CRISTIANE N SILVA – HEAD OF INFRASTRUCTURE, MINISTRY OF HEALTH, RIO DE JANEIRO MATERNITY CARE


Considerations in the careofpregnantwomen


Ambience is extremely important in the study of maternity wards and there is a need to understand the sensitive issues that might affect a woman positively or negatively during childbirth. Childbirth involves psychological, physical, social, economic and cultural influences that also affect perception of the environment.


Today, childbirth usually takes place in a maternity ward, where theoretically it is safer, but the setting should also fit in with the local culture. It is therefore important for architects to tailor their designs to meet this need. In order to do so it is necessary to observe behaviour related to childbirth in different cultures as well as in relation to architectural spaces and their functions. In most societies, pregnancy and birth


have a significant role; they also function as markers of the transition from ‘woman’ to ‘mother’. This involves specific rituals and behaviours that are intended to protect the woman and the baby, as well as introducing the baby into society. With the ‘medicalisation’ of childbirth,


many of these rituals have also become ways of reinforcing societal values.1 Whether childbirth is viewed as a natural or a medical phenomenon varies from culture to culture. The way it is viewed determines many other differences also observed in important aspects of childbirth, such as the preparation that is undertaken, where it will take place, the people who will accompany or assist, the available technology and medication, and the participation of the woman in decisions, making the experience culturally determined.2 For example, in the US, cultural


differences are seen during childbirth among white middle income groups and certain social and ethnic groups, such as lower income black people, Mexican


Americans and people who are of Chinese origin. These include whether or not the father is present during the birth. A traditional Chinese view is that men should not be present during childbirth or have any contact with the woman for a certain period of time after she has given birth. In many cultures, a woman lying on her back to give birth is unusual. In countries such as Latin America, Northern Thailand, India, Sri Lanka and West Africa, women have their children standing,


Cristiane N Silva


Cristiane N Silva has a PhD in architecture from the Federal University of Rio de Janeiro – PROARQ/FAU/UFRJ and a specialism in health networks management from the National School of Public Health Joaquim Venâncio – ENSP/FIOCRUZ. She currently works as head of the infrastructure sector in the hospital management department of the Ministry of Health in Rio de Janeiro. She has experience in the architecture of healthcare buildings, hospital building maintenance and the management of contract processes and works in hospital environments


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squatting, sitting or leaning against something. In some cultures, women observe a postpartum period of rest, during which they must eat a certain diet as well as following other rituals and are attended to mainly by women. Also common in some cultures is the prohibition of sexual relations between husband and wife during the postpartum period.1


Medicalisation Many behaviours that are considered normal during pregnancy are dependent on the culture of the individual, their perceptions, beliefs, values, attitudes and view of the world. This results in different perceptions of health and illness, and beliefs and health protection practices that depend on a person’s cultural group and social class.3 In many countries, current trends in


women’s health are in line with the 1986 World Health Organization guidelines on good practice in childbirth. However, it could be said that ownership of childbirth


IFHE DIGEST 2018


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