Empathy in architecture

A friend of mine works in a healthcare building; her office, windowless. Stark white walls frame the shiny tiled floors in the also windowless laboratory that surrounds her office. Rectangular fluorescent lighting looms eerily overhead. Working in this space for the majority of her waking hours amounts to constant longing for sunshine and an overall agitated demeanor. I imagine the architect of this space wasn’t much of an empath.

Photo by Robert Katzki on Unsplash

This effect is being documented in a growing body of research demonstrating how color, texture and patterns affect human emotions.

Generally, humans are quite robot-like, performing our daily duties without a great deal of attention paid to the building structures, layouts or designs that we move through. 

“When we don’t notice the built environment, it’s silently affirming our right to be there, our value to society. When we do, too often it is because it’s telling us we don’t belong. Those messages can be so subtle that we don’t recognize them for what they are,” Kim Tingley writes, later quoting architect Joel Sanders: “‘We sleepwalk our way through the world…Unless a building interior is strikingly different or lavish or unusual, we are unaware of it.’” 

The first time I saw a lactation pod at an airport– unusual at the time– I had mixed emotions. Part of me became excited that this was an option for traveling, lactating, pumping, and breastfeeding people, but most of me scoffed, annoyed, thinking something along the lines of: “Of course breastfeeding moms would be given this messaging to go hide themselves away from the public eye.” 

What Tingley wrote, that our built environment affirms our right to be in a space, affirms our value to society, is certainly a powerful concept. 

The COVID pandemic has forced us to think more about the built spaces we move through, adding layers to this idea of how and what and who we value.  

In a recent episode of Uniquely Milwaukee Salam Fatayer of 88Nine Radio Milwaukee poses the question: “What could our city, neighborhoods and community spaces look like if they were created based on people’s emotional, psychological and social needs?”

Photo by Coasted Media on Unsplash

Local architects and scholars answer with ideas about how they’re supporting the users of the spaces they create, with the goal of making sure people feel safe, at peace and nurtured by those built environments. 

On Our Milky Way, we’ve had the honor of highlighting the work of those thinking about how built spaces affect birth, lactation and beyond. 

For example, in conjunction with the Institute of Patient-Centered Design, Inc., The MomFriendly Network created The Lactation Design program which consists of research and outreach projects to enable the Institute to contribute design resources that  improve accommodations to support breastfeeding. Read more about this project here: https://www.ourmilkyway.org/physical-environment-influences-breastfeeding-outcomes/ 

Renée Flacking and her colleagues’ work, Closeness and separation in neonatal intensive care, explores how architecture influences outcomes in neonatal units. Single-family room designs are increasingly replacing traditional open-bay units for reasons documented in their paper.

Source: United States Breastfeeding Committee (USBC)

“This architectural structure provides the family with an opportunity to be with their child in the neonatal intensive care unit day and night providing facilities for parents’ basic needs including the need for privacy. This design has been suggested to be associated with a lower rate of hospital-acquired infections, similar to single patient rooms in adult intensive care (48), earlier full enteral nutrition, higher breastfeeding rates and a more soothing environment with, for example, lower ambient sound levels (49). As this design has been shown to reduce the length of stay in hospital significantly, for example, by 10 days in preterm infant below 30 weeks of gestation in a Swedish study (50), it shortens the time of separation for the infant from the home and family. Parents have reported that they felt that a single family room design in a NICU facilitated their presence with their infant (51), but the increase in parent–infant closeness gained by a single family room model during hospital care is not well documented in scientific literature.”

Read Our Milky Way’s coverage on this concept here

In stark contrast, attorney Leah Margulies recently shared in Protecting Breastfeeding in the United States: Time for Action on The Code that formula companies provide architectural designs to maternity care facilities in a deliberate attempt to separate dyads, making bonding and breastfeeding difficult and consequently,  families more likely to become reliant on their artificial products. It’s a sickening example of how the industry saturates our systems, down to the skeletons of our buildings.

Photo credit: Henrico County Public Library

Venturing beyond the very early postpartum period, it’s exciting to explore how community spaces are supporting young families. The Henrico County Public Library – Fairfield Area Library is accommodating families with their Computer Work + Play Stations which were conceptualized by library staff and materialized by architects at Quinn Evans and TMC Furniture staff. Read more about that inspiration and process here

Supporting lactation and breastfeeding in the workplace is a vital part of ensuring that lactating individuals feel valued. Setting up lactation spaces sometimes calls for innovation and creativity. You can explore our collection of stories about workplace accommodations in the stories below: 

CLC advances breastfeeding protection and support in the workplace

Workplace supports breastfeeding mother of triplets

Making Breastfeeding the Norm through The Breastfeeding Family-Friendly Community Designation (BFCD)

Alameda sergeant improves lactation space and support in county

Artist celebrates working mothers with ‘Liquid Gold’ project

Worksite program caters to nursing moms

Photo credit: Meredith W. Gonçalves

 

Pulling back the lens further, the architecture of communities themselves influences well-being too. One of the effects of redlining is poor health outcomes. Part of this equation involves the placement of industrial buildings and factories. Vann R. Newkirk II points out in Trump’s EPA Concludes Environmental Racism Is Real that The National Center for Environmental Assessment released a study indicating that BIPOC are much more likely to live near polluters and breathe polluted air. “Specifically, the study finds that people in poverty are exposed to more fine particulate matter than people living above poverty,” he writes.  

NICHQ hosts a webinar The Residual Impact of Historical Structural Inequities: Connecting Residential Segregation and Mortgage Discrimination to Current Infant Mortality and Breastfeeding Rates where maternal child health experts including speakers Jaye Clement, MPH, MPP, Brittney Francis, MPH, Kiddada Green, MAT, Arthur James, MD and Jessica Roach, LPN, BA, MPH share examples for supporting efforts to reduce infant mortality and improve maternal and infant health. 

Circling back to Tingley’s piece, the article raises the concern that although we’re equipped with knowledge about how under-resourced populations are being affected by current structures and practices,  “funding earmarked for expanding inclusivity [may] be diverted toward making existing facilities safer for those they already privilege.” 

Drawing on Sanders’ work, Tingley writes,  “Throughout history… the built environment has reflected and reinforced inequality by physically separating one group from another, often in the presumed interests of health or safety. Women-only bathrooms, so designated by men, supposedly preserved their innocence and chastity; white-only bathrooms separated their users from supposedly less ‘clean’ black people. It’s no coincidence that Covid-19 has disproportionately sickened and killed members of demographic groups — people who are black, Indigenous and Latino; who are homeless; who are immigrants — that have been targets of systemic segregation that increased their vulnerability. It’s also not hard to imagine the pandemic, and a person’s relative risk of infection, being used to justify new versions of these discriminatory practices.”

Art by Liz Richter, Photo by Leslie Rodriguez
Find more of Richter’s art here: https://www.lizrichterart.com/public-art

In this vein, Glenn Gamboa details where some funding gets funneled in a piece published this spring. 

“Twelve national environmental grant makers awarded $1.34 billion to organizations in the Gulf and Midwest regions in 2016 and 2017, according to a 2020 study by The New School’s Tishman Environment and Design Center. But only about 1% of it — roughly $18 million — was awarded to groups that are dedicated to environmental justice.” 

The climate crisis is an accelerating threat that is both affected by and affects architecture. 

“Architecture has to mediate between the perceived needs of the moment versus the unknowable needs of the future; between the immediate needs of our bodies and the desire to create something that will outlast generations,” Tingley goes on to write. 

Across the globe, architects push to be “mindful of their projects’ environmental impacts and resilience, including an emphasis on upcycling, the use of solar power, better building practices, and, of course, structural longevity,” Alyssa Giacobbe writes.  [More on ecological design here.] 

Alongside resilience and sustainability, there must be a focus on design that specifically serves mothers and their children. Mothers are too often left out, unseen, underserved despite there being about two billion of us worldwide, with an increasing likelihood of women becoming mothers

Photo by Dimitry Anikin on Unsplash

Lisa Wong Macabasco puts it this way: “Although the experience of human reproduction touches all of us at least once in our lives, its effects remain taboo, under-researched and excluded from exhibitions and publications covering architecture and design history and practice. In these spheres, maternity is treated furtively or as unimportant, even as it defines the everyday experiences of many – some 6 million Americans are pregnant at any given time.” 

It isn’t surprising that “design for children, design for healthy spaces, design for those with disabilities, care of and for their colleagues – these discussions and follow through are happening largely through female-led firms and initiatives,”  Julia Gamolina comments in The Unspoken Burden on Women in Architecture

In an exciting development, Wong Macabasco describes design historians Amber Winick and Michelle Millar Fisher’s Designing Motherhood, “a first-of-its-kind exploration of the arc of human reproduction through the lens of design. Their endeavor encompasses a book, a series of exhibitions and public programs in Philadelphia, and a design curriculum taught at the University of Pennsylvania.” 

This is exciting, and it’s progress. But as Wong Macabasco quotes Juliana Rowen Barton– architecture and design historian and curator who also helped organize Designing Motherhood– “Progress is not the fact that this show happened – progress is these conversations continuing to happen.” 

Designing Motherhood is on view at the Mutter Museum in Philadelphia through this month of May 2022.

It’s Black Maternal Health Week: “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care”

April is National Poetry Month. “[It] reminds the public that poets have an integral role to play in our culture and that poetry matters,” says the Academy of American Poets.  In a beautiful convergence, this week is also Black Maternal Health Week (BMHW) nestled intentionally within National Minority Health Month

Written decades ago on a different continent,  Poem for South African Women by June Jordan resonates today with the message of fighting systemic racism. 

“We are the ones we have been waiting for,” Jordan penned.

It embodies the #BMHW22 theme, “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care”. The theme reflects founding and leading organization Black Mamas Matter Alliance’s (BMMA) work in centering Black women’s scholarship, maternity care work, and advocacy across the full-spectrum of sexual, maternal, and reproductive health care, services, programs, and initiatives. 

The BMHW22 campaign is a week of awareness, activism, and community building intended to:

  • Deepen the national conversation about Black maternal health in the US;
  • Amplify community-driven policy, research, and care solutions;
  • Center the voices of Black Mamas, women, families, and stakeholders;
  • Provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice; and
  • Enhance community organizing on Black maternal health.  [https://blackmamasmatter.org/bmhw/]

You can watch BMMA’s National Call surrounding the fifth-year anniversary of BMHW here which highlights all of the major activities happening online and across the nation in celebration of Black mothers and their families. On April 17, individuals have the opportunity to get to know the organizations that make up BMMA, Black-led organizations that are doing the work and making a difference for BIPOC families. Of those organizations is reproductive justice organization Restoring Our Own Through Transformation (ROOTT). ROOTT’s Jessica Roach’s TEDx talk is just one example that encapsulates both the maternal infant health crisis we find ourselves in and the triumphs that are to be elevated.  

Helping families flourish in southeastern Alaska

As a young child, Jasmine Esmay, RNC-OB, CLC, now a nurse at a Baby-Friendly critical access hospital in southeastern Alaska, watched a mare birth her foal. 

Esmay was struck by the “reverent atmosphere”. The horse has fresh hay and water. Calm and quiet hushed over the scene. 

“I was in awe of the whole process,” she says, making the connection early on that we, too, are mammals.

Most young children play house at some point, but I was never interested in pretending to cook or playing house,” Esmay shares. “I wanted all my friends to pretend they were in labor and I was the midwife, much to the dismay, I think, of their parents.”

Then when Esmay was 17, she was invited to attend the hospital birth of a friend she babysat for. 

“Again, I was in awe of the power and strength and miracle of new life,” she says. 

Her personal birth stories further shaped her passion and work within maternal child health, fully realizing the importance of evidence-based practice. These stories were a sharp contrast to the gentle, supported births she had witnessed, and she began to understand that how women experience birth can influence outcomes such as bonding, breastfeeding rates and  postpartum depression occurrence. Early on in her work, she realized the significance of a calm, patient-centered approach. 

Latching babies or empowering parents 

Esmay eventually volunteered with WIC, making house calls and inviting others to her home to help with breastfeeding whenever she could. Since 2008, she’s been working solely as an OB nurse. 

“…It seemed wherever I was working in an obstetric unit people would always say “Go find Jasmine, she can get any baby to latch!’” she shares. 

In 2017, she completed the Lactation Counselor Training Course (LCTC)

“What [our instructors] taught me through that course was to put my hands in my pockets and take in the entire picture, and then to help the breastfeeding dyad to find their own ways to be comfortable and successful with breastfeeding,” she explains. 

“They really stressed starting newborns with laid back positions, to encourage instinctual feeding behaviors, and to help new parents be comfortable and confident in their ability to breastfeed,” Esmay continues. “It was so hard those first few months to trust the process. I had to learn that my method of so-called helping was really not helpful.”

Esmay found it helpful to remind herself of the words of Cindy Turner-Maffei: “You may be able to get a baby to latch, but is it teaching the parents or empowering the parents so that when they go home, breastfeeding is successful?” 

Over time, Esmay says she came to realize that confidence is half the battle.

“I’ve heard over and over ‘I didn’t think I could do it’ or ‘I couldn’t have done it without all the help and support’,” she reports. “It’s nice to know that we not only encourage breastfeeding, but that we give people the tools they need to really succeed at breastfeeding and enjoy it. I really hope that those feelings of success and empowerment reach into the rest of parenting and pass down into generations.”

She’s noticed too that parents prefer a hands-off approach most of the time. 

“As this approach was implemented, I began to see less parents coming back supplementing or with nipple pain or other breastfeeding issues,” she reports. “It is very rewarding to see the parents’ confidence grow, and see how that affects bonding and the integration of the newborn into the family.” 

Expanding lactation care support 

Esmay plans to take the IBCLC exam in April, a process she’s been working toward for five years. 

“I can honestly say that out of all the trainings and books and lectures and conferences I attended, the training I received through Healthy Children Project changed my practice the most,” she comments. 

Esmay was recently honored as a member of USLCA’s advisory board.

“My hope is that through knowledge and idea sharing we can think outside the box on ways to expand lactation support and education to marginalized populations,” she reflects on her new role. 

Esmay shares that she has conflicting thoughts regarding the exclusive use of IBCLC credentialing for “the gold standard” of lactation care. 

She explains: “It is important to recognize credentials, and licensing will help with getting lactation care reimbursed, but I also know from experience how expensive it is to obtain and maintain. The reality is that obtaining an IBCLC at this point is just not possible in many rural and marginalized populations. 

I think more focus should be on training all healthcare workers in normal breastfeeding support and the importance of breastfeeding. Statistically breastfeeding is just as important to overall health as teaching cardiac wellness and cancer screening. The focus should be on breastfeeding as a normal part of maternal child health, with referrals to experienced lactation care professionals when there are complicated feeding issues.” 

Barriers and triumphs 

In her work today at the critical access hospital, Esmay and her colleagues serve 15 remote communities. Their hospital was the first tribal affiliated hospital in the state to receive Baby-Friendly status. 

Esmay says their patients are plagued by many of the same barriers as those in the rest of the nation; namely, limited access to evidence-based breastfeeding support, physical distance and travel barriers for perinatal care, breastfeeding not being the socially acceptable norm, abysmal parental leave, little or no workplace pumping accommodations and/or childcare. 

“I think our biggest barrier though is in the current medical model of care where there is a lack of continued support throughout the postpartum period,” she says. “It doesn’t make sense to have 10 plus prenatal visits, and then only one postpartum follow up 4 to 6 weeks after a baby is born.” 

Adopting the midwifery model of care could offer many solutions in regard to postnatal care, she adds. 

Location lends itself to some challenges too. 

“It seems the very nature of where I live lends itself to always being a bit understaffed. Living on an island has its challenges and some of the community is transient by nature due to seasonal work or contract work.

 I think it is well known that healthcare in general is a very mentally and physically challenging calling. For obstetric care in general, I think that is why it is so important to get more feet on the ground for lactation support. If we can encourage routine breastfeeding education and training to all women and children’s nurses and providers, that will lessen the burden and improve access to breastfeeding support.

In my opinion, if you work anywhere in healthcare, but especially maternal child health, then basic breastfeeding knowledge should be the standard, not the exception. There are always those special feeding needs that will require a higher level of care, but every women’s and children’s healthcare provider should know what normal breastfeeding patterns look like, how to support a breastfeeding dyad and how to spot problems.”

Despite the aforementioned barriers, Esmay and her fellow colleagues are unrelenting in their service. The team offers a variety of breastfeeding support programs including:

    • Postpartum phone call 7 to 10 days after birth as a safety net between 3 to 5 day check and 2 week newborn follow up
    • Free lactation clinic 
    • Monthly peer breastfeeding support group 

Alaska scores quite well on their breastfeeding rates compared to U.S. national averages. Esmay attributes this in part to necessity. 

“Many of the communities in southeast Alaska are very remote and cannot always rely on shipments of food or formula to survive,” she explains. “I think it speaks to the importance of family-centered communities and the knowledge sharing that happens in extended families.”

Community is strong in her area, and there’s strong community awareness of the state of maternal child health in America. 

Esmay brings attention to community gatherings like that of a group called NEST (Nurture, Empower, Support, Transform). She recently partnered with the Alaska Breastfeeding Coalition and the hospital to implement a “Breastfeeding Welcome Here” campaign for area businesses.

Encouraging trauma informed care 

While Alaska is making a difference with small changes, Esmay sheds light on an area that needs improvement: trauma informed care.

“The statistics in Alaska for women experiencing trauma are astronomical,” she begins. “Thirty-seven percent of women in Alaska have been victims of sexual violence– that rate goes to 50 percent if you are an Alaskan Native Woman– and in some areas of the state that number can be more than 90 percent. 

When women who have survived sexual violence give birth, there are triggers. Often the traumatized person is not expecting these triggers. How care is given during prenatal visits and throughout the birth process can affect how a labor progresses, how parents bond and how they view themselves as new parents. 

It can make the difference between a healing and empowering experience or becoming a victim of violence once again. If care is taken adhering to the principles of trauma informed care, there will be better birth outcomes, like less postpartum depression and a higher rate of breastfeeding success. 

Ultimately it will lead to healthier families, and that’s really the long term goal of healthcare for women and children.” 

Esmay recommends When Survivors Give Birth by Penny Simkin and Phyllis Klaus to help us understand how to best care for the pregnant person who has experienced trauma. 

Esmay shares a few closing thoughts:

    • Approach breastfeeding from a preventative healthcare point of view. A study reported in the Surgeon General’s Call to Action found that if 90% of U.S. families followed guidelines to breastfeeding exclusively for six months, the United States would save $13 billion annually from reduced direct medical and indirect costs and the cost of premature death.  
    • Populations most affected by dangerous diseases have the least access to breastfeeding support and education. 
    • Breastfeeding is a global health issue of the highest importance. Corporate healthcare and governments need to invest as much money and energy as possible into promoting breastfeeding. 
    • We need human donor milk available in every hospital, we need equitable and affordable access to breastfeeding support, and we need the U.S. to uphold the WHO code of marketing to prevent formula companies from preying on vulnerable populations. We need the organizations that support breastfeeding to brainstorm new ways to improve education and access for all. 
    • Really the answer to world peace could be in breastfeeding, but that’s a topic for another day.