Date of Award

8-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Architecture and Health

Committee Chair/Advisor

Dr. Anjali Joseph

Committee Member

Prof. David Allison

Committee Member

Dr. Arelis Moore

Committee Member

Dr. Veronica Parker

Abstract

In the U.S., thousands of birthing persons (BPs) experience unanticipated complications during labor and childbirth resulting in severe morbidity and mortality each year. However, BPs from racially and ethnically diverse historically underrepresented communities (HUCs) are disproportionately affected by these outcomes. Existing research suggests that a culturally sensitive maternal care approach can help overcome these disparities by improving provider-patient trust, treatment adherence, experience of care, and maternal health outcomes. The physical environment of maternal care settings also affects childbirth experiences and maternal care outcomes. However, few studies explore how the physical environment supports the culturally sensitive maternal care experiences of BPs from HUCs. This mixed methods study uses surveys, interviews, and case study analysis to explore how the physical environment of community-based midwifery care settings, such as free-standing birth centers (FSBCs), supports the culturally sensitive maternal care experiences and outcomes for BPs with low-to-moderate risk pregnancies from HUCs. The main objective of this study is to develop evidence-based design guidelines to improve culturally sensitive maternal care experiences for BPs from HUCs. The resulting evidence-based design guidelines focus on (1) BPs’ autonomy, (2) social support, (3) comfort, (4) proximity and access to key design elements and features, (5) cultural significance in elements of positive distraction, (6) spaces reflecting HUCs’ maternal care needs, (7) flexibility and adaptability of spaces, (8) physical, psychological, and cultural safety, (9) elements that help BPs from HUCs feel welcome and represented, (10) BPs’ privacy needs, (11) familiarity of maternal care environments, (12) functionality and aesthetics of maternal care spaces, and (13) visibility between care and support spaces. Understanding these guidelines and their implementation strategies can help design culturally appropriate facilities to improve the maternal care experiences and outcomes from BPs from HUCs and reduce the prevailing maternal health disparities.

Author ORCID Identifier

https://orcid.org/0000-0001-6267-1203

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Available for download on Monday, August 31, 2026

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