OBSTETRIC DESIGN
Obstetric care in Brazil: design guidelines
When strategically conceived, architecture can be a powerful tool to promote the wellbeing, safety, and autonomy of individuals during the birthing process. Here, architect Cristiane N. Silva and nurse and public health specialist Renata P. Freire propose design guidelines to enhance the ambience in obstetric care within Brazil’s Unified Health System (SUS), focusing on humanisation, diversity, and the accommodation of everyone’s specific needs.
Obstetric care in Brazil has been the subject of intense debate and transformation, seeking to align with international best practices and the needs of individuals who gestate and give birth. The Unified Health System (SUS) – a fundamental pillar of Brazilian public health – plays a crucial role in this scenario, being responsible for most births in the country. However, the quality of ambience in health services, especially in labour and birth spaces, still represents a significant challenge. Hospital ambience, particularly in birthing spaces,
transcends mere functionality – it encompasses sensory, emotional, and social aspects that directly impact the birth experience. A welcoming and humanised ambience is one that respects the physiology of birth, offers privacy, comfort, and safety, and allows for free movement and choice of positions. The humanisation of birth – a movement gaining global momentum – seeks to restore the protagonism of the gestating individual, valuing their choices and their body. This implies spaces that favour the presence of companions, the use of non-pharmacological methods for pain relief, and the creation of an environment that resembles a home more than a sterile medical-hospital setting. The diversity of bodies, cultures, and expectations demands that architectural designs be flexible and adaptable; capable of meeting a wide range of needs.
Hospital ambience, particularly in birthing spaces, transcends mere functionality – it encompasses sensory, emotional, and social aspects that directly impact the birth experience.
New subjects in birthing spaces Historically, birthing spaces were conceived from a predominantly biomedical perspective, focused on pathology and intervention. However, the contemporary understanding of birth recognises the gestating individual as an active subject, with rights and desires. This includes not only cisgender women, but also trans men, non-binary individuals, and other gender identities who can gestate and give birth. Architecture must, therefore, be rethought to accommodate this diversity. This means considering the privacy, safety, and comfort of all, regardless of their gender identity or sexual orientation. The creation of accessible and gender-neutral toilets, the provision
Guidelines for support in cases of intrauterine fetal death and perinatal death.
HEALTHCARE PROFESSIONALS
• Professional qualifications
• Support for emotional needs/ psychological support
• Effective and efficient team communication.
Guidelines for support in cases of intrauterine fetal death and perinatal death INFRASTRUCTURE
ATTRIBUTES OF CARE
•Private room • Keepsake collection
• Refrigerator for preserving the baby’s body
• Storage space for keepsake boxes.
•Privacy • Individualised attention
• Clear and respectful
• Informed
communication decision-making
• Evidence-based care
• No assumptions about the feelings and behaviour of the bereaved family
• Continuity of care.
PRACTICE
• Decide on the type of delivery
• See and hold the baby
•Say goodbye • Organise the memory box
• Decide about the baby’s body
• Provide information.
INTERMEDIATE ELEMENTS
• Creating positive memories: • Emotional memories.
MAIN OBJECTIVE
• To provide care that facilitates and supports healthy perinatal grief.
October 2026 Health Estate Journal 135
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