Meet Stiliyana Minkovska – the MRes Healthcare & Design alumna reimagining how we view childbirth

Tell us a little bit about your background – you’re a qualified architect and also studied MA Architecture at the RCA earlier in your career. What was your journey to studying the MRes Healthcare & Design at the RCA and what drew you to this particular programme?

I came to study MA Architecture at the RCA in 2014. The RCA was one of these places where I felt a strong belonging every time I visited a show. I couldn’t wait to embrace the challenge. The programme was amazing, I was taught by some incredible people and loved every moment of it. Initially, I was drawn to the architecture of preservation and theories related to this concept, but everything changed when I found out I was pregnant at the end of my first year. It was a massive shock to my whole system, I thought I was delusional and in need to wake up – I couldn’t imagine having a baby alongside the lifestyle I had as a student. But now when I think about it, I feel this was the missing element in my personal and professional lives.

When I graduated in 2016, my daughter was only six months old. I decided to take some more time off before joining the architecture world. In 2017 I started working as an Architectural Assistant at Sheppard Robson. At the end of 2018 I qualified as an Architect with the Bartlett, UCL. Then somehow everything changed, it wasn’t enough to be an architect and run projects or tasks I wasn’t passionate about or didn’t quite believe in, even though at the time I had a great team and a project I loved.

In 2019 the Design Museum had their annual open call for Designers in Residence. The theme was ‘COSMIC’ and this was quite literally my thesis MA Architecture project as I designed a planetarium for birth giving to replace the conventional hospital environment which often feels sterile, even hostile.

I ended up designing a series of birthing furniture elements, which were exhibited at the Design Museum but then donated to St Thomas’ hospital where I had my two daughters and where my entire journey in maternity commenced. After the donation, I felt desperate to do something else. I looked for a practice-based PhD but couldn’t quite find what I needed. Then somehow, completely by virtue, I discovered the MRes Healthcare & Design programme and thought that it was perfectly aligned with what I needed and wanted.

During the MRes you founded M.O.T.H.E.R. &Design – could you tell us more about this and about how your practice expanded or developed during your time at the RCA?

This is a story that has a whole chapter in my thesis. I joined the programme with the ambitious and ambiguous idea to reform the maternity care system. I struggled a lot finding myself, but that’s always my process I guess – I need to go deep and beyond to search, I need to wander and I need to discover.

M.O.T.H.E.R &Design stands for Midwifery and Obstetric Transformations in Healthcare Environments through Research &Design. It exists to offer a set of creative problem-solving lenses to one of the most profound experiences and the most common reason for hospital admission in England – childbirth. It is composed of various research and design methods, which could serve as a universal blueprint for addressing issues across the maternity landscape.

M.O.T.H.E.R &Design is made up of eight methods with eight experts’ contributions. For now, it lives as a template for executing human-centred and ethical design. However, my plan is to expand on it beyond the MRes and found a not-for-profit organisation. I do believe that design and systems thinking is of huge need in healthcare environments, especially learning this more so every day through my current role as a service design architect at Acacium Group.

Could you tell us more about your work with Acacium Group? What else are you working on at the moment?

Acacium Group is a leading healthcare solutions partner. My role as a service design architect is to create delivery models which offer expert solutions for healthcare, social care and the global life sciences industry. It is a role for impact where I have the chance to put myself in the shoes of the most deprived and excluded social groups or individuals and design according to their needs. The team I work with sits centrally within the group, which gives us a fantastic exposure to the different businesses under the Acacium umbrella such as Xyla Health & Wellbeing, Pulse, Maxxima, A&E Agency, CHS Healthcare, Bank Partners and many others. I love my role as I can see how much creativity and design thinking is necessary within the health and care spaces.

I also have a part-time role as Patient and Public Voices Lead for the NHS in the North West of England. I joined in January 2022 and my role is to bridge the Maternity Voices Partnership Chairs with the North West Perinatal Board. So far, I can confidently say that there’s been some incredibly positive change since I began and it feels so rewarding. It’s funny saying this as a designer as we are used to seeing our labour materialised in one form or another – in this instance it’s all intangible, but it could be systemic.

In parallel to this, I also run my own architecture and design services. I will be participating in the FemTechLab programme [an accelerator programme for start-ups addressing women's health and wellness] with my work on the redesign of the vaginal speculum, which could open a whole new world of opportunities.

Your practice spans architecture, interior design, product design and research – what made you take a multidisciplinary approach to your work and why is this important to you?

Being transdisciplinary is everything to me. Ever since my first year in Architecture at Oxford Brookes I was keen on using mixed media. In my final, third year I joined a cinematic architecture unit which changed me forever. I saw architecture as everything and vice versa – everything was architecture. I think humans are highly versatile and multi-skilled species and this is very much reflected in my own practice as a designer and researcher. The methods can vary to suit the process. I enjoy learning and the challenges it comes with.

As designer in residence at the Design Museum, you developed Ultima Thule – an immersive childbirth environment with a ‘triptych of furniture’ that centres the experiences of the birthing person. Could you talk us through each element of Ultima Thule?

I love Ultima Thule with my whole heart. It really established me as a designer, and set my passion for maternity in stone. Labour wards have the same hospital bed, designed by Bruce Archer, and the same waiting room chair which has been around for decades. Our ways are constantly changing. The supporting elements are not there for people to experience giving birth in a safe and ergonomically friendly manner. For my labour, I had a mattress on the floor, which did not help at all, as all I was craving was to dig my nails in and climb. I guess this inspired the ‘Labour Silla’ and its progressiveness to accommodate mammalian behaviours during labour and delivery. There is so much more that could be done and explored in order to make the experience not only better, but also fully committed to the act.

It’s designed as an alternative birthing environment for supporting and empowering mothers and children during childbirth. The design consists of three chairs responding to the specific demands of three phases in childbirth: ‘Labour Silla’ (labour stage), ‘Parturition Stool’ (the birth-giving stage), and the ‘Solace Chaise’ (the post-parturition stage). It's a project that interrogates the design landscape of childbirth within a hospital setting. The term Ultima Thule is derived from a Latin phrase meaning ‘a distant unknown region’ or ‘beyond the known world.’

The Labour Silla works as a cushion and an aid that allows the pregnant body to adopt any desired position in order to prepare for parturition. It is an accommodating element, which allows the expectant parent to sit, kneel, squat, rest, lean and crawl until they find comfort. It is a gradual element, where the mother could either take the journey on her own or be supported by a partner, doula or a midwife.

The Parturition Stool supports those in labour from the back. Space is provided for a second person to sit behind the birthing parent for leaning support. This collaborative act assists with both pushing and pulling. The back of the body is supported with a soft cushion. The partner’s armchair embraces the mother’s stool by design.

The final element of the birth suite is the Solace Chaise – a chaise lounge for postpartum use or recovery. It has been designed to create a secure cocoon for parent and baby to bond in comfort and privacy immediately after the birth. This inclusive element can be used after vaginal birth, through medical intervention, caesarean, miscarriage or post-elective abortion. In times like these, when we question the decisions over one’s own bodily autonomy and agency, I feel designs which liberate are most needed. That was the intention of the Solace Chaise – to celebrate every woman’s own choice over her own reproductive economy.

What made you want to reimagine the birthing environment, and how can design help us to reevaluate the current medical approach to childbirth?

Design can either make or break us and it can do it very well. The surrounding environment has a huge impact on us, how we feel, how we behave and how we navigate our daily tasks. Childbirth is the most universal experience, a primary one. There are two really – birth and death as we all share these two by default. The rest can vary.

Today, birth centres, labour wards, operating theatres and home environments seemingly aim for a non-clinical appearance to provide a calm setting for the expectant mother. During the primal period – which includes the foetal life, birth and a year after birth-giving – it is crucial for parent and baby to be in secure, private and human-centred surroundings.

Current hospital settings are devoid of many qualities that medical researchers have deemed necessary, such as privacy, sanctuary and comfort. Although they have developed techniques to hide the presence of technology and equipment, the spatial quality is not warm, womb-like, soft or female-centred. During my pregnancy, I yearned for a calm space, with a carefully chosen colour and lighting palette. I wanted to limit distraction and foreign stimulation, since researchers have demonstrated that doing so can lead to more melatonin discharge – otherwise known as ‘the darkness hormone’. This hormone works along with oxytocin to assist labour and delivery, and to reduce neocortical activity, which is key to physiological pain-reduction during labour.

While some women value giving birth in an open space where medical professionals are on standby, others value privacy. Through Ultima Thule, I created a space that caters to this latter group. I reduced direct lighting and encouraged warmer colours and materials. It is also crucial for the mother not to be cold, as warmth induces the release of oxytocin.

There’s still a long way to go, but I feel we are on the right track by focusing on what women and birthing people want by listening and attending to their needs.

Ultima Thule has since been donated to St Thomas’ Hospital Home from Home Birth Centre – how has it been received? Have you had any feedback on it?

Ultima Thule belongs to St Thomas’. Sometimes I still pinch myself asking if this really happened. It is currently in Birth Suite 29. I know this full well as last year when my second daughter was born, I saw it there, in the exact same room where I left it upon donation. It just looks perfect.

The feedback has been super positive and that’s the best reward. They do not use the pieces for labour and birth, unless you happen to have this particular room, but they do use them for training and educational purposes by instigating conversations about what maternity care could be, look and feel like.

Are there any particular experiences, skills, approaches, or good advice, from your time on the MRes Healthcare & Design programme that still resonate with you now?

Overall I really enjoyed myself on the programme. I connected with some incredible professionals across different disciplines with a passion for humanising the most basic human right – accessing adequate and supportive healthcare provision. I participated in an endless amount of opportunities during the programme which resulted in fantastic exhibitions as part of London Design Week (for OPPO x RCA) and Great Exhibition Road Festival at the Science Museum in London (for Art x Science). The programme gave me wings to pursue what I love and care about – female-centred health and care.

Thanks to the programme, I left my role as an architect (already pregnant) and decided to do some freelance work. I owned my own time and space, which gave me flexibility and chance to focus on the programme and its demands more, but also work in healthcare, such as a role I did part-time as a Service Designer for Think Next and AstraZeneca. Then I did some work for the Helen Hamlyn Centre for Design on the Future of Betterment, which was more research-based but very much health and care related.

During the Business Toolkit for Healthcare module I developed a business model, a whole product mapping and some IP research, which were incredibly useful to understand the financial side of being a creative and owning your designs. Thanks to this module I gained confidence in doing this, which I used to apply for the FemTech Lab programme where I will be taught by some incredible mentors.

I’d say the programme was very much a platform I used to my own drive and benefit. I knew what I wanted to get out of it and I think I managed to get it – I am very happy and grateful for its existence for sure!