Understanding How the Built Environment Affects Pregnancy-Related Falls

Did you know that nearly one in three pregnant women in the United States experiences a fall each year? That’s a staggering number is comparable to the risk level among older adults. Yet, when we talk about fall prevention, we often overlook pregnancy as a vulnerable life stage that deserves special attention.

Most fall-risk assessments in maternity care focus on physical or behavioral factors, not on the spaces women move through every day. From home layouts to bathroom design, the built environment plays a powerful yet underrecognized role in supporting or compromising maternal balance and safety.

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The Study: Looking Beyond the Individual

A recent study, Physical Environment Factors Influencing Falls Among Women During Pregnancy (Nahirafee & Pati, 2025) explored how physical environments interact with behavioral and physiological changes during pregnancy. Specifically, it examined how women in their third trimester experience falls or near-falls in their daily routines.

The findings challenge the notion that falls are isolated “accidents.” Instead, they emerge from a dynamic system where the person, her intentions, and her surroundings continuously influence one another.

A New Way of Seeing: Dynamic Systems & Ecological Theory

At the heart of this research is a theoretical framework that combines Dynamic Systems Theory and Ecological Theory. It sees movement and balance as the result of a constant conversation between the individual and her environment.

Let’s break it down:

• The individual: A pregnant woman’s changing body, her posture, weight distribution, and sensory perception shapes how she perceives her surroundings and plans her movements.

• The behavior: Her goal-directed actions like standing up, walking, and reaching depend on what the environment “affords” her at that moment.

• The environment: Furniture height, lighting, floor texture, and spatial organization all provide (or fail to provide) the necessary support for safe movement.

When the environment’s affordances (its action possibilities) align with the woman’s physical capabilities, movement feels stable and safe. But when these affordances mismatch (think: a slippery floor or a too-low chair), the risk of losing balance increases dramatically.

The Research in Practice

The study used a qualitative approach, conducted directly in participants’ homes. Thirteen women in their third trimester shared weekly experiences over a twelve-week period, describing and documenting their fall or balance-loss incidents through interviews, photos, and measurements.

These real-life accounts revealed powerful patterns about how everyday settings shape stability.

Common Environmental Triggers

Several environmental conditions consistently contributed to instability:

• Low or soft furniture requiring extra effort to stand up

• Slippery surfaces in kitchens and bathrooms

• Uneven or dim lighting that distorted depth perception

• Cluttered walkways that restricted movement

• Lack of handrails or stable supports near stairs or tubs

Conversely, accessible supports such as nearby walls or sturdy furniture edges often helped women recover their balance and avoid a fall.

The Four Faces of Affordance

The study identified four main types of affordances within the built environment:

1. Functional–supportive: Enables the intended action safely

2. Functional–preventive: Helps prevent a fall by offering timely support

3. Dysfunctional–misleading: Appears stable but leads to imbalance

4. Dysfunctional–ineffective: Fails to prevent a fall when relied upon

This nuanced view reframes “fall risk” not as a personal failure, but as a mismatch between body and environment.

What Designers Can Learn

The implications go far beyond pregnancy. Designing environments that adapt to human variability rather than expecting humans to adapt to rigid spaces.

Simple design choices can make a profound difference:

• Ensure appropriate heights for seating and fixtures

• Maintain consistent, glare-free lighting

• Keep pathways clear and unobstructed

• Incorporate stable surfaces and reachable supports

By integrating such principles, designers can create spaces that not only reduce falls but also promote autonomy, dignity, and comfort for everyone from expectant mothers to older adults.

The Bigger Picture

This research expands the conversation on maternal health beyond medicine and movement science. It positions interior design as a key player in public health, capable of shaping environments that foster safety and well-being during life’s most physically dynamic stages.

It also calls for collaboration between designers, healthcare professionals, and researchers to rethink how we build spaces for vulnerable populations.

Final Thoughts

Pregnancy transforms the body, but the world around it often stays the same. By designing environments that evolve with people’s changing needs, we move toward a more inclusive, empathetic, and evidence-based design practice.