's things happening with that, which is really exciting.
Alexandra: So, what do birth and architecture have in common?
Kim: So, birth and architecture—the common thread is design. Women have been giving birth, since the beginning of time. Our bodies are literally designed to give birth, they're designed anatomically to give birth, they're designed physiologically to give birth. And so that's something I really focus on with my clients. So there's design at the scale of the human in birth. Um, you know, the way the baby descends, and rotates engages in the pelvis, right, that's a huge part of labor that people don't talk about. There's mostly focus on the cervix dilating and effacing, but you know, understanding how you're built and how you're designed, so there's that.
Then the design of your birth environment is really important. So mammals seek a place to give birth, where they feel safe, where they have privacy, and where they are unobserved. So that's why a cat, for instance, will go in a dark place where nobody can see them with little interruption. All mammals do that. Humans are no different. So when you think about your birth, thinking about a safe environment in every way—emotionally and physically—right, you want to feel calm and relaxed and supported.
So, that looks different for everybody. Some people might feel safer birthing in a hospital, and that might actually reduce stress. Other people might want to stay at home as long as possible. But there are ways of transforming your environment no matter what it is to be more customized to your needs, and what you want your environment to be like. So that can be everything from the lighting, to sounds, smells—all of the senses can play into that.
So when you think about a labor and delivery room in a hospital in this country, your room pretty much looks the same as it would as if you were going in for [a] heart surgery or gallbladder removal. Why is that? You're not sick. A birthing person is not sick, you know, in most cases. Obviously, there are exceptions to that. But, you know, why are you going into this very institutional feeling, particularly during a pandemic, right?
So, you know, there are a lot of elements to design in that. And then scaling up even more the design of labor and delivery floors. There was a study done by Mass Design in association with, Dr. Neel Shah and Ariadne labs at Harvard, about how design affects birth outcomes. And it's an incredible study, but the long and short of it is the configuration of a labor and delivery delivery floor, and the proximity of the nurse's station to a labor and delivery room is directly correlated to the number of C-sections.
Right, so what does that mean? Also, zooming back down—instruments, tools—they look medieval, they look like torture devices—all of these things increase anxiety, and make people question their own ability to give birth. And that is significant in trying to birth because when you're going back to mammals, and what they need—privacy to be unobserved and to feel safe—that's really not an environment in a hospital where there are, you know, beeping machines, and it always feels very rushed. And it's scary, it can feel scary, and everything can feel like an emergency. So, you know, your fight or fight or flight hormones kick in, and that will slow down labor.
And then that leads to and this is a whole other conversation—maternal mortality. Maternal mortality instances and rates in this country are abysmal, particularly with black women and birthing people of color. So it's all related. And I do think it all kind of goes back to environment, and rethinking the design and the flow of labor and delivery. And trying to demedicalize what this has become, giving you back your sense of agency and making you feel dignified. I think that will ultimately lead to a positive birth experience.
Alexandra: Why do you think we've had it wrong for so long? Why has this been seen strictly as a medical issue?
Kim: Well, it's a really good question. It goes in this country. It goes back to the early 1900s when doctors were lacking in their knowledge of birth, midwives did almost all of the births. And many, most of them were black. So this was seen as an opportunity to generate revenue. And the sector in the medical profession that sort of was lacking the most, was birth.
So the introduction and the invention of instruments like forceps started this shift, and it was run by white men. And so, you know, this sort of implication was, well, this is modern, and this is new, and, don't you want to sort of be on the, you know, the cutting edge, and this is where it's all going. And, you know, why would you want to do this at home, when you can go to, you know, a nice facility to do this? So it started that shift, and then that led to, you know, using ether, to put women out completely and then extracting the baby with forceps—and that was generating revenue.
So it all kind of goes back to a financial model. And how can we generate revenue? Right, fast forward to now? Well, C-sections cost a lot more money than a regular regular vaginal birth, or certainly an unmedicated vaginal birth. So there's really not any incentive to to not continue to medicalize it in terms of the financial, the economics of it. So I think that's, that is where that's where it came from, and then it just was like a speeding train that continues to this day, but I, I think that we have an opportunity to slow it down and to stop it and to pivot, and to just at least give other, give people other options, and to educate people.
I mean, I think that oftentimes, I'm always shocked by, you know, when I'm interviewing with a new client, you know, who just, you know, top of their field, you know, incredibly knowledgeable about other topics, and know very little about birth. And that's not to say that that's in any way their fault. But I think that as a society, we don't understand our bodies, and you know, that the things that really need to be taught in sex ed and health ed aren't taught. So yeah, you can tell I have a lot to say about this.
Alexandra: Some of it seems kind of counterintuitive to me, like, Why are women laying on their backs instead of using gravity? That seems much more intuitive. So where does that come from?
Kim: So women lay on their back to give birth, because it's easier for the doctor. That's it. That's where it comes from. And it completely works against what your body wants to do. Like you were saying, you know—gravity. Women, up until recently—it's squat, squatting, or being on all fours, or whatever you feel the urge to do. Your body knows what it needs to do. So, you know, I tell my clients, you know, they said, well, we're, we don't really know how we should move and labor and birth. And I say, Well, here are some ideas. But when you really get into active labor, your body… You're going to have a mom say, ‘Oh my gosh, I have to lunge on my left side, or I have to get on all fours’—that's because that's what the pelvis needs to do to help the baby rotate, you know, and navigate its way through the birth canal. But lying on your back, that is for the convenience of the doctor.
And I will say that I do want to say there was a time and a place for everything, and we are lucky that we live in a time where medical interventions are available to you when necessary. The problem is that obstetricians, they are trained surgeons. They are trained to look at birth as a medical event, not a natural occurrence. So that's the difference.
Alexandra: I can imagine that it really affects the mother if everyone facilitating this birth to happen treats it like a medical problem--what are the psychological effects there? Like, oh, there's something wrong with me, not my body is literally designed to do this. So on that note, how, you know, how do you see design solving some of these problems?
Kim: Yeah, yeah, no, really good question. I just want to go back for a second to talk about how it affects women, because I wanted to add that there's so much that kind of erodes a woman's ability to feel like she can do this, including the nomenclature, and the words that are used surrounding women's bodies and women's health.
So for instance, you know, terms like ‘failure to progress’. Failure to progress usually just means in labor usually just means that your body is taking its time doing its thing, right? By using the word ‘failure’, you're undermining that woman's confidence. ‘Geriatric pregnancy’ is another one. It makes you sound like you're like an old lady. So this is after 35, it's called a 'geriatric pregnancy'. ‘Incompetent cervix’ is another one. ‘Hostile cervical mucus’, right? So, you know, the equivalent of this that other way, it's by contrast, imagine if low sperm count was actually described as 'sperm production failure', or 'hostile testicles'. That's the equivalent, right? So like that, it's no wonder women are like, ‘Oh, I'll just defer to the doctor’—or birthing people, 'I'll just defer to the doctor, they know best'. It's because constantly you hear these terms, on television, your own doctor, using terms like this. So, it's no wonder you're like, ‘Well, I can't do this, I need all the help I can get’, you know. So I'm sorry, I kind of veered off.
Alexandra: Actually, and I think this was something else you said, you know about the language using the term delivery? And like, you know why that kind of language really matters?
Kim: Yeah. So the word ‘delivery’ implies that the doctor or care provider is doing the work. Right? I mean, that's that, really, and you're you are birthing your baby. You have grown this human being in your body, and you are birthing your baby. Yes, there are people around who you know, will help you. And this is not to devalue, you know what your care provider does. But let's give you credit, like you are frickin doing this, you know, like, yeah, so let's say you are birthing your baby. So it's little things like that, that kind of build up and you don't even realize it, but just that, you know, but the doctor delivered my baby. No, you birthed your baby. That's a big difference.
Alexandra: Yeah, I think that's pretty important. So I guess maybe to go back to the question I had before, how do you see design solving some of these problems?
Kim: Sure. I think we have a lot to look at, in terms of prototypes, in the Western world. In much of Europe, midwives are the norm. And obstetricians only come in if there's a problem or a high risk. And with that, the environment looks very different there. So you could walk into a birthing room there, and it would look more like a yoga studio, or a spa, right? So you've got the bed hidden away. You've got birthing balls, yoga balls, what's called peanut balls, you have silks hanging from the ceiling, a little kitchenette, for you and your partner and your family or whomever your you know, your your birth partner, your doula, whomever, where you can eat and drink as you wish, which you aren't allowed to do in the hospital.
It just normalizes it, it's very cheery, sunny, and it's just like, this is normal. So we're going to come here and you're going to, you're going to be supported. And it doesn't feel like a hospital because again, you're not sick and you can wear your own clothes, you don't have to wear a johnnie.
So, it's so simple and basic and so would be so kind of easy to do. But you know, making space for the birth partner. So when I when I attend birth, and I join my clients at hospitals, the rooms are tiny. There are often no tubs and if there are, they're tiny and disgusting. Sometimes there's a place for the partner to go to sleep—like the chair will turn into a flat surface. There's often nowhere for me to go, so I'll sleep on the floor, I'll bring a yoga mat or something. It's like little things like this.
There's very little privacy. There's, you know, like it's going back to the beeping of the machines. So I'll give a real example of how environment can influence labor. I've seen this many times where a client is laboring really well at home. They're with their dog or with their partner. They're eating, drinking, watching Netflix, kind of making sure their bag is ready, going for walks. [Once] really in labor, you know, it's really kicking in. We determine it's time to go to the hospital.
And they get to the hospital. And they go check into triage, where they kind of assess you, they usually give you an exam to see how dilated you are. And then you're put into a labor and delivery room. It is very common that your labor, not only slows down, but sometimes can stop. Why is that? It's because of the change of environment. It's because you were feeling comfortable and relaxed and calm in your home. You get to a hospital, where maybe the nurse doesn't even introduce herself, right? And it feels very dehumanizing. So then, a little bit later, the nurse will come in and say, ‘Oh, your labor is really slow down, we want to augment that we want to get it going. So we're going to add some pitocin’—which is synthetic oxytocin. And oxytocin is the hormone of labor, which is also the love hormone. So indicating, you know, feeling loved and supported.
So what's happened is your fight or flight hormones have kicked in your labor stopped, you need time to get acclimated, you need time to take out your battery operated candles and have your partner or your doula kind of just give you a massage or you know, just time to kind of get used to your surroundings. But because the agenda of the hospital is very different, and they're trying to like, you know, move people through, and they come and you get, you know, you hear well, oh, failure to progress. Oh, wait, there's something wrong. Oh, yeah, I'll take the pitocin. And then the pitocin makes the contractions [stronger] and more painful than just normal contractions. So then you're going to ask for pain relief. Getting an epidural too early can slow it down, and then suddenly, you're getting a C-section.
So there's nothing wrong with the C-sections. Sometimes it's medically necessary. It's the unnecessary C-sections that I concern myself with, and trying to help my clients advocate for themselves and ask the right questions, and try to to avoid that if they can.
You know, if it's necessary, then absolutely, yes. And there are cases where that is absolutely necessary. But there's so many cases where it's not. So, your hormones are directly affected by your surroundings and about how you're feeling physically, emotionally—all of those things. So that's why environment is so critical. You know, and thinking about what that looks like. And again, it's different for everybody, but there's so much that you can do, just as a birthing person and a partner with that, but then there's a lot that I can do as an architect, and a bigger set to kind of help with that.
Alexandra: I can only imagine, so, how has your architecture practice experience influenced your approach?
Kim: I really do think that birth is similar to design and architecture in that you're solving a problem. And when you solve a problem, it's about doing the research, informing yourself, it's about project management, it's about reading a room. [In the] hospital, there's a whole cast of characters, you really have to read that room and understand kind of, like, you know, who's got an agenda and, you know, kind of be very respectful, but also advocate, right?
And that's something you do in architecture, you know, project meetings, and you know, in the office or whatever. And then it's also about navigating different parameters. So, in architecture, it might be the zoning. With your client, it might be that this person has gestational diabetes, and so how would that kind of affect their birth plan?
And so thinking about it, like taking it as a direct parallel. So like, I was just jotting this down before, pre-schematic design is getting pregnant and choosing the right care provider, which is critical. You want to be you know, on the same page as your care provider. Schematic design—maybe research, books, resources, preparing your body physically for birth exercises that you can do, prenatal visits with your doula, designed development, understanding pieces of the puzzle, you know, how you'll interact with your birth team and your partner.
And then construction documents, maybe like, putting your birth preferences together and knowing what to take to the hospital, especially during COVID, which kind of looks a little bit different. And then construction—construction administration, maybe it's it maybe that's the labor and birth right and then the punch list is all that postpartum which is so, so overlooked, particularly in this country. You know, you're sent home, you have one visit at six weeks, you know, in all those weeks leading up, you have like maybe 10 visits with your care provider.
So, it's, um, I'm using all of these skills, you know, and architecture is one of those professions that is an education that I think you can apply to anything, you can apply to any industry, any profession. Using that, and that just using my, my obsession, or passion [for] all things design and the rethinking problems.
And one other thing I want to mention is another thing that's really critical, and I don't know, I mean, this may be an extension of what I did as an architect but, informed consent, and understanding your rights as a client and a patient. And, you know, when confronted with any sort of choice to make or decision—and this can happen in architecture can happen on a construction site. I use the acronym brain—B R A I N. So B is for what are the benefits? R, what are the risks? A, what are the alternatives? I, what does your intuition say? What's your gut? And then N, what if I do nothing? or How long do I have to wait before making a decision?
So I try to help my clients, you know, again, speed the train down, hit the pause button, and nine times out of 10, you can always do that. I say, when it's an emergency in the hospital, you will know, right? You will know. But every other time, you can always say we just need to understand, and it is within your rights for your care provider to explain it in a way that you can understand. So that's something that a lot of people don't realize. So that's, that's something that we talked about as well, in our prenatal meetings.
Alexandra: So maybe could you explore this a little bit deeper—ow can some of these well designed birthing environments change, you know, qualities of life on maybe both a micro and a more macro scale?
Kim: Good question. A positive birth experience, as I was saying, before the birth experience, whatever it is, I will stay with you forever. And women who have less than positive—and I'm using women, and I should be using ‘birthing people’, using them interchangeably, but I, but just know that I want to be inclusive. Sometimes I forget. I think your birth experience will stay with you for a lifetime. Women who have less than positive birth experiences are more at risk for postpartum depression. Women who don't have the support to deal with that, it will affect them, their mental health, forever, can forever, and also just affect their family, their relationship with their partner.
I think if you get the support early on, so it starts with the positive birth, then support during postpartum, you're going to create a really solid foundation for your family, for your relationship, that will carry over into every other facet of your life, and every other facet of your community. So, you know, if we do this, and then this also carries into maternity/paternity family policies in the workplace, right? It's all related. And I think if you create a good foundation for families, you create a good foundation for life, and all of society benefits. So I think just right there, it's kind of a no brainer, and it really doesn't take a lot. I mean, that's the thing.
It just really doesn't, and there are some people who I have been connecting with who are thinking of ways to use design to kind of promote this idea and move things forward. So I don't know if you've heard of them, Designing Motherhood, so this is Michelle Millar Fisher and Amber Winick. They're in the process of putting together a book which will also be an exhibition. The book is, I think, by MIT Press and the exhibition is going to be at the Museum in Philadelphia, but it's about all things design that have to do with motherhood and labor and birth. So promoting these ideas and sort of getting it out there like that.
Your question before, Alexandra of, you know, why do women lay on their back? Why? Where does that come from? What's the derivation? Why aren't women "allowed"? And I use inverted commas here, because we have to flip the script, right? You know, with informed consent, you're not supposed to be allowing anyone to do anything, you're supposed to be asked if someone can touch you or touch your body, not saying, ‘Okay, I'm just going to do this’ or, you know, I'm going to allow you to, you know, birth, you know, on your, on your side, or whatever it is. So, starting to question a lot of these things, and where do they come from, and that's what Michelle and Amber are doing with their book.
And then there's another woman, her name is Stiliyana Minkovska, and she's in London, she's an artist, when she's just started a joint degree between the Royal College of the Arts and the Imperial College, looking at maternal health, and well being, and evaluating design—instruments and tools and things like that. So I think, you know, trying to make these connections, I think we're stronger together.
And then with Deborah Polzin-Rosenberg, she's the nurse, who is now an architect. So kind of together, I think, in building these blocks together, is ultimately going to lead us to a better place. And then also understanding the organizations. I think this was one of your questions too, about, you know, how can we affect change?
So you know, understanding how we can put pressure on the decision makers and affect real change... It does start at the local level. So there's an organization here, it's based in Brooklyn, called Movement to Birth Liberation, we meet on zoom every couple of weeks, and local officials and people running for local office are invited to come and hear about the issues facing maternity and reproductive rights and reproductive justice.
So bringing those people in, and that the platform also helps people, anyone who want to get it, who wants to get involved can fill out a form with their address and know who their local representatives are, and know what they can do to help like, write a letter or do this. Because there are people who want to help, but they don't really know what to do. So that's one way. And then there are other organizations, like Every Mother Counts, or Moms Rising, or Black Mamas Matter, that are all sort of trying to affect change and difference here.
Alexandra: Amazing. I'm glad to hear that there's like so much more of this than I mean, I think when you look at this through that lens of like—this is where everyone starts, everyone is born. And that, we go out into society, and rather, if that creates unconscious trauma. It just made me start to think about how that translates into the built environment and communities and, you know, cities, and that might be a stretch. Does that make sense?
Kim: It is not stretch at all. I mean, birth trauma is trauma, it's trauma, like any other trauma, and it is really common, and it doesn't need to be sure.
Alexandra: I think it's something to consider, really, where our conception of life is and how that translates. So thank you for sharing all that. It’s pretty powerful.
Kim: Thank you for listening, and asking the questions. Really, really appreciate it.
Alexandra: Of course. So what about the environment? Are you changing or hoping to change the kind of concrete birthing environments in hospitals?
Kim: That's what I'm trying to figure out. I'm trying to figure out how I could go about that. Right now what I'm really focused on is fact finding and gathering as much information to understand why things are the way they are. Policy wise, legislation wise, those kinds of things. You know, why is there only one Birthing Center in New York now? So, I feel that I have to understand that first.
I'm kind of parallel tracking, because you know, one, another silver silver lining of the pandemic is, and I alluded to this before, is that women are like, ‘What do you mean I have to go to the hospital to give birth and there are no other options?’ So women are starting [ask more] questions now. So there [are] more birth centers in the works, more birth centers opening. That's more accessible, that scale. And so those are things that are actually happening.
But then there's also the scale of the hospital. So that is a bigger animal, like a monster. And so I have to figure out kind of like how to get in there. So that is what I'm one of the things I'm trying to figure out—how can I affect change in that environment, in that institution. Which is, there's a lot of layers there. So COVID is making you know, it's accelerating, I think, change that maybe there was this, there were the seeds of this. I have seen a trend, I mean, in the most positive way.
There are more holistic women's health care centers popping up, both bricks and mortar and virtually. So like KindBody, as an example. That's a fertility center, and you walk in and it looks like you're going to a spa. It's a one stop shop for all things fertility and infertility. There is a center called Oola that just opened in, I think it's in Park Slope, where you can go and you can see a midwife or a therapist, or, you know, if you have a UTI, you can go see them all in one spot. And it doesn't look like a doctor's office—you walk in, it's calming and there are flowers, it just goes back to your hormones, your physiology. And so that's, I think, really good and indicative of these future trends.
And just in the last couple of weeks, there have been articles in the Washington Post, a couple days ago, the State of Doula Care, there was like a six part series. And the New York Times, there was an article on How Food Traditions Nourish New Moms. And then in Forbes, there was Wellness Designed for Home Birth. So it's being talked about, I think the moment is right, right now. And I don't know if that would have happened without COVID. Honestly, I think it has accelerated. It's been an accelerator.
These are what cities are about, this is, its families, it's you know, families are cities, so it's all kind of wrapped up together. And whether it's like the, you know, the bricks and mortar or articles or food—that's the fabric of our cities. And so to bring it back to reSITE, and what you're doing, I think that's the connection.
Nicholas Kristof just did an opinion piece in The New York Times yesterday about the thing that the city needs most is more toilets, like access for people to be able to pee, then that includes like, toddlers, like if you're a mom, and you have like two kids, and you have to like, ‘Okay, I'll go to Barnes and Noble, or I'll go to Starbucks’ or go wherever you have this in your head, like a map. Now, you can't do that anymore. And then what about the people who don't have homes? What are they doing? It's just, you know, it's, let's give people their dignity back, you shouldn't have to be peeing behind a car, like, you know. So, people are talking about these things. And I think that's really great.
Alexandra: Yeah, 100% agree. I'm feeling optimistic to see what will come out of it. So another question I had, you know, in relating to your experience in Nepal, and working and traveling there, you know, what can we learn from other cultures? And you know, how they handle birth that maybe isn't so economically motivated?
Kim: Great question. I think the common theme everywhere is women supporting women and that birth as a team sport and surrounding yourself with love. And also philosophy that this is a normal occurrence, it's not a medical event. And so all of, you know, whatever the traditions are, a lot of it has to do with food, a lot of it is focused on, well, the birth, but postpartum.
So in many cultures, even today, for the first six weeks—it's called the fourth trimester. So in some cultures, it's the first 40 days after birth, and some, it's the first 100 days—this is a lying-in period where the mother's only job—she has two jobs, to heal her body, and to nourish her baby—the community does everything else. So you're not supposed to lift a finger, basically, you're supposed to be fed.
There are certain foods that address different stages of the postpartum. So in early postpartum, your whole digestive tract has been shoved up, you know, and it's got to navigate back to where you know, it originally resides—that affects your digestion. So, there are certain foods nutritionally, [can] help with that.
But I would say another common theme is generally like, you are not lying down, you are squatting, you are sitting on a birth stool or you are hanging from a, you know, a some sort of fabric or a bar, or, you know, you see, you know, someone you know, a woman is putting a cold compress on someone else is doing massage, even acupuncture during labor can speed things up. So, it's, it takes a village—birth takes a village, and, you know, and I think, you know, it's a normal occurrence. So those are, those are the common, those are the common themes.
Alexandra: Definitely, and I just had a thought, I really want to share it with you, because I think this was like the perfect depiction of it, in how you were describing this means of giving birth, and like the physicality of how women should be positioning themselves. There's this French film on Netflix, and I can't recall its name, but basically, the premises is the gender roles are reversed. And women have all these masculine qualities, and men have more feminine ones. And there's a scene where the woman is giving birth, and she is, you know, literally hanging on to some bars on the bed or from the celing and giving birth, and then once the baby has come to the world, she's just passed on to the the men. And it's such an interesting kind of look and into really how these gender roles play out. And I think, you know, we're talking in terms of birth, it's also quite represented, so I just thought I would share that with you.
Kim: I haven’t. I would love for you to send me the name. I thought it would be.
Alexandra: Yeah, I can't think of what it is. No, it's like something... not a man. Yeah. It's, it's really clever.
Kim: Well, I mean, you know, the power and strength and empowerment that is required to birth a baby, it's just, you know, they're, you know, goddesses, fertility goddesses for a reason. You know, it's, it's, you know, your birthing person is a goddess, it really, it's just truly amazing. What we can do, and, you know, and it's a privilege to be able to do that. And I think people should be in aw of us.
There's that there's one one other thing—there's a video of a birthing elephant. And she's surrounded by all the other elephants and they surround her so that to protect her from prey to keep this off to keep it dark, and they all sway with her. And she's laboring, and that is that is that that's an ideal birth right? Like that's what it is. And so that's what we should be doing.
Alexandra: Yeah, it’s that village. So on that note, what role do you see design or urban design, providing, you know, just more inclusive infrastructure for families in cities?
Kim: When I had my first daughter, and I was navigating the city, for the first time in my life, I had appreciation for what it must be like to have a disability, and to navigate the city, with a stroller. That's right, so you know, lugging the stroller up and down the stairs—that was choice A. The other choice was getting into a really scary, smelly elevator, right? So those are the two going into the subway and then seeing a sign that says, make sure you fold your stroller up before getting onto the train. The person who wrote this has obviously never tried to take a squirming and screaming toddler out of the stroller, hold on to that kid, [and] also fold the stroller up and grab the bags that are hanging off the back of the handle before going on to the train. So, um, there's a lot of room for improvement. Right there.
And then nursing and feeding. Breastfeeding should be totally normal. And, you know, people shouldn't have to sort of go into you know, bathroom stalls to feed there. That would be like, you know, you ordering dinner and going and eating it in the bathroom stall. I mean, really?
On the one hand, I think there should be more private spaces for people who are breastfeeding to feed their babies. But on the other hand, I'm like, ‘Why do we have to hide?’ Right? You know, ‘Why can't it be out in the open?’ But, you know, there, there's a whole spectrum of how breastfeeding moms feel, and, you know, maybe they wouldn't feel like they needed privacy if it was normal. And people are like, ‘You are breastfeeding your baby. That's amazing’.
There's a story I was just reading about where a woman finally was able to go out for breakfast to a diner and she brought her toddler with her. And, or sorry, her newborn with her. And she just ordered her food, the food had just come and the baby was crying. And the baby started crying because the baby wanted to be fed. So she brought the baby to her breast, but there was no way for her to cut her meal. And this woman who was sitting next to her from the next table came over and said, ‘Can I cut your food for you?’ Right? So there's also little moments like that just sort of an awareness. Like really, little actions like that. It's all part of all part of this, right? So little, just an attitude shift and attitude change and people helping people.
Alexandra: Do you have any advice for women? I guess this is switching a little bit, but for new moms, who are also working professionals, to evolve into their new role. And this applies to women of any industry, not just architecture—but for women who want to have children while maintaining their practices or their career. Do you have any advice for that?
Kim: I do. I think hiring a doula. I mean, I'm not trying to promote myself in any way. But I really think that hiring a doula to help you navigate, what you're about to embark on is the best decision you can make other than choosing the right care provider. That your doula can customize information for you. I mean, people are busy, and get you and your new family off to a really good start. They can be there for you in the postpartum to answer your questions and encourage you and tell you're doing a good job when you feel like you're failing at everything. And just, you know, doula has been through this before, many, many times, you have not. This is your first time this is your partner's first time. So I think it's a really good investment And I do think, There are doulas available for everyone. There are pro-bono doulas. So I think that's the first thing that I would suggest.
The second is having a mentor or mentors, other women who have gone through this and who you feel comfortable going to for advice about how to juggle everything from, you know—what's the best playground to go to. I need a nanny—how can I hire a nanny? or, you know, I think my child has a tongue tie, who do I go to? So there's that. And then also finding your people, finding your community. And it's even during COVID, there are ways of doing that while you're pregnant. And it's easier to do it while you're pregnant, because after you're pregnant, it's because you're so busy with the baby. But childbirth classes, there are all sorts of like mom’s groups in different neighborhoods around the city, and in every city these exist. And so that's one of the benefits of living in the digital age. You can find your people that way.
You know it really, and don't try to be a hero. I know that I did at times try to be a hero, and I didn't ask for help when I needed it. I wish I'd asked for help more. And just acknowledge that yeah, I couldn't do everything. And then the last one is remember who you are, remember who you are as a person, remember, you know when you become a mother, you're not just a mother. You're still yourself but so often that gets buried. Remember who you are and guard that fiercely You know, it may look a little bit different, a little less of you than it was before, but guard that fiercely.
Alexandra: Yeah, that's great advice. So maybe one of the last questions I have is now that you've really stepped out of a traditional architecture practice and have begun looking at this specific problem through the lens of design, have you started to see other problems that can be solved with design through a similar approach? I know, you're very focused on the doula aspect, but I'm just curious if that stimulated any other thoughts or, you know, inspired anything?
Kim: Every day, I think of new ways that I can apply design to, to women's health and birth and design. It just, there's so much possibility and so much potential. So, yes, I'm sure. There's so many examples of that. When I think about my graduating class at Columbia, so many people went outside of the field of architecture, and are excelling in their fields, whether it's jewelry design, or film, or, you know, whatever it is, and they're applying their design skills to be the best in their industry. So that's something that you know, just to say, to design an architecture student or architecture students. So, but yeah, I'm so focused on my, on what I'm doing that.
Alexandra: I really appreciate this, that you've shared, like this journey with us, and that you've, you've gone through this and really kind of stepped out of a really successful architecture practice. And then just, like, felt that that pull towards something you felt really passionate about. And I think a lot of other people might relate to that and be inspired. I hope. And I love this narrative to have, you know, not just being an architect, but being a multi dimensional, multi dimensional person and multidisciplinary focused. I think it's really inspiring.
Kim: Thank you so much for asking all the right questions and providing a platform for all of these issues, which are so important. And you know, the more we talk about this, and the more women and birthing people demand it, the more likely things will change. And that can be just as small as going into your care provider and asking questions, right? Is there nitric oxide at the hospital? And if not, why not? Right? There's so much that you can do, that's easy, but know that when it comes to birth, you want to be the boss of your own birth, you want to have the right team. And your body was designed to do this. In most cases, obviously, there are exceptions, but in most cases, your body is designed to do this.
And you can do this in the way that you want. And not be judged, whatever your birth looks like, but make sure you have the right team, make sure you have [the right] resources and make sure that you know how to advocate for yourself.
Alexandra: 100% So on that note, do you have anything else you don't feel like we didn't touch on or you would like to share or go into?
Kim: Oh, yeah, I did want to say one other thing, and that's just with regard to COVID and accelerating some of these trends and ideas. I think that this, um, you know, working from home and zoom meetings, and it's great because it provides more flexibility. And despite all of the challenges that women in particular are experiencing with trying to balance, you know, homeschooling their children, while doing a job, while doing the housework. I do think that it has been very humanizing. You know, when someone's cat steps across their keyboard or someone's little kid runs into the room during a meeting. It shows that we're kind of all in the same boat, so why are we hiding that when we're in the workplace? Right? I mean, this is reality. This is life. Life is messy. So I do hope that continues and I don't I hope that we don't go back to the way things were, I hope that there's more of this humanity.
Alexandra: Absolutely. Me too. That's a great note to end on. Thank you so much, Kim for joining us. This was so powerful and I'm really excited about this conversation. I think it's super important and you know, I'm glad to hear more people are having it. But it's, it's not enough. I want this to just be the norm. So, thank you.
Kim: Normalize birth, that's my end quote. Normalize, normalize and rebrand birth.
Looking at birth through the lens of design gives us the opportunity to push its boundaries, to rethink how external environments impact well-being, and to consider that environment as the deliverer of new generations … It's a unique application onto something not typically seen as a design problem that begs the question—what other issues in our society can we address through design?
This episode was produced by myself, Alexandra Siebenthal with the support of Martin Barry and Radka Ondrackova as well as Nano Energies, the Czech Ministry of Culture and Project Syndicate. It was recorded in the reSITE office in Prague and edited by LittleBig Studio.
Cover photo by Kate Carlton Photography
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