Towards restorative spaces for postnatal recovery in urban tertiary hospitals

Modern living and globalisation are increasingly contributing to access to and utilisation of modern healthcare services in both developed and developing countries; from diagnosis, treatments, and even to birth in a specialised healthcare environment. In many resource-rich countries, birth is one of the main reasons for women’s hospitalisation. Research suggests that physical environments of healthcare impact on patient/users’ health outcomes. Yet decisions about healthcare facilities’ design and programming are often made without input from users.  A key challenge for patient-centred care in the maternity field is the assumption that healthcare spaces and facilities created for the general “unwell” hospital population can support the emotional, physiological and psychological needs of healthy women who give birth in hospitals. Previous research into the childbirth environment has focused on physical environments and satisfaction with the labour and birth process. But studies examining the impacts of physical environments on women’s postnatal recovery experience and wellbeing have been limited. The aim of this thesis is to determine the design factors that influence women’s recovery experiences and wellbeing with a view to proposing design guidelines for optimal postnatal environment in large, tertiary hospitals.  A two phase sequential explanatory mixed methods approach was taken to the research which combined a quantitative method (online survey questionnaires) with a qualitative approach (focus group discussions – FGDs). Research was conducted with two user groups, comprising postnatal women and midwives, to examine perceptions of physical environment factors that influence women’s recovery experiences and wellbeing in New Zealand hospitals. The results of the questionnaire surveys were followed up in phase two FGDs to provide explanations and descriptions of architectural factors and design features that impacted on women’s recovery experiences and psychological wellbeing. The results were compared, synthesised and interpreted to inform the outcomes of this thesis.  The research found several physical environment factors and design features which were significant and a number which were non-significant among the two user groups in all four categories investigated: perception of postnatal room features; interior environment; sensory comfort environment and social comfort environment. The research found factors related to maintenance (e.g. cleanliness), environmental design (e.g. noise/quiet in rooms, and daylighting), and interior spatial characteristics (e.g. view to nature, combined home-like and clinical features and privacy) are more important in fostering wellbeing. Strong evidence was found on how building spaces impact on postnatal recovery experience, especially regarding single-bed rooms for emotional support and psychosocial support environments such as communal spaces and outdoor environments.  The original contribution of this thesis is an identification of the environments which have the potential for enhanced recovery experience of women during the postnatal period. This understanding of the architectural design factors and building spaces could help architects, healthcare designers and hospital care providers in applying and promoting restorativeness in large, tertiary hospitals to better help in providing quality postnatal care for women whose hospital stays are crucial to their wellbeing and health prior to going home with their new baby.