Cultural dimensions of birthing spaces in Malaysian public healthcare system - the malay-muslim practices

Abstract

Birthing, in the continuum of life, is a natural event and not a clinical process. Each society celebrates a new life with different cultural significance. Birth has traditionally been conducted at home in a family atmosphere. However, due to concern for safety of the mother and the unborn child in home-birth setting, societies were encouraged for hospital birth. Medicalization of birth for a natural event in a clinical setting is currently a fact. Birthing spaces in current maternity facilities are designed as ‘clinical spaces’ for the function that ensures safety of the mother as well as the safe delivery of the unborn child. This realisation led to movements in the Western society to de-medicalise or humanise the birthing process and environment to how it was. The emergence of the ‘homelike’, or ‘salutogenic environment’ approaches to birthing spaces, with a home-like treatment, familiar to mothers, is one of the most crucial transition phases in normalizing birthing experience. Many researches in the development for a safe and comfortable birthing environment linked its findings to the mother’s cultural dimension i.e. the familiar or normal daily environment. The cultural dimension would provide the calming effect, and, therefore, create a humanised experience for better birth experience. In Malaysia, with the exception of a few, almost all mothers gave birth in hospitals. Birthing spaces or labour delivery rooms (LDR) are not design to the need of the Malaysian mothers’ cultural dimension. The aim of this thesis is to highlight the importance of cultural dimension in the design of birthing spaces for Malaysians, with the Malay-Muslim practices as the case study. The thesis focuses on the architectural design of birthing spaces only. Qualitative and quantitative research methods are appropriately employed to achieve the objective of this thesis. The thesis had gathered both observational and empirical data through content analysis, post-occupancy-evaluations (POE), including semi-structured interviews in identifying the cultural aspects of the Malay-Muslims birthing practices. The thesis explores and assessed current birthing spaces design in-use, for both cultural and clinical dimension, in the LDR spatial studies within the Malaysian public healthcare system. The analysis identifies the core space of birthing within the LDR as the ‘critical dimension’, while considerations for privacy, family involvement and required tangible and non-tangible cultural traditions as the ‘cultural dimension’ or the ‘soft space’. The findings identify ‘culturally imbued environment’ as a safe and comfortable environment for birth. The findings also noted that although the ‘cultural dimension’ exist in the form of obligations to privacy, modesty and psychological support spaces in existing LDR, is significant, it is however, required to be gazetted as an essential activity within the standard operating procedure (SOP) for designers to mandatorily include in the space planning and design. It is, therefore, imperative that the cultural dimension of the birth practice be integrated holistically with the ‘critical dimension’, as part of the design process, to achieve appropriate space and configuration for the safe birthing. With the Malay- Muslim birth practices as the case study, these findings thereby serves as a recommendation for the future LDR room designs for Malaysians, and thus act as an impetus to the designs of other healthcare spaces that cares for Malaysians.