"The Impact of Design on Clinical Care in Childbirth" is a design study examining how the physical environment of birth facilities influences clinical processes and outcomes across the United States.

Although mothers in labor are among the healthiest patients in a hospital, they are often treated in environments designed for the sickest. Research shows that a woman’s likelihood of delivering by cesarean section varies more by hospital than by her personal risks or preferences. Cesarean rates range tenfold—from 7% to 70% depending on the facility—a striking disparity given that up to 45% of c-sections may be avoidable. This raises a critical question: How does the physical design of maternity units affect decision-making in childbirth care?

With support from the Robert Wood Johnson Foundation, MASS partnered with Ariadne Labs—a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health—to investigate. Our team studied twelve diverse facilities, from independent birth centers to large tertiary hospitals, spanning rural Arizona to metropolitan Boston. By analyzing floor plans and observing care processes, we developed testable hypotheses about how design correlates with clinical outcomes.