In most parts of a hospital, patients arrive because something has gone wrong. Labor and delivery is different. Many birthing moms come in healthy, hopeful, and ready for a once in a lifetime family milestone. That contrast is exactly why the experience of care matters as much as clinical outcomes and why design and operations can either support dignity and control, or unintentionally compound stress.

In this episode, Adrienne Erdman, Director of Design Research at EwingCole and Vice President of Research and Development for the Trauma-Informed Design Society, connects human factors, trauma-informed thinking, and real-world birth stories to a practical challenge for healthcare leaders: how do we design environments and workflows that make birth feel safe, supportive, and human?

Human factors in healthcare design: a “liaison for the human”

Adrienne frames human factors as the study of what makes us human, including capabilities and limitations shaped by physiology, cognition, psychology, and social behavior. In a built environment context, that means going beyond “Can staff do the task?” to also ask “How does this feel, and what does it demand of someone’s nervous system?”

Operationally, it’s also a systems problem. Birth experiences are not shaped by one design element in isolation. They are shaped by the interplay between space, process, staffing patterns, handoffs, policy, communication, and how well the care model matches real life.

Actionable move: When you launch a maternity project (new build, renovation, or operational redesign), put human factors questions directly into your design criteria, not as “nice-to-haves,” but as measurable requirements: sensory control, visibility, choice, privacy gradients, and frictionless wayfinding.

“Experience does not equal outcome”: why trauma shows up even with “good results”

A striking finding from Adrienne’s team survey of nearly 400 people who have given birth in the U.S. was that about 40% described their birth as traumatic, even when outcomes were clinically “good.” That gap forces an uncomfortable truth: a healthy outcome does not automatically mean a healthy and positive experience.

For healthcare organizations, this is more than patient satisfaction. Trauma has long-term health impacts and can shape how patients engage with care in the future (and whether they return at all).

Actionable move: Treat “experience harm” as a real quality domain. Consider adding postpartum debrief touchpoints, trauma-informed communication training, and environmental mitigations that reduce sensory overload and feelings of helplessness.

Move beyond the patient journey: blueprint the whole service

Patient journeys are common in design research, but Adrienne argues they often fall short because they don’t fully connect the patient experience to the behind-the-scenes work required to deliver it. Her preferred tool is the service blueprint, grounded in the patient journey but expanded to map:

• Frontstage interactions (what patients and families see)
• Backstage interactions (handoffs, supply workflows, documentation, protocols)
• Operational dependencies (staffing, lab timing, equipment readiness, escalation paths)

The key is designing for what is actually required to make the “ideal experience” real, not aspirational.

Actionable move: Run a service blueprint workshop early. Include patients, nurses, OBs, anesthesia, EVS, lactation, transport, and unit staff. Then identify failure points that create “snowball” stress (expired labs, missing equipment, miscommunication during scheduling, etc.) and redesign the workflow and environment together.

Design for “normal birth plus escalation,” not “worst case everywhere”

One of the core tensions in maternity design is medical readiness versus emotional support. Many spaces are designed like high-acuity rooms by default, which can unintentionally signal danger and reduce autonomy. Adrienne suggests designing primarily for physiologic birth while keeping escalation capabilities close but unobtrusive (equipment stored out of sight, flexible room layouts, and supportive tools like birthing balls or ropes).

Actionable move: Create a “calm default” baseline for every LDR room: concealed equipment, dimmable layered lighting, controllable temperature, and a layout that supports movement and multiple labor positions, with a clear, rehearsed pathway to escalate when needed.

Low-hanging fruit that still gets missed

The episode surfaces practical issues that are easy to overlook on drawings but obvious in real life:

• Lights that cannot dim, disrupting rest
• Constant interruptions, especially postpartum
• Partner accommodations that exist in name but fail in function
• Layouts that isolate partners (and reduce support)
• OR sensory overload and poor visibility of the newborn for the birthing parent

Adrienne also noted survey results that only about 25% of respondents reported access to a couch or convertible bed for a partner, a design choice that signals whether the partner is considered part of care or an afterthought.

Actionable move: Test rooms in full-scale mockups or in-situ walkthroughs. Have staff and patient advisors “act out” a labor scenario, a C-section transfer, skin-to-skin, breastfeeding support, and an exhausted night. You will find problems no checklist can reveal.

The access reality: choice is shrinking in many communities

As leaders discuss “experience,” access constraints are tightening. A recent analysis reported that since the end of 2020, 124 rural hospitals have closed maternity units or plan to close by the end of 2026. Indiana was cited as one of the most affected states, with 13 labor and delivery unit closures since 2020.

At the same time, models are evolving, including advanced birth centers in Florida that allow C-sections outside hospitals, reflecting both experimentation and debate about safety, cost, and access.

Actionable move: If you are a health system leader, treat maternity as a strategic front door for longitudinal relationships, but also as a community obligation. If closures are on the table, explore alternatives that preserve local access: partnerships with birth centers, tele-OB support, midwifery integration, transport protocols, and redesigned prenatal access pathways.

Key Takeaways for Healthcare Leaders

• Measure experience as a safety issue, not a branding issue. Trauma can occur even with good clinical outcomes.
• Use service blueprints to connect the patient journey to staffing, handoffs, documentation, supply chains, and escalation workflows.
• Design for calm by default, with hidden readiness for escalation rather than high-acuity cues everywhere.
• Give patients control over sensory inputs (light, noise, temperature, interruptions) to reduce stress and support rest.
• Design partner support as essential infrastructure, not an amenity. Room layout matters as much as furniture.
• Prototype in real scale and simulate real scenarios to catch “obvious in life, invisible on paper” failures.
• Reimagine prenatal access so care fits working lives (space to work, streamlined workflows, fewer logistical burdens).

Call to action

If your organization is redesigning maternity care, start with one concrete step: blueprint a birth experience end-to-end and identify where operations and environment amplify stress. Then redesign those moments with patients, families, and staff at the same table. When you design with people, not for them, you build trust, reduce friction, and create birth experiences families will remember for the right reasons.