Book Review: Home and away: Mothers and babies in institutional spaces

Discussion

The broad-focused introductory chapter aims to lay the foundation for the project, outlining research questions built around the design of a Mother Baby Unit (MBU) in a psychiatric setting. The goals are lofty but important in the context of how an MBU shapes the experiences of those who are cared for or work within the MBU. The goals of the project were the following:

How can built space affect the relationships and interaction between staff and clients;

A unique feminist approach was also introduced in this chapter which highlighted cultural gendered norms. The authors provided a history of unrealistic standards of mothering imposed by society for the purpose of providing insight into how these issues as well as the gender of the designers influenced the build of the MBU. This approach is important to consider since the majority of MBU users, those being cared for and those providing care, are female.

The World Health Organization changed the way maternity wards housed infants beginning in 1990 with the Baby Friendly Initiative (WHO, 2018). The initiative supports breastfeeding by providing hospitals with a framework to guide practices supporting breastfeeding. The initiative highlights the importance of babies rooming in with the mothers. Although the importance of mother baby bonding and attachment was well known when the initiative was released, hospitals were utilizing a newborn nursery, separating babies from mothers except for feedings. This separation was common practice in all maternity wards, including psychiatric units for postpartum mothers.

Chapter 2 of Home and Away: Mothers and Babies in Institutional Spaces explores the emergence of the MBU within the psychiatric setting and provides historical background to understand the importance of this type of care for mothers experiencing mental health conditions in the postpartum period. The chapter provides information on the specific MBU utilized for the study, which was a government-run MBU in Australia. The MBU in the study provides inpatient services to mothers who experience a wide range of mental health concerns postpartum and their babies and/or children. The methods used for the MBU case study included ethnographic observations, interviews with architects, interviews with staff, and interviews with clients and family members to ascertain answers to the research questions regarding built space designed to promote positive mental health outcomes.

According to Tavacoli et al. (2020), the physical environment of a maternity space and the design have considerable effect on the psychological conditions of mothers. This is particularly important in the design of an MBU in the psychiatric setting. The next two chapters focus on the architect’s perspective of the MBU design and the functional use of the built space itself and was based on the ethnographic observational data. The themes that emerged from the analysis of the architect’s interviews illustrated many complexities of gender in a primarily male-dominated profession designing for a significantly female-dominated area of perinatal caregivers and mothers. The architectural plan was to create a residential, domestic feeling in a more interesting way than they believed would typically be seen in a mental institution. The lack of consensus on what constitutes evidence in architecture, especially as related to design of an MBU, led to the architects following a practice-based evidence approach, following a village-type model they had successfully used in the past. The authors describe the consulting phase as being quite contentious with the male architects, stating that there were too many voices contributing to the discussion. Complicating the consultation phase, the staff who were mostly female felt that their voices were not heard in the planning of the space. Perhaps an empathetic design (Sandman et al., 2020) would have provided more understanding of the users’ needs in designing the MBU space. The theme of “home” reemerged as the functionality, use, and effects of the space were analyzed from the ethnographic observations. The architectural design, despite the difficult consulting phase, managed to balance the need to create a psychiatric setting that was homelike yet maintained a clinical or temporary feel much like a hotel, lending to the sense of being both “home and away.”

The remaining chapters of the book discuss the workspace of the MBU from the staff perspective, the therapeutic space from the use perspective, and offers concluding thoughts on the built space. The staff were asked open-ended questions on the design space and asked to reflect on what was good and what was bad in the design. A major issue identified was the nurses station workspace. Staff felt it was not well designed for privacy and overcrowding typical in the MBU. The large size of the facility also prompted comments regarding safety since it was difficult to always hear what was happening in several portions of the unit that were further away from the nurse’s station. It was also noted that the many elements required for the institutional nature of the MBU, such as the communal spaces, detracted from the “hominess” desired in the facility. The staff perspective again reiterated the lack of understanding in the design for the needs of the users of the space. The interviews with the mothers focused on the hominess of the space and the users noted that the MBU felt inviting. Elements of the design that users felt detracted from the hominess aspect included temperatures being too warm, lighting, and distracting noises. The mothers in the study understood the importance of uninterrupted sleep in the healing process and did not feel they were getting adequate sleep in the MBU. In fact, high levels of disruption negatively impact the healing process for new mothers and their newborns (Aditia et al., 2014), which is in direct contrast with the purpose of the MBU. The users also felt that the space did not provide for relationship building with their children, which goes back to the designers not fully understanding the use of the facility for mothers and their children.

Conclusion

Home and Away: Mothers and Babies in Institutional Spaces provides thought-provoking ideas on various types of built spaces. An important discussion in the conclusion of the book explores what it truly means for a space to be “purpose built.” The authors were successful in providing new ways of imagining the design and use of MBUs with the key focus on understanding use, the concept of home, and, more specifically, how a space can be both home and away for the families seeking care.