David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host David Cummins, and today we are speaking to Professor Leonie Callaway, who is a professor of medicine.

Leonie is also a general and obstetric physician at the rural Brisbane and Women's Hospital in Brisbane. Leonie is also the Executive Director of Women and Family Stream at Metro North, and we are very excited to speak today to Leoni as part of our Women's Health Series.

Welcome, Professor Leonie. Thank you for your time to be here.

Leonie Callaway: Thank you, David. Thank you very much for inviting me.

David Cummins: me I must admit, I've done a few interviews now and I've not met too many professors of medicine in the world and certainly none within the world of women's health.

How hard was that to become a professor of medicine and be such a, certainly local, but also national, dare I say, global phenomenon that you are with the world of women's health?

Leonie Callaway: Ah, well look, David, you do one thing at a time. You graduate from medicine, you become a doctor, you do some research and so forth.

It's just one step at a time. It's not different to your career running massive construction businesses, nothing special.

David Cummins: I feel that you are so humble just by even saying that in one sentence and comparing it to building a building, but I think it's extremely impressive. How important is it to ensure that we do get designed right in the world of women's health?

Because according to me, women's health is such a plethora of things. Not only women, but you've got babies, you've got families, you've got partners. It is such a plethora of complexity. How do we get that right?

Leonie Callaway: Well, David, it's just a delight to speak to you about this, and I hope that we inspire people to really think about good design for mothers, babies, and families.

I think we can all agree that the start of a new family is really one of the most important parts of human life, and we know that what happens for mothers and babies in early life really sets the trajectory of someone's health for the rest of their life so it's very important.

Obviously this is a highly emotionally charged space, and so care with the design and a pleasant working environment, a pleasant environment for women, families, partners, and babies at a very vulnerable point in their lives makes a big difference to the quality of the healthcare that we're able to provide.

David Cummins: It's a very interesting field of medicine, especially obstetrics where I would almost argue it's one of the only fields of medicine where people are planning to go into hospital, where generally speaking, most people do not plan to go into hospital. You know, a hip and a knees planned, but they don't necessarily want to go there.

But it's actually one of the destinations that people want to go to, to be planned as in nine months of planning. So in that sense, I would argue as well, birthing would be quite traumatic for some people, quite emotional, for some people, quite a joy for some people.

What are things that we need to focus on as designers and planners and builders in this world to make sure that that patient care is safe, not only for the patient, the families, but also the staff and the doctors.

Leonie Callaway: You're absolutely right. It's mostly a very exciting time, but it also can be a very dangerous time. I don't think that there's any more dangerous day in your life than the day you get born. I think it's the riskiest day that you ever have, of course, apart from the day that you die, which is definitely risky.

The considerations I think are really about making family friendly spaces. Birthing and having newborn babies is very noisy. And there's a lot of sleep deprivation involved for women and their babies after babies are born.

So making spaces that are welcoming to families that are large enough that take into account that it's not just the patient that the hospital's responsible for, but it's really a family event.

Women increasingly want to support people as well as the hospital staff that need to take care of them. So the spaces need to be large and spacious to take into account. The additional support people that. that are wanted around that episode of bringing a new baby into the world.

The importance of soundproofing in these spaces in birthing suites and soundproofing within maternity wards probably can't be underestimated because I don't think we've got any more noisy in-patients in an entire hospital than newborn babies.

And they're slightly older, toddler and child siblings that like to run around. That's another thing that's really an important consideration. Many women need to come to clinic and need to be in hospital with their other young children visiting, and we've never really thought about the needs of the young children that need to come with their mothers or visit their mothers on a regular basis.

So, you know some play spaces, some outdoor connection where children can run around, particularly if their moms are in hospital for a number of weeks.

David Cummins: I imagine the point about acoustic treatment for rooms is really important. I imagine also the opposite would also be true if a family has just gone through a bereavement during that process, they probably don't want to be hearing newborns next door.

And I imagine that would be quite triggering.

Leonie Callaway: Yes, bereavement spaces are a very important part of design for maternity care. Unfortunately, a number of babies die in utero, and that's obviously a very, very difficult point in a family's journey.

Like all other deaths, this one is profoundly grieved and it's grieved in a special way because people are both meeting their baby for the first time and also saying goodbye to their baby at the same time.

 The best bereavement spaces for families are once again large and really inspired by palliative care spaces with some extra beds for families to stay over.

Some self-contained facilities, coffee, tea, toast, making facilities, and obviously a private bathroom. In many situations, the families choose to keep their baby with them for a period of time, and we manage that with special little cots that are refrigerated that allow the, the family to be with their baby for as long as is required for them to undertake those tasks of bonding, grieving, and saying goodbye.

And obviously there's often a lot of aunts and uncles, grandparents, brothers and sisters and so forth that want to come and say both hello and goodbye to the baby at that time. So those particular bereavement spaces in maternity care are really important.

If they're very well designed, they're also valuable if you are looking after someone who's very unwell or had a tragic diagnosis. For example, sometimes in maternity care we unfortunately diagnose people with metastatic cancer severe end stage cardiac diseases.

They're probably the commonest things that come to mind. This can be just a completely devastating experience for both the patient and their family to be informed that at a time of life that should be happy and all about bringing a new life into the world.

That actually you're talking about tragic diagnoses and potentially very short periods of time to live.

And so those bereavement spaces that are well developed to look after families where they've had a little one who's died are also very valuable when we are taking care of women and their families where there's a terrible diagnosis.

So designing those beautiful, large, quiet, self-contained family spaces into maternity services is really important.

David Cummins: I must admit, I've never design a bereavement room, but do you need things like oxygen and special gases, or pretty much you just want to create a hotel style . Environment with windows and natural light and biophilic design or access to nature.

What is the ideal bereavement room look like?

Leonie Callaway: I suppose, David, if a bereavement room has got piped oxygen and all of the usual medical care, it does allow it to be more flexibly used. So for example, if we've got someone who's just been diagnosed with metastatic melanoma or metastatic breast cancer or a brain tumor, and we are wanting to provide a family with a place to grieve and to process that information and to take care of the patient in a private space.

Then obviously good monitoring facilities and oxygen and all of the usual medical inputs into that room are important. So I would say that it's worth including those things, just so that those spaces can be used in multiple different ways.

Obviously, if it's just a mother who's given birth to a baby, there may not be any reason for that. But for example, if the baby has died as a result of the mother being very sick with preeclampsia, for example, a condition of high blood pressure and many other complications, then you may have the situation where you've got a sick mother, a baby that's died, and where you're needing to take care of the family.

So I would say that having good medical support and facilities is useful but obviously also that space for families.

David Cummins: Yeah, so it'd be a good challenge for designers to find that balance between comfort compassion, warmth, but clinical as well so that's a good point to take.

Yeah.

Leonie Callaway: One of the other things that's really important, I suppose, in designing these spaces is appreciating something that we call trauma informed or trauma sensitive care.

You may not be aware that at least one in three women who are having a baby have experienced sexual trauma.

And actually recently the Australian Childhood Maltreatment study was just published in the Medical Journal of Australia and it demonstrated that about 39% of all Australians have got two or more forms of childhood maltreatment.

So when we are taking care of women, we do look after a lot of vulnerable women with a lot of a significant background of trauma.

And obviously if you're having a baby and you've had a history of sexual abuse, then there's a lot of considerations in taking care of someone and keeping them safe and not triggering off their post-traumatic stress disorder.

One of the things we've discovered in this is that very often having a support person be that person's partner, a doula, a close friend, a mum or an auntie being with that person throughout their hospital admission or as much as possible is very important.

So the other thing I would say in designing maternity spaces, is that there needs to be at least some rooms available where you can sleep the patient plus their support person. Because in these situations you often have people in hospital for a week or two needing a lot of intensive support with an extra person beside their bed.

Obviously enough space to house two people is important from a safety perspective. And also having comfortable sleeping arrangements so that that support person doesn't burn out and become diminished in their capacity to provide support is really important.

David Cummins: You talked earlier about some babies that get sick during this process.

 With NICU design (Neonatal Intensive Care Unit), I have worked on a NICU before, and I've also worked on a bad one before.

What's some good design principles for a good NICU for a staff member and a professor, and literally having access to the baby, noting that there are so many other moving parts and so many requirements for a baby in NICU.

Leonie Callaway: So David, I look after big people, not little people but, I can make a couple of comments about it. I would say that one of the main things we discovered during Covid in neonatal services across Australia was that actually they're so cramped that we weren't able to maintain social distancing.

And our focus on trying to make sure that there's much better bonding between families and their babies, there's just not enough space for both a mother and a father to be sitting at a baby's bed.

There's also not the recognition that actually the mother or father might want to stay with their baby.

There's no sleeping facilities, there's no facilities for that bond between the mother, father, or parents and the baby to be really promoted so those caregivers can increasingly take over skin to skin contact.

So the feedback that I get from my neonatal colleagues is that neonatal intensive care nurseries and special care nurseries need to be vastly more spacious and need to take into account the fact that parents want to be with their babies and in fact may want to sleep near their babies and be with them as much as possible.

David Cummins: Yeah, it's a really good point. It's probably something I hadn't considered the opportunity for someone to stay there in neonatal spaces so that's very interesting.

You've obviously worked in many, many hospitals no doubt around, not only Brisbane but around Australia.

What are some strong design principles that you would like listeners to take on board to try and help not only improve your workability with an interaction with patients would also have patient experience as well.

Leonie Callaway: There's one other thing just to flag. At the moment the leading cause of maternal death in Australia is maternal suicide, and we're really struggling with a high burden of peripartum mental health issues.

And so the design of our hospitals and birthing suites really needs to do what it can to diminish the risks of worsening mental health. And so some of the design principles that are very important, the postnatal ward include doing things that allow people to get some sleep.

Reducing all of the machines that go ping and making sure that there's dark spaces where people can sleep trying to get some noise control and not have lots of footsteps and other babies crying and so forth.

Minimising interruptions, allowing people as much privacy as is able to be obtained. And also trying to make sure that we get a good circadian rhythm with light exposure. So one of the difficulties with hospitals is you can have the problem of people really just living in a dim lit environment 24 hours a day.

And so as much as possible getting sunshine into rooms and making sure that at night it's truly dark and that you don't have all sorts of fire alarm lights and other lights shining. And also that during the day you've got as much natural light or you've got access to open spaces.

The other thing that's important is to make sure that you've got some of the beds very close to where your staff are sitting, particularly on the night shift so that sick patients can be carefully supervised.

And increasingly maternity patients are very unwell and got a lot of medical issues. And so I feel that it, an ideal design is to have an almost high dependency unit capacity for some of that space for intensive monitoring.

That's close to where the nurses are sitting overnight and then of course, the flow of staff, the total number of staff that are providing maternity care now has really increased in Australian hospitals.

Aboriginal and Torres Strait Islander health liaison people, social workers, psychologists, obstetric physicians, obstetricians midwives and so forth, pharmacists. So the total number of people that are working together to look after the increasingly complex nature of maternity care.

I think the way that we design the spaces for people to sit to conference about patients enough computers, thinking through the workflow of what it is staff need to do and being careful about where all of that noise that's related to staff gathering together and the impact that that potentially has, especially in the middle of the night, to try and think about where staff are working and how you try and keep that Quiet and away from where people are trying to sleep.

David Cummins: So, in these spaces, whilst a woman has given birth or just given birth, is there an actual risk of self-harm within these spaces itself that we have to consider? Something like a ligature point for these spaces?

Leonie Callaway: It's very rare for there to ever be a case of self-harm within a maternity service. If we have patients like that, we generally try and co-manage them in a purpose-designed psychiatric facility.

But of course it would always be lovely to have one room in a ward that has taken those sorts of things into consideration if you're looking after someone who's very unwell and that is genuinely a concern.

For example, women who are really struggling and have got eating disorders and they're pregnant so it's certainly a possibility. It's not something that I've come across frequently. I don't think it's a high on the list of priorities, but certainly considering the mental health needs of at least one or two rooms within a maternity space is a very good idea.

David Cummins: Thank you so much.

Professor Leonie, I just think you are a powerhouse of amazingness. I think the level of knowledge you have in this space is phenomenal. I'm just so grateful for the opportunity to speak to you.

Thank you so much for your time and so much for your dedication to this field. I think without people like you and your research and your ability to drive things forward you've helped so many, so many women and children in this space.

I just think without someone like you, we would be a little bit behind the eight ball. So thank you so much for your constant dedication and research and ability to help so many people.

So I just really want to say thank you very much.

Leonie Callaway: Thank you very much, David.

David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go.

To learn more about the AHDC, please connect with us on our LinkedIn or website. Thank you for listening.