HEALTH BUILDING NOTE 09-02 Maternity care facilities 09-02 2011.pdf · pregnancy is intra-uterine. This is a very anxious time for women, and the facilities This is a very anxious

For queries on the status of this document contact [email protected] or telephone 029 2031 5512

Status Note amended March 2013

HEALTH BUILDING NOTE 09-02

Maternity care facilities

2011

STATUS IN WALES

APPLIES

This document has been created from the two Space for Health website content manuals

It will eventually be superseded by a new

Welsh Health Building Note

It superseded Health Building Note 09-02 Maternity care facilities

2008

For queries on the status of this document contact [email protected] or telephone 029 2031 5512

Status Note amended March 2013

HEALTH BUILDING NOTE 09-02

Maternity care facilities

Please Note that this is an interim document and no changes have been made to the two manuals from which it was created. The Policy and Service Context Manual is followed by the Planning and Design manual each of which had its own contents page and page numbering.

fromspaceforhealth.nhs.uk

Maternity care facilities: Policy andservice context manualVersion:0.6:Wales

© Copyright Welsh Health Estates Published: Fri, 23/09/2011 - 11:11am

Maternity care facilities - Maternity care facilities: Policy and service context manual 39:0.6:Wales

Contents

page

Overview 11 v1.2 p4

Policy context 49 v1.2 p5

Key policy and standards 6646 v1.2 p5

Service context 53 v1.2 p6

Care pathway 74 v1.2 p6

Midwifery-led units (MLUs) 3543 v1.2 p6

Consultant-led units (CLUs) 6619 v1.2 p6

Antenatal care 951 v1.2 p8

Antenatal out-patient care 1133 v1.2 p8

Ultrasound services 1135 v1.2 p8

Early pregnancy care 1137 v1.2 p8

Pregnancy (fetal and maternal) assessment 1139 v1.2 p9

Antenatal in-patient care 1140 v1.2 p9

Birth 952 v1.2 p10

Surgical procedures 953 v1.2 p11

Postnatal/neonatal care 954 v1.2 p12

Postnatal care 1144 v1.2 p12

Newborn care 1145 v1.2 p12

Transitional care 6286 v1.2 p13

Adult high dependency/critical care 955 v1.2 p14

Bereavement support 956 v1.2 p15


Overview 11

1This topic covers the policy and service context, and planning and designconsiderations for maternity care facilities.

The planning and design manual covers the following:

1. antenatal clinics, early pregnancy assessment units, pregnancy (fetaland maternal) assessment units;

2. birthing facilities and in-patient areas, including the requirements forthe routine care of neonates;

3. obstetric theatres.

It covers facilities provided in:

1. midwife-led units, often known as birth centres – which may belocated alongside a consultant-led unit on an acute hospital site, co-located with a community healthcare facility, or exist as a stand-alonecentre;

2. consultant-led units.

The guidance recognises that the services and facilities provision will be differentbetween CLUs and MLUs. It also recognises that MLUs located alongside a CLUmay have differences in provision to those that are separate.

Maternity care facilities - Maternity care facilities: Policy and service context manual Version 39:0.6:Wales

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Policy context 49

47Maternity care is provided in several different healthcare settings, decided on alocal basis by commissioning bodies. This can be either on a hospital site, in thecommunity or at home. There is an increasing call for woman-centred, user-friendly services offering choice and continuity of care.

Each setting should be designed so it is appropriate for use by the family and thestaff who are providing care. Whatever the setting and model of care, the mainobjective is to provide for the safe care of both mother and baby in a comfortable,relaxing environment that facilitates what is a normal physiological process,enabling self-management in privacy whenever possible, and enhances the family’senjoyment of an important life event.

In all units, rooms should be designed to give women choice and control over theirlabour and birth, to normalise the process and welcome family participation.

The “normality” of the experience is a key driver, but appropriate facilities areneeded for intervention when complications occur.

Key policy and standards 6646This guidance takes account in particular of the following key standards andreports:

National Screening Committee ReportRCOG Standards for Maternity Care: Report of a Working PartyCQC: Towards Better Births: A Review of Maternity Services in EnglandNICE guidelines: Intrapartum care: management and delivery of care to women inlabourNational Service Framework for Children, Young People and Maternity ServicesBritish Association of Perinatal Medicine Obstetric standards for the provision ofperinatal careBAPM Standards for hospitals providing neonatal intensive and high dependencycare and Categories of babies requiring neonatal careNational Childbirth Trust: Creating a Better Birth Environment toolkit


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Service context 53

Care pathway 74

ANTENATAL

SCREENING

EARLY

PREGNANCY

ASSESSMENT

TRIAGE

MLU –LED

BIRTH

POST-PARTUM

AND

ROUTINE

NEONATAL CARE

NEONATAL

CARE

ANTENATAL CARE BIRTH POST-NATAL/NEONATAL CARE

PLANNED

C-SECTION

PARENTHOOD & HEALTH ED

ANTENATAL

SCREENING

FETAL AND

MATERNAL

ASSESSMENT

ANTENATAL IN-PATIENT CARE

INCLUDING HIGH-DEPENDENCY CARE

Time

EMERGENCY

C-SECTION

INDUCTION

CLU-LED

BIRTH

HOME HOME HOME

NEONATAL

SURGERY

TRANSITIONAL

CARE

Midwifery-led units (MLUs) 3543These units are managed and staffed by midwives and are sometimes known as“birth centres”. They can be separate from or adjacent to a hospital. They aresuitable for women expected to have an uncomplicated birth. Women can givebirth in these units with little or no intervention. If complications arise they aretransferred to a CLU. Transfer to the nearest unit is a key issue for birthing unitsthat are stand-alone. For MLUs adjacent to a hospital, their protocols for acceptingmothers may be influenced by the proximity of the more specialist facilities andstaff.

The services provided within an MLU will vary depending on its location. Iflocated on a hospital site the MLU may use the main antenatal and out-patientclinics. If located off-site it may include these and other diagnostic services.Antenatal and outreach services will also be provided in the community, in linewith the National Service Framework (NSF) for Children, Young People andMaternity Services (WAG, 2005).

National Service Framework (NSF) for Children, Young People and MaternityServices (Wales)

Consultant-led units (CLUs) 6619These are secondary-level units, providing team-based care. They are located on ahospital site and provide antenatal out-patient and in-patient services, birthing and


6 for use in Wales

http://www.wales.nhs.uk/sites3/home.cfm?OrgID=441

http://www.wales.nhs.uk/sites3/home.cfm?OrgID=441

postnatal care, with facilities for neonatal care and access to adult critical carefacilities.

CLUs with perinatal centres provide team-based care for mothers with fetal ormaternal complications. They will provide the same range of services and requirethe same facilities as CLUs, with the addition of facilities for neonatal high-dependency and intensive care. Many of these units will be professorial/medicalschools.


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Antenatal care 951

Antenatal out-patient care 1133In the antenatal period, a pregnant woman usually attends for antenatal care andscreening tests at a site that is as local and convenient as possible. This may be at aGP surgery/community health centre, local birth centre, children’s centre, or anantenatal clinic in an acute hospital. She may also attend for parenthood and healtheducation sessions in any of these settings. If she requires more specialist antenatalcare, she will be referred from the community to an antenatal clinic in a CLU.

Antenatal clinic

Ultrasound services 1135Ultrasound examinations are an important element of most antenatal screening andmonitoring. Some women may require more than the routine two ultrasoundexaminations to assist in the diagnosis and management of complications ofpregnancy, whereas others may require procedures under ultrasound guidance – forexample amniocentesis. Ultrasound examinations are also important in themanagement of neonates, a factor that should be considered when planningultrasound facilities.

A large CLU will have dedicated ultrasound facilities, a proportion of which willbe equipped for invasive procedures. Some small units may not have their ownultrasound facilties but will access the ultrasound facilities in the main imagingdepartment.

Ultrasound suite

Early pregnancy care 1137This guidance reflects the increasing provision for early pregnancy managementfor women with complications in the first few months of the pregnancy, includingspaces for screening and counselling. Some women with complications may bemanaged in the community. Others will be seen in the early pregnancy assessmentunit (EPAU). This may be located in the maternity unit or within the gynaecologydepartment.

Facilities are required for confirmation of pregnancy by pregnancy test andultrasound to check the viability of the pregnancy, gestational age and that thepregnancy is intra-uterine. This is a very anxious time for women, and the facilitiesmust above all be easily accessible and designed with these sensitivities in mind.

Early pregnancy assessment unit


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http://www.spaceforhealth.nhs.uk/Wales/articles/antenatal-clinic

http://www.spaceforhealth.nhs.uk/Wales/articles/ultrasound-suite

http://www.spaceforhealth.nhs.uk/Wales/articles/early-pregnancy-assessment-unit

Pregnancy (fetal and maternal) assessment 1139Women may attend a pregnancy assessment unit in a CLU for more detailedscanning or fetal assessment in late pregnancy. This is to assess potentialcomplications in later pregnancy without the need for admission to the antenatal in-patient facilities. The unit provides a full range of fetal monitoring services, whichincludes cardiotocography and ultrasound. Access is required to laboratoryfacilities for biochemistry and haematology and urgent laboratory results.

Pregnancy (fetal and maternal) assessment unit

Antenatal in-patient care 1140A pregnant woman may need to be admitted as an in-patient in a CLU for moredetailed assessment and monitoring. The stage of gestation must be taken intoaccount – some units now routinely take women from an early gestation forconditions such as hyperemesis. A woman may need to stay on the antenatal wardfor a few hours only, or until delivery. A mixture of single rooms and multi-bedaccommodation can be provided.

In-patient spaces


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http://www.spaceforhealth.nhs.uk/Wales/articles/pregnancy-fetal-and-maternal-assessment-unit

http://www.spaceforhealth.nhs.uk/Wales/articles/patient-spaces

Birth 952

1157Unless she has been previously admitted as an antenatal patient, a woman in labourwill go directly to the MLU or CLU. On arrival she will be assessed, ideally in atriage suite. This facility is increasingly being used to assess women before transferto birthing rooms, to reduce unnecessary admissions. All women in confirmedlabour should be admitted to a single birthing room with an en-suite facility, whichmost will usually occupy for the entire period of their stay.

Women who are in hospital for induction of labour may go to an induction suite/antenatal ward and then be transferred to a birthing room when the delivery processcommences. Those who go into spontaneous labour while an in-patient will betransferred to a birthing room at the onset of labour, so that they have the sameprivacy as women in early labour at home.

The birthing rooms in an MLU will be set up and designated for straightforwardbirths and will often include birthing pools.

In the case of any unexpected complications arising, the mother will be moved to aCLU with the appropriate facilities and equipment. There should be goodtelecommunication links with other units within the managed clinical network andfacilities for transfer and transport arrangements as and when required. Any MLUon a community hospital or isolated site will need clear and unfailing transferarrangements. There should be a clear referral pathway for each unit.

The birthing rooms in a CLU will be designed and equipped for birth that willencompass different levels of intervention, assistance and support. They providefor a higher clinical function than is required in an MLU. The appropriateconcealment/ storage of interventional equipment is important.

Whatever the setting and the type of care that the woman is receiving, theenvironment should be as non-clinical as possible with a comfortable, non-institutional ambience and should enable self-management in privacy wheneverpossible. In all units, rooms should be designed to give women choice and controlover their labour and birth, to normalise the process and welcome familyparticipation. The social needs of higher-risk groups should not be overlooked.

Partners and other supporters should be made to feel welcome, and their presenceshould be a key consideration in designing facilities for birth. There should beovernight accommodation for partners within the rooms or within or close to theunit.

Birthing spaces


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http://www.spaceforhealth.nhs.uk/Wales/articles/birthing-spaces

Surgical procedures 953

1143A woman will be moved to a dedicated obstetric theatre if unanticipated problemsarise or more serious interventions are required than can be offered in the birthingrooms. Arrangements must be in place for MLUs to transfer women to a hospitalwith the appropriate facilities. Access routes to the theatres for emergencycaesarean sections, both from within the unit and from outside, must be designed toensure speed of access and high levels of privacy for the mother.

Elective caesarean sections may also take place in these theatres or in the maintheatres. Women usually go straight to theatre then to a single room following theprocedure.

Obstetric operating theatre suite


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http://www.spaceforhealth.nhs.uk/Wales/articles/obstetric-operating-theatre-suite

Postnatal/neonatal care 954

Postnatal care 1144This guidance recognises the general need for an increase in single room provisionin the postnatal period in order to enhance the experience and improve privacy anddignity. Women will either remain in the birthing room for their recovery periodand go straight home from it, or be transferred to the postnatal area, ideally to asingle room. Women’s preferences are generally not to move but to stay in thesame room until they are transferred home. However, project teams should ensurethat there are sufficient postnatal beds available in order to maximise the efficientuse of space at peak times. Women who have had a caesarean section will need tobe accommodated in a bed in the postnatal bed area.

Multi-bed accommodation may be provided.

Where there have been complications, the mother and/or the baby may need extracare or intervention. The main philosophy of care is that mothers and babies shouldstay together. The project team may decide to provide a well-baby nursery to allowmothers to obtain rest; security will be an important consideration.

In-patient spaces

Newborn care 1145Every type of birthing unit, whether or not care of sick babies is undertaken, musthave clearly established arrangements for the prompt, safe and effectiveresuscitation and thermal care of babies, and for the care of babies who requirecontinuing support, either in the birthing unit or by safe transfer elsewhere.

All birthing rooms should include:

1. an area designated and equipped for resuscitation of a newborn baby;2. space at the bedside so that a healthy newborn baby can be cared for

alongside its mother;3. the ability to care for a baby for short periods in a warm environment,

for example during neonatal examination, or for observation afterbirth. This will normally be achieved in a cot alongside the mother.Phototherapy may be carried out here.

Healthy newborn babies, healthy pre-term babies, those born by assisted andoperative procedures and babies transferred from the neonatal unit will be cared forin cots alongside the mother, where general maternal care and certain medical andnursing procedures will be carried out.


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A neonatal unit is a facility for those newborn babies requiring care that cannot beprovided beside the mother (see the BAPM 'Standards for hospitals providingneonatal intensive and high dependency care and Categories of babies requiringneonatal care' (2001) for definitions of the levels of neonatal care). A neonatal unitmay be provided depending on the clinical network and local requirements,equipped according to the level of care that the unit is designated to provide.Accessibility of neonatal units and parent facilities is very important.

Birthing spacesBAPM Standards for hospitals providing neonatal intensive and high dependencycare and Categories of babies requiring neonatal care

Transitional care 6286Transitional care facilities are increasingly being provided, where parents can lookafter their baby/babies with supervision from midwives and neonatal professionals(for up to two weeks) prior to transfer home. This area will usually be provided inthe neonatal unit, or within the post-natal bed area, depending on localcircumstances.


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Adult high dependency/critical care 955

1151Women who develop serious problems, for example fulminating pre-eclampsia oreclampsia, major organ failure, clotting disorders or severe haemorrhage, requireprompt access to high dependency, intensive care and/or resuscitation facilities.These women will need intensive observation, treatment and nursing care and mayrequire invasive cardiovascular monitoring. Provision will depend on the workload,casemix and local circumstances. High dependency care may be provided withinthe CLU, but critically ill women requiring artificial ventilation will need to betransferred to critical care facilities.

Every CLU, secondary and tertiary, must have ready access to high dependencyand critical care facilities on site. The provision required will relate to the numberof births per year and needs to be assessed locally for each project. In tertiarycentres, the number of cases requiring high dependency care can be more than 5%of the number of deliveries per year.

At an MLU remote from a hospital, temporary high dependency care can beprovided in the birthing room. A paramedic ambulance would treat and stabilisethe mother before transfer. There should be recognised routes of access to criticalcare facilities, together with equipment and staff for safe transfer.

In-patient spaces


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http://www.spaceforhealth.nhs.uk/Wales/node/17

Bereavement support 956

1154Access to appropriate facilities is very important for women and families whosuffer bereavement at any stage of pregnancy.

* Women attending the out-patient clinic, EPAU and pregnancyassessment facilities should have access to quiet spaces forcounselling in the event of bad news.

* The birthing suite and in-patient facilities should include singlebedroom(s), away from the birthing area and with separate exit fromthe ward, for use in the event of a bereavement.


15 for use in Wales

fromspaceforhealth.nhs.uk

Maternity care facilities: Planning anddesign manualVersion:0.5:Wales

© Copyright Welsh Health Estates Published: Fri, 23/09/2011 - 11:11am

Maternity care facilities - Maternity care facilities: Planning and design manual 72:0.5:Wales

http://www.wales.nhs.uk/sites3/Documents/254/Maternity%20Policy%20and%20service%20context.pdf

Contents

page

Overview 11 v1.2 p7

Summary of key changes 7891 v1.2 p8

Key changes since the August 2008 edition of Health Building Note 09-02 7890 v1.2 p8

Whole maternity unit considerations 139 v1.2 p10

Location of birthing facilities 292 v1.2 p10

Combined CLU and MLU – key functional relationships 293 v1.2 p12

Separate CLU and MLU – key functional relationships 294 v1.2 p13

Design considerations 302 v1.2 p14

Inclusivity 296 v1.2 p14

Security 297 v1.2 p14

Infection control 299 v1.2 p15

Records 1855 v1.2 p15

Storage 301 v1.2 p16

Antenatal clinic 143 v1.2 p17

Scope and size of provision 407 v1.2 p17

Functional relationships 409 v1.2 p18

Spaces 145 v1.2 p20

Reception and waiting 144 v1.2 p20

Consulting/examination rooms 285 v1.2 p20

Pregnancy assessment room (MLUs only) 286 v1.2 p22

Interview rooms 287 v1.2 p22

Preparation for parenthood room/relaxation classes 288 v1.2 p23

Preparation for parenthood store (optional) 289 v1.2 p23

Treatment room (optional) 290 v1.2 p23

Support spaces 291 v1.2 p24

Ultrasound suite 966 v1.2 p25



Spaces 147 v1.2 p26


Reception/waiting 413 v1.2 p26

Ultrasound rooms 414 v1.2 p26


WCs 416 v1.2 p26


Early pregnancy assessment unit 344 v1.2 p28



Spaces 345 v1.2 p31



Touchdown base 1049 v1.2 p31



Sitting area 6015 v1.2 p32


Pregnancy (fetal and maternal) assessment unit 346 v1.2 p33



Spaces 347 v1.2 p35

Reception/sitting 1058 v1.2 p35


Pregnancy assessment room/bays 1060 v1.2 p35



Staff communications base 6071 v1.2 p38


Birthing facilities (and associated in-patient facilities) 348 v1.2 p40


CLU functional relationships 429 v1.2 p41

MLU functional relationships 993 v1.2 p42

Front of house spaces 999 v1.2 p43


Triage room 1068 v1.2 p43

Induction suite 1070 v1.2 p43

Birthing spaces 1032 v1.2 p44

Birthing rooms 1624 v1.2 p44


En-suite 1078 v1.2 p51

Birthing pool areas (optional) 1073 v1.2 p52

Assisted bathroom(s) 1076 v1.2 p54

Birthing room layouts and ergonomic evidence 351 v1.2 p55

Activities 1030 v1.2 p56

Birthing room suitable for single births 1102 v1.2 p56

Birthing room suitable for twin and complex births 1105 v1.2 p56

Space studies 1031 v1.2 p58

Bed location and privacy 1113 v1.2 p62

Local storage 1657 v1.2 p64

Evacuation of the mother in the bed/door width 1115 v1.2 p65

Room layout options 349 v1.2 p69

Single/twin birth – room layout options 1116 v1.2 p69

Single birth with pool – room layout options 1118 v1.2 p70

Specific spatial/functional issues 1119 v1.2 p72

In-patient spaces 1003 v1.2 p74

Antenatal and postnatal bed spaces 1085 v1.2 p74

Multi-bed spaces 1087 v1.2 p75

Isolation facilities 1088 v1.2 p76

High dependency area 1089 v1.2 p76


Bereavement suite 1090 v1.2 p77

Staff communications base 1092 v1.2 p77

Treatment room (optional) 1670 v1.2 p78

Day room(s)/transfer lounge 1675 v1.2 p78

Private rooms for expressing milk 1679 v1.2 p79

Milk kitchen/store/training room 1683 v1.2 p79


Other support spaces 1697 v1.2 p80

Staff facilities 1698 v1.2 p80

Obstetric operating theatre suite 352 v1.2 p82


Spaces 353 v1.2 p83

Anaesthetic room 1699 v1.2 p83


Obstetric theatres 1701 v1.2 p83

Recovery spaces 1704 v1.2 p84

Whole maternity unit staff accommodation 354 v1.2 p85

Specific engineering considerations 355 v1.2 p86

General engineering 362 v1.2 p86

Sustainability and energy efficiency 364 v1.2 p86

Ventilation 365 v1.2 p86

Hot and cold water systems 366 v1.2 p87

Medical gases 367 v1.2 p87

Electrical services 368 v1.2 p89

Bedhead services 369 v1.2 p89

Acoustics 7050 v1.2 p90

Schedule and cost information 2259 v1.2 p91

Maternity schedules of accommodation 2230 v1.2 p91


Overview 11

1This topic covers the policy and service context, and planning and designconsiderations for maternity care facilities.

The planning and design manual covers the following:

1. antenatal clinics, early pregnancy assessment units, pregnancy (fetaland maternal) assessment units;

2. birthing facilities and in-patient areas, including the requirements forthe routine care of neonates;

3. obstetric theatres.

It covers facilities provided in:

1. midwife-led units, often known as birth centres – which may belocated alongside a consultant-led unit on an acute hospital site, co-located with a community healthcare facility, or exist as a stand-alonecentre;

2. consultant-led units.

The guidance recognises that the services and facilities provision will be differentbetween CLUs and MLUs. It also recognises that MLUs located alongside a CLUmay have differences in provision to those that are separate.

Maternity care facilities - Maternity care facilities: Planning and design manual Version 72:0.5:Wales

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Summary of key changes 7891

Key changes since the August 2008 edition of HealthBuilding Note 09-02 7890The following key changes have been made since the August 08 edition of HBN09-02:

Birthing facilities

Previously paragraph 7.7, now ‘Birthing facilities (and associated in-patientfacilities)’ – ‘Birthing spaces’: ‘Birthing rooms’

Now reads “Based on these studies, two room sizes have been used within theschedule of accommodation and are illustrated in ‘Room layout options’: a roomintended for single birth and a room suitable for twin/complex births. Theschedule of accommodation assumes that 20% of the birthing rooms in a CLUwill be the larger size but that all the rooms in an MLU will be sized for singlebirths. The detailed supporting ergonomic information is available in anassociated, separate report (forthcoming).” This is an additional clarificationfollowing the most recent ergonomic study and development of the schedule ofaccommodation.

Previously paragraph 7.9, now in Planning and design manual – ‘Birthing facilities(and associated in-patient facilities)’ – ‘Birthing spaces’: ‘En-suite’

Now reads “This guidance assumes that all en-suite facilities include a bath. […]Where a shower is required, it should be included separately within the room andnot located over the bath.” It was previously recommended that only birthingrooms without a pool should have a bath. A woman requiring pain relief should not

have to wait for a pool to be filled, so a bath is recommended in every en-suite.

Theatres

Previously paragraph 8.2, now ‘Obstetric operating theatre’ – ‘Spaces’: ‘Obstetrictheatres’

Now reads “A general theatre space is appropriate for undertaking obstetricprocedures. In addition: …” Deleted“Health Building Note 26 Volume 1 currentlyrecommends a standard size of 55 m² for all in-patient operating theatres and this isconsidered to be appropriate for obstetric procedures.” Based on evidence from apost-project evaluation of 12 schemes, the general theatre area has been changedfrom 55 sq m to 48 sq m, with a note to say that further research will be necessaryto validate this. The data actually suggests that many maternity theatres are


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operating satisfactorily within a smaller area than 48 sq m – but further work will

be undertaken.

Schedule and cost information

New – see ‘Schedule and cost information’

Birthing room layouts

Previously Appendix 1, now ‘Birthing facilities (and associated in-patientfacilities)’ – ‘Birthing spaces’ – ‘Birthing room layouts and ergonomic evidence’

The new layouts are based on the same previous ergonomic studies, butsupplemented by findings from a subsequent additional study. They have beenpresented in a format that is designed to assist users to assess their own designsolutions. The full supporting ergonomic report will be available separately at alater date.

Birthing spacesRoom layout optionsSpacesSchedule and cost informationBirthing room layouts and ergonomic evidence


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http://www.spaceforhealth.nhs.uk/Wales/articles/room-layout-options

http://www.spaceforhealth.nhs.uk/Wales/articles/spaces-3

http://www.spaceforhealth.nhs.uk/Wales/articles/schedule-and-cost-information-0

http://www.spaceforhealth.nhs.uk/Wales/articles/birthing-room-layouts-and-ergonomic-evidence

Whole maternity unitconsiderations 139

Location of birthing facilities 292The consultant-led unit (CLU) should be located to enable 24-hour easy access forambulances and cars. Women may arrive by ambulance, taxi or car and need to bedropped off at the entrance to the unit. Particular consideration is needed to ensurethat partners can park their cars easily and then accompany women into thebuilding.

The CLU should be adjacent or close to the midwifery-led unit (MLU), if there isone, and have good access to the neonatal unit. Adult high dependency and criticalcare facilities should be close enough for direct transfers to take place, and closeenough for the mother to visit the baby or vice versa. Easy access to surgical andmedical consultants is desirable to facilitate consultation.

Access to external spaces is important in all units. The location should protect otherpatients and visitors in the hospital from the noise of women in labour whether thewindows are open or shut. Positioning of courtyards is important, since these areasare used for relaxation or play.

Units should ideally not be sited near A&E or mental health units as these patientsmay wander, and security of the CLU/MLU is an important consideration.

A maternity unit should have its own separate entrance, because of the need for 24-hour access and security control. The entrance to all units should be designed andlocated to provide easy access and to provide a welcoming, non-clinicalenvironment. WC facilities should be provided in this area. Entrance areas to largerunits may incorporate a café facility.

It is essential that 24-hour immediate access for women in advanced labour isprovided. On arrival, the means of communicating with staff and the routes to theunit need to be immediately clear inside the entrance. Entrance via a deserted lobbyshould be avoided.

If an MLU is provided within a hospital, it should have direct access for womenand families separate from the access to the CLU. Ideally, it should have adedicated entrance. There should be internal communication for ease of transfer ifnecessary, and a time-efficient access route between the two.


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Reception area, Barts and the London NHS Trust – Photographer: Lisa Payne

The figures below illustrate the key relationships of separate and combined units.


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Combined CLU and MLU – key functional relationships 293

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Separate CLU and MLU – key functional relationships 294

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US

= U

ltra

sou

nd

NN

U =

Neo

nat

al u

nit

Sup =

Su

pp

ort

fac

ilities


13 for use in Wales

Design considerations 302

Inclusivity 296In calculating numbers of birthing pools, project teams will need to take intoaccount that certain ethnic groups will not use pools.

General guidance on inclusivity is set out in the manual 'General design principles'(under 'Functional design issues') – see the link below.

Functional design issues

Security 297General security guidance is set out in the manuals 'General design principles'(under 'Functional design issues') and in 'General engineering principles' (under'Security') – see the links below.

Security is an issue of importance for staff, mothers and babies.

1. Babies born in hospital should be cared for in a secure environment towhich access is restricted.

2. An effective system of staff identification is essential.3. A robust and reliable baby security system should be enforced, such as

baby tagging, closed-circuit television, alarmed mattresses.4. Strict criteria for the labelling and security of the newborn infant are

essential.

The number of entry and exit points to the unit should be reduced to a minimum.Public access and egress should be limited to one door, which should be in thevicinity of and with good natural surveillance from the reception desk/staffcommunication base; although security should not solely rely on the presence ofstaff/observation. The use of centrally managed access control using one of thefollowing systems should be considered essential: swipe card, proximity orbiometric recognition. Swipe cards are considered the least secure, with biometricrecognition being the most secure. Digital code locks should be avoided. Wherethis is not possible, access/egress controls to wards should be operated at wardlevel.

Overt and well-publicised CCTV cameras should be installed at all entrances to theunit. Where the unit is only one department within a larger health facility building,consideration should be given to installing CCTV at all exits from the building inorder to maximise the opportunity for detecting, identifying and apprehending anabductor. Previous infant abductions have shown that abductors generally plantheir abductions thoroughly, which includes visiting different maternity units to


14 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/articles/functional-design-issues-0

establish security strengths and weaknesses. CCTV should ideally be monitoredand recorded at the security control room. Digital recording is now normal practiceas it allows for instant retrieval of images while the system is still recording andbeing used during an incident.

A system of electronic tagging of babies may be considered. See ‘Safe and Sound:Security in NHS maternity units’ (National Association of Health Authorities andTrusts, 1995) for further information. In some centres, controlled entry using FMcards has been used in preference to baby tagging, which has been difficult tocontrol. Project teams should consult their local security adviser when consideringany electronic tagging system.

A separate, differently-coloured identification badge is commonly used to denotestaff permitted access to young children and infants.

An integrated security system should link the building/fire door alarm system to thebaby tagging, and CCTV systems to an appropriate monitoring station.

Signage should be displayed alerting users of the security systems in place, forexample CCTV cameras and baby tagging systems.

Security systems in place should not impede movement of staff or safe transfer ofmother or baby in the event of an emergency.

The need to provide system security to deter potential criminal behaviour and toreassure parents should be balanced with the need to create a welcomingatmosphere on the unit.

In birthing rooms, the woman should be able to control access of visitors from thebedhead. Staff should be able to override this from the staff base.

Functional design issuesSecurity

Infection control 299Birthing pools and other equipment should be disposed of or thoroughly cleanedand dried after every use, in accordance with local infection control policies. Localinformation and guidelines regarding prevention of legionella build up in watersupply from seldomly used pools should be obtained from the local estates teamand should be adhered to.

HFN 30: Infection control in the built environment

Records 1855There is a statutory requirement in maternity care to provide contemporaneousrecords of all events, and records need to be kept for 25 years to support anylitigation claims. There should be storage facilities to keep records traceable and


15 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/articles/functional-design-issues-0

http://www.spaceforhealth.nhs.uk/Wales/articles/security-5

https://publications.spaceforhealth.nhs.uk/index.php?option=com_documents&Itemid=6&task=do_search&title=HFN+30&description=&pub_date=&isbn=&keywords=&locale=-1&documents=all

secure against loss, damage or use by unauthorised persons. Archived records donot need to be kept on the unit itself, but should be accessible within 24 hours.

Women carry their own notes in the antenatal and postnatal period. In antenatalfacilities some space is required for the storage of paper overview records, whilepostnatal facilities require a retrieval system for re-filing full records.

Storage 301Over and above general storage requirements, which are dependent upon localsupply and storage policies, maternity facilities require storage space for a largevolume of items such as birthing packs.

Supplies, storage and distribution


16 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/articles/supplies-storage-and-distribution

Antenatal clinic 143

142Within a hospital setting, the antenatal clinic should be designed so that it has anidentity of its own and can function independently from the general out-patientsdepartment. It should be located on the ground floor, well signposted and with aseparate entrance that is easily accessible from outside the hospital. This can be viathe main entrance to the maternity unit.

Antenatal clinics may also be used as gynaecology clinics. There are likely to belocal variations in where the early pregnancy assessment unit (EPAU) is located.The EPAU is usually separate from the antenatal clinic, but nearby to allowpatients with unexpected problems on scanning to be referred easily.

Attendance at an antenatal clinic is often a woman’s first introduction to ahealthcare facility. The suite should appear attractive and user-friendly, with aquiet, relaxed atmosphere that will maintain the woman’s confidence and dignity.The partner, friends or other family members, including children, may accompanyher. Waiting areas should be planned with this in mind, with access to play areas,drinking water and WCs. Wall décor should be non-clinical in nature and notadorned with medical diagrams.

Scope and size of provision 407Specific clinical areas include:

* a suite of standard/multidisciplinary consulting and examination (C/E)rooms;

* interview rooms;* ultrasound rooms, which may be shared with the EPAU.

The size of the antenatal clinic suite will depend on the number of expectedattendances per session, the number of proposed sessions, the number of doctorsand midwives, and the number of education classes. Clinic sessions may bededicated to women with specific care needs, for example diabetes, other medicalconditions or pregnancy complications, and this should be considered whendetermining the clinic size. An influential factor in determining the number ofsessions will be the level of services provided in other facilities. Rooms should bedesigned for maximum flexibility of use.

The schedules of accommodation are based upon estimated attendances/clinicsessions for the given numbers of births.


17 for use in Wales

It is assumed that a Midwifery-led unit (MLU) co-located with a Consultant-ledunit (CLU) would utilise the clinic facilities in the CLU.

Where stand-alone MLUs remote from the CLU are providing antenatal clinics andmaternal assessment, they should include at least two C/E rooms and the ability toundertake ultrasound scanning.

Functional relationships 409C/E rooms should have easy access to ultrasound. The link to pathology servicesmay be by way of a pneumatic tube transport system. Near-patient testing facilitiesmay be provided within the unit, depending on local policy. There should be easyaccess to the birthing area and maternity in-patient beds.


18 for use in Wales

C

CounsellingR = Reception/Waiting/

Child play

C = Consultation

G = Group room/ Parentcraft

Staff link

Patient flow/link

Admin

Sto

res

An

ten

atal

clin

ic

R

G

Entrance

Ultrasound

Ultra

sou

nd

Whole maternity unit considerations


19 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/articles/whole-maternity-unit-considerations

Spaces 145

Reception and waiting 144The waiting area should have a welcoming and informal atmosphere. Manypregnant women will be accompanied by a friend or relative and may have smallchildren with them. The area should be planned so that it can be subdivided intoseparate waiting spaces.

Within or adjacent to the waiting area, an information/resource space should beprovided. This is likely to include a combination of printed and electronic media.

If not conveniently located elsewhere, the following facilities should be provided:

* WCs* Refreshment facilities* Children's play area* Baby changing* Infant feeding* Wheelchair parking bay

WCsEntrance, reception and waiting

Consulting/examination rooms 285A general-purpose single-sided C/E room should be used, to increase flexibility ofuse. The C/E room will be large enough to accommodate electronic monitoring anddiagnostic equipment. The examination couch should be screened by a curtain toallow privacy. The couch needs to be accessible on the right-hand side and at thefoot. The design and layout of the room should ensure that the privacy and dignityof the woman is protected. Acoustic privacy is also important.

Blood-taking may be carried out in the C/E rooms (in line with the Children’s NSFpreference), or separate phlebotomy rooms may be provided, depending on localdecision. The schedules of accommodation are based upon blood-taking beingcarried out in the C/E room.

Some C/E rooms may be larger to facilitate multi-disciplinary consultations. Thiswill be a project decision.


20 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/topics/wcs

http://www.spaceforhealth.nhs.uk/Wales/topics/entrance-reception-and-waiting

C/E room, Consultant-led unit (CLU) antenatal clinic Courtesy Queen Elizabeth Hospital NHS

Trust Photographer: Lisa Payne


21 for use in Wales

C/E room, Midwifery-led unit (MLU) antenatal clinic Courtesy Queen Elizabeth Hospital NHS

Trust Photographer: Lisa Payne

Consulting/examination room: single-sided couch access: Design manual

Pregnancy assessment room (MLUs only) 286In a stand-alone MLU remote from a CLU, one C/E room may be used to carry outpregnancy assessments. Ultrasound examinations will not usually be carried out inan MLU unless an antenatal clinic or pregnancy assessment clinic is associatedwith it. Portable equipment may be used.


Interview rooms 287Depending on the size of the unit, rooms may be used flexibly for counselling,parental education, staff training and meetings. However, ideally, dedicated


22 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/manuals/consultingexamination-room-single-sided-couch-access-design-manual


facilities should be provided so that there is always a space available whenrequired.

The locations of rooms used for counselling should be discreet, and exit routesfrom them should not pass through public or waiting areas. These rooms shouldprovide a non-clinical environment for discussion with people who may bedistressed. Privacy is essential.

Interview room: 4 places: Design manualInterview room: 7 places: Design manual

Preparation for parenthood room/relaxation classes 288Local community facilities are often used for this activity. If provided in thehospital it should be used flexibly. The location should facilitate easy access forpeople in the evening and at weekends. It should not create any security issues andshould ideally be located within a 24-hour functioning unit. The room shouldprovide enough space to accommodate at least ten couples (plus facilitators), withroom to move freely and use birth balls, mats and other equipment. This room willalso be used for relaxation classes.

Equipment used in classes will include: mats; cushions; birthing aids such as balls;comfortable chairs; display boards for posters; a flipchart stand and sheets;audiovisual equipment (OHP/video/ DVD); and a whiteboard. Ceiling hooks andropes may be provided for use with slings. Computer(s) with Internet access shouldalso be available.

It is important to be able to control the lighting, and have access to fresh air andcool drinking water. Ideally there should be access to tea and coffee-makingfacilities. There should be access to WC facilities close by.

Group rooms

Preparation for parenthood store (optional) 289The preparation for parenthood store may be located within or adjacent to thepreparation for parenthood room. The door should be lockable for the safekeepingof valuable teaching aids. Storage is required for mats, bean bags, pillows, ballsetc.

Treatment room (optional) 290A treatment room may be required for diagnostic and clinical procedures, whichmay include specimen collecting and cardiotocography (CTG). A couch and twochairs should be provided, along with an adjustable examination lamp. A clinicalwash-hand basin is required. Adequate space is required for mobile surgicaltrolleys, and monitoring and diagnostic equipment.

Treatment rooms


23 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/manuals/interview-room-4-places-design-manual


http://www.spaceforhealth.nhs.uk/Wales/topics/group-rooms

http://www.spaceforhealth.nhs.uk/Wales/topics/treatment-rooms

Support spaces 291The following support spaces are required, but may be shared with other out-patient or maternity facilities:

* Clean utility* Dirty utility* Disposal hold* Cleaners' room* Staff changing* Staff rest/beverage bay* Offices* Stores* Specimen collection/pneumatic tube (optional)

UtilityRefreshments and restSanitary spacesOfficesFacilities management


24 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/topics/utility

http://www.spaceforhealth.nhs.uk/Wales/topics/refreshments-and-rest

http://www.spaceforhealth.nhs.uk/Wales/topics/sanitary-spaces-0

http://www.spaceforhealth.nhs.uk/Wales/topics/offices

http://www.spaceforhealth.nhs.uk/Wales/topics/facilities-management

Ultrasound suite 966

969Imaging procedures may be required for the diagnosis of complications in thepostnatal period or for the management of newborn babies. Although suitableportable imaging equipment should be available within a Consultant-led unit(CLU) and within easy access of the neonatal unit, it is assumed that most womenrequiring ultrasound imaging procedures will have these performed in the mainimaging department.

Scope and size of provision 970The accommodation requirements will depend on local factors including thenumber of deliveries in a particular unit, the casemix, the ultrasound scanningpolicy for the population served by that unit, and whether portable ultrasoundequipment is used. An ultrasound scanning room can cope with approximately5000 mixed routine examinations per year. This guidance is based on the provisionof a minimum of two scanning rooms in a CLU to allow invasive procedures, forexample amniocentesis, to be performed while routine scanning continues in theother room.

The wider introduction of nuchal translucency across the NHS will have an impacton the number of ultrasound rooms required in a unit. These examinations takelonger to perform and slow down the throughput in clinics.

Functional relationships 971Where a dedicated ultrasound suite is provided within a larger unit, it should belocated within, or close to, the antenatal clinic. It should be close to the C/E roomsand reception, with easy access to records. WCs should be provided immediatelyadjacent to ultrasound rooms. There should be easy access from the pregnancyassessment facilities. Consideration should be given to access from in-patient areas,depending on local policy.

Antenatal clinicWhole maternity unit considerations


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http://www.spaceforhealth.nhs.uk/Wales/articles/antenatal-clinic


Spaces 147

Reception/waiting 413Women will be directed to the ultrasound suite from the reception desk in theantenatal clinic. Waiting space is required close to the ultrasound rooms (this maybe shared with the antenatal clinic). The number of seats required will depend uponthe estimated throughput of women. Cold water drinking facilities will be required.

Ultrasound rooms 414A standard treatment room with black-out and a dimmable lighting system isappropriate for the procedures carried out in this clinic. An examination lightshould be provided. Privacy for women dressing and undressing is essential.Seating is required for the sonographer and the woman’s escorts. In accordancewith current policy, instruments will be sent to central sterilizing facilities.

Treatment rooms

Interview rooms 415Interview rooms for counselling should be located adjacent to the ultrasound roomsto avoid families having to walk through busy circulation areas. Two exit/entrydoors may be considered.


WCs 416WC facilities should be provided immediately adjacent to ultrasound rooms. OneWC is required per scanning room; one should be an accessible WC. AdditionalWCs should be available in the waiting area.

WCs

Support spaces 417Support facilities are required as for the antenatal clinic, with which they may beshared:

* Clean utility* Dirty utility* Disposal hold* Cleaners' room* Staff changing* Staff rest room/beverage bay* Offices


26 for use in Wales





* Stores* Specimen collection/pneumatic tube (optional)

UtilitySanitary spacesOfficesFacilities management


27 for use in Wales





Early pregnancy assessmentunit 344

418Within a Consultant-led unit (CLU), a dedicated early pregnancy assessment unitmay be required with its own reception and waiting area. This may be co-locatedwith the gynaecology clinic/ward, with which it may share certain facilities. Forreasons of privacy and dignity, patient spaces in a dedicated EPAU should bephysically separate from the antenatal clinic and the pregnancy assessment unit.

Scope and size of provision 419Specific clinical areas include:

* C/E room(s) (pre-scanning);* ultrasound room(s), although ultrasound facilities close by may be

used;* interview room(s) (post-scanning).

The number of C/E and scanning rooms will depend upon the number of womenattending per session. There will also be a percentage of emergency assessments toconsider. The schedule of accommodation is based upon estimated attendances/clinic sessions for the given numbers of births.

Functional relationships 421A key consideration in its location is ease of accessibility for staff. It should also bewithin easy reach of the in-patient beds and the operating theatre suite. Womenwho need to be admitted overnight will be transferred to an in-patient area.

There should be good links to pathology facilities and the blood transfusionservice. WCs should be immediately adjacent. Easy access is required to restfacilities and counselling facilities.


28 for use in Wales

R = Reception/waiting

FEM

A

EPAU

Gyn

ae

EntranceR

To Path lab To A&E

To Day surgery

Blood-transfusion

service

KEY

Staff link

Patient flow/link

Counselling

Sitting

Discrete exit

Consult/ exam

Ultrasound scanning

Admin/staff amenities

Gynaecology/OPD ward


29 for use in Wales



30 for use in Wales


Spaces 345

Reception and waiting 1046The waiting area should have a welcoming and informal atmosphere. Manypregnant women will be accompanied by a friend or relative and may have smallchildren with them. The area should be planned so that it can be subdivided intoseparate waiting spaces.

Within or adjacent to the waiting area, an information/resource space should beprovided. This is likely to include a combination of printed and electronic media.

The waiting area may be shared with the gynaecology clinic.


* WCs: located conveniently for the waiting area, C/E rooms and theultrasound rooms. These include a wheelchair-accessible WC. Theyshould not be directly overlooked by the waiting area.

* Refreshment facilities* Children's play area* Baby changing* Infant feeding* Wheelchair parking bay


Consulting/examination rooms 1048Blood-taking may be carried out in the C/E rooms (in line with the Children’s NSFpreference), or separate phlebotomy rooms may be provided; this is for localdecision.


Touchdown base 1049A midwifery/nurse touchdown base is required for regular observation of women,and co-ordination of movements to theatre and in-patient areas.

Touchdown base: Design manual

Ultrasound rooms 414A standard treatment room with black-out and a dimmable lighting system isappropriate for the procedures carried out in this clinic. An examination lightshould be provided. Privacy for women dressing and undressing is essential.


31 for use in Wales




http://www.spaceforhealth.nhs.uk/Wales/manuals/touchdown-base-design-manual

Seating is required for the sonographer and the woman’s escorts. In accordancewith current policy, instruments will be sent to central sterilizing facilities.

Treatment rooms

Interview rooms 1052One or two interview rooms should be provided for discussion post-scanning.


Sitting area 6015A small waiting/sitting area is required; privacy and quiet are essential.

Support spaces 1064The following may be provided separately or shared with other units that may beco-located, depending on the overall design:

* Patient beverage and snack preparation facilities* Clean utility* Dirty utility: There should be easy access for women who often bring

their own urine specimens for checking. It should be adjacent to theWC facilities so that women can also provide specimens forinvestigation within easy reach of the test room.

* Disposal hold* Cleaners' room* Staff changing* Staff rest/beverage bay* Offices: A medical/midwifery office is required within the pregnancy

assessment unit to allow for administration duties and privatediscussion of problems by medical and midwifery staff. This shouldinclude telecommunications facilities.

* Stores* Specimen collection/pneumatic tube (optional)

Refreshments and restUtilitySanitary spacesOfficesFacilities management


32 for use in Wales









Pregnancy (fetal and maternal)assessment unit 346

422Local policy will determine the functional requirements, and the opportunity forsharing facilities will depend on the size of the unit and the timing and organisationof clinics.

Scope and size of provision 423Facilities are required for C/E, ultrasound, phlebotomy, amniocentesis (invasivetesting) and continuous CTG. These may take the form of individual rooms and/ormulti-bay spaces. Reclining chairs and possibly beds should be provided, withaccess to ultrasound facilities within or adjacent to the unit.

The level of provision of pregnancy assessment facilities will depend on thenumber of patients and appointment times and the number of healthcareprofessionals available to work in the unit.

The schedule of accommodation for an assessment unit is based upon estimatedattendances and clinic sessions for the given numbers of births.

Functional relationships 425The pregnancy assessment unit should ideally be located close to the birthingfacilities. It would then have access to emergency laboratory facilities. If the sameworkforce is shared between the antenatal clinic and the pregnancy assessmentunit, the proximity of the two units is desirable.


33 for use in Wales

Ultrasound

Pregnancy assessment

Consult/ exam

Counselling

R

R = Reception/sitting/beverage bay

FEM

A

FEMA Birthing

Ultra

sound

Admin/staff amenities

Entrance

Triage

Birthing area



34 for use in Wales


Spaces 347

Reception/sitting 1058The waiting area should have a welcoming and informal atmosphere. Manypregnant women will be accompanied by a friend or relative and may have smallchildren with them. The area should be planned so that it can be subdivided intoseparate waiting spaces.

Within or adjacent to the waiting area, an information/resource space should beprovided. This is likely to include a combination of printed leaflets, videos andselected websites.

The waiting area may also be used as a sitting area, where women can sitcomfortably and relax during the assessment. This combined facility should beprivate and separate from the circulation areas. It should include comfortableseating, entertainment services and access to refreshments.


* WCs* Refreshment facilities* Children's play area* Baby changing* Infant feeding* Wheelchair parking bay


Consulting/examination rooms 1059Consulting/examination room: single-sided couch access: Design manual

Pregnancy assessment room/bays 1060These are multi-use rooms with reclining chairs for performing CTGs. Sufficientspace should be provided by the recliners for using the CTG monitor and mobileultrasound machine. Curtains should be provided round each area.


35 for use in Wales




Pregnancy assessment bay


36 for use in Wales

Two-bay layout

Separate C/E room – in a Consultant-led unit (CLU)

All images above Courtesy Queen Elizabeth Hospital NHS TrustPhotographer: Lisa Payne


37 for use in Wales

Ultrasound rooms 1062These may be dedicated facilities or shared with the antenatal clinic if co-located.

Treatment rooms

Interview rooms 1063These may be dedicated facilities or shared with the antenatal clinic if co-located.


Staff communications base 6071This is the central communications hub of a unit, a base at which midwives mayreceive, read or give instructions and record information in the records held there.It should be centrally located and easily identified by staff and visitors. It may belocated near the clean utility room. The staff base should be wired as the centre forthe help call system within the area and central monitoring equipment for telemetryif used.

There should be good communication links, including telephones and IT. Acomputer terminal and associated equipment with a link to laboratories and EPRand PACS will be required. The security of records and noise associated withequipment should be considered.

Work stations for the computers will be needed, the quantity dependent on localpolicy.

Support spaces 1064The following may be provided separately or shared with other units that may beco-located, depending on the overall design:

* Patient beverage and snack preparation facilities: may be adjacent tothe reception/sitting area

* Clean utility* Dirty utility: There should be easy access for women who often bring

their own urine specimens for checking. It should be adjacent to theWC facilities so that women can also provide specimens forinvestigation within easy reach of the test room.

* Disposal hold* Cleaners' room* Staff changing* Staff rest/beverage bay* Offices: A medical/midwifery office is required within the pregnancy

assessment unit to allow for administration duties and privatediscussion of problems by medical and midwifery staff. This shouldinclude telecommunications facilities.

* Stores


38 for use in Wales




* Specimen collection/pneumatic tube (optional)

Refreshments and restUtilitySanitary spacesOfficesFacilities management


39 for use in Wales






Birthing facilities (andassociated in-patient facilities)

348

426This guidance describes facilities required in all types of maternity unit for:

1. direct admission of women;2. observation and assessment of pregnant women;3. uncomplicated labour and births;4. complicated labour and births (Consultant-led units (CLUs) only);5. operative obstetric procedures (CLUs only);6. resuscitation of the baby;7. observation and recovery of infants;8. observation and recovery of mothers;9. partners, relatives and friends;10. medical, midwifery, nursing and other staff;11. clinical training of midwifery, nursing and medical staff.

Scope and size of provision 427The number of antenatal beds, birthing rooms and postnatal beds will be a localdecision based on a number of factors. The aim is to provide appropriate care forwomen and babies close to home. Project teams should consider the model of care,current practices and any perceived changes planned over the short, medium andlong term. The following are key considerations:

* the size of the population served, including any tertiary referrals;* the demographic trends that will influence the number of deliveries in

the area;* the existing and predicted work trends in relation to any clinical

developments;* whether or not the unit will attract women arriving by ambulance;* whether or not the unit will attract transfer in of mothers and babies

from other units (that is, tertiary referrals);* whether or not the maternity services are likely to be reorganised/

relocated in the foreseeable future;* whether or not the unit has undertaken any workforce study (for

example Birth Rate Plus) that is likely to change the way care isdelivered.


40 for use in Wales

Length of stay is variable in all stages of the maternity care pathway. Whenplanning a unit, length of stay should be considered in the context of the model ofcare.

CLU functional relationships 429In-patient accommodation should be easily accessible from, and within a shortdistance of, the hospital entrance. Antenatal and postnatal areas should be co-located for flexibility and they should not be located adjacent to gynaecologicalfacilities.

CLU Hospital

24-hour access

R

As

Anaes office

Obs theatres

Critical care

As = Assessment

R = Reception

Neonatal unitPost-

natal bedsAnte- natal bed

Birthing rooms

Planned and emergency (from outside unit) C-sections

Support facilities

Ad

min

/sta

ff

amen

itie

s

CLU functional relationships


41 for use in Wales

MLU functional relationships 993

MLU

Reception

24-hour access

Note: may be located in CLU

Antenatal clinic

Staf

f co

m.

bas

e

Assessment

Birthing rooms

Access to outside space/ garden

Transfer to secondary/ tertiary care

Discreet route

Admin/ staff

amenities

Stores

MLU

OR

Possibly primary care



42 for use in Wales

Front of house spaces 999

Reception and waiting 1067The reception desk should be located to enable all visitors entering or leaving theunit to be monitored.

Entrance, reception and waiting

Triage room 1068A two-sided C/E room may be required for the initial medical examination andmidwifery assessment of newly-arrived women, depending on local policy. Thereshould be easy access to WCs, ideally en-suite, otherwise close by.

Consulting/examination room: double-sided couch access: Design manual

Induction suite 1070A four-bed bay with en-suite toilet and shower should be provided for women whoare admitted for induction of pregnancy. The number of beds will be based ondemand. They will be equipped as a standard four-bed bay. They should be locatedclose to the birthing rooms.

Multi-bed room: Design manual


43 for use in Wales


http://www.spaceforhealth.nhs.uk/Wales/manuals/consultingexamination-room-double-sided-couch-access-design-manual

http://www.spaceforhealth.nhs.uk/Wales/manuals/multi-bed-room-design-manual

Birthing spaces 1032

Birthing rooms 1624The key principles for the design of birthing rooms are:

1. ensuring the safety of mothers and babies;2. offering people privacy, dignity, comfort and freedom of movement;3. enabling staff, equipment and services to be available to women in

one place, that is, without them being moved;4. being functionally suitable for all activities that will take place in

them;5. providing flexibility in their use both on a short-term basis and as

needs and policies develop;6. reducing the risk of cross-infection.7. providing access to water during labour to relieve pain.

Key recommendations

All birthing rooms should include the following:

1. en-suite sanitary facilities;2. convenient storage for the mother’s holdall and belongings;3. access to facilities to make hot drinks and to cold water;4. local storage within or adjacent to the room for storage of equipment,

sterile packs etc out of sight until required. Storage facilities will befitted out to meet project-specific storage requirements;

5. provision for partners to stay at night. The layouts and spacedefinitions in this guidance assume that this is achieved using a fold-up bed, which can be stored within the local store for the room. Theother available options either permanently take up space in the roomor, if folded back into the wall, may reduce the flexibility in the use ofthe room;

6. a wall-mounted baby resuscitaire with oxygen, air and vacuum outlets,and, if a multi-birth room, space for additional mobile resuscitaires tobe brought into the room (which will require additional medical gasoutlets and socket-outlets if not running off battery and bottledsupplies). The location of the wall-mounted resuscitaire is likely to beinfluenced by and/or to influence the location of access to the en-suiteand/or the birthing pool area, and should be away from draughts;

7. medical gas outlets (including oxygen, nitrous oxide/oxygen andvacuum) at the bedhead for the mother. The nitrous oxide/oxygenoutlet should be accessible to women using a variety of birthing aidsand a variety of positions within the room. To assist with achieving a


44 for use in Wales

non-clinical environment these services can be concealed untilrequired.

8. twin socket-outlets. Some outlets should also be provided in the storeto be available for charging equipment;

9. if Electronic Patient Records are in use, a trolley in the room, asrequired. A small writing surface may be required depending on localpolicy;

10. a clinical wash-hand basin.

A series of ergonomic studies was carried out into birthing room design during thepreparation of this guidance. The range of activities from the most straightforwardto the most complex births was investigated, and the space required for eachactivity measured.

Based on these studies, two room sizes have been used within the schedule ofaccommodation and are illustrated in the room layouts: a room intended for singlebirth and a room suitable for twin/complex births. The schedule of accommodationassumes that 20% of the birthing rooms in a Consultant-led unit (CLU) will be thelarger size but that all the birthing rooms in a Midwifery-led unit (MLU) will besized for single birth.

Birthing room set up for high-risk birth


45 for use in Wales

Birthing room set up for low-risk birth

Both: Courtesy Queen Elizabeth Hospital NHS TrustPhotographer: Lisa Payne


46 for use in Wales

Bedhead services


47 for use in Wales

Mobile resuscitaire


48 for use in Wales

Wall-mounted resuscitaire

All: Courtesy Queen Elizabeth Hospital NHS TrustPhotographer: Lisa Payne

Birthing room in adjacent MLU


49 for use in Wales

Courtesy Dartford and Gravesham NHS TrustPhotographer: Lisa Payne

Birthing room in stand-alone birth centre (view from the doorway)

Birthing room in stand-alone birth centre (view from the wall)


50 for use in Wales

Courtesy Barts and the London NHS TrustPhotographer: Lisa Payne

Birthing room layouts and ergonomic evidence

En-suite 1078This guidance assumes that all en-suite facilities include a bath. Where a shower isrequired, this should be included separately within the room and not located overthe bath. The bath need not be free-standing, but this will be a project decision. Theareas defined in the schedule of accommodation assume that it is not free-standing.

Studies have shown that women’s preference for bidets varies considerably(National Childbirth Trust 'Creating a Better Birth Environment' toolkit, 2003).Where these are to be provided, the specification of the fitting should meet therequirements for bidets in Health Technical Memorandum 64 ‘Sanitaryassemblies’. The schedule of accommodation assumes that bidets are not provided.

Courtesy Barts and the London NHS Trust


51 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/articles/birthing-room-layouts-and-ergonomic-evidence

Queen Elizabeth Hospital NHS Trust

En-suite facilitiesPhotographer: Lisa Payne

BathroomsNational Childbirth Trust Creating a Better Birth Environment toolkit

Birthing pool areas (optional) 1073Birthing pool areas, where provided, should be an integral part of some birthingrooms. The number of these will be a project decision. When not in use, they canbe curtained off from the main room. The area needs non-slip flooring suitable forwet areas, and this flooring usually extends a little way into the main room.

There are a number of birthing pools on the market. They vary in shape, size, andmeans of getting in and out, and offer different sitting positions. In selecting amodel, it is important to assess it in respect of the ergonomic implications of the


52 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/topics/bathrooms

midwife’s activities as well as the woman’s – in particular, the positions they willbe adopting while assisting the mother and in accessing the drainage controls.

Several different models of fixed pool are available in this country and fromEurope. Manufacturers’ instructions regarding installation, routine maintenanceand disinfection must always be followed, and local operational policies should bein place. In particular, regular flushing is required to avoid stagnation of water ifthe pools are not used regularly. Filtration systems should be checked with themanufacturer. Cleaning regimes should be agreed locally with the infection controlrepresentative.

There are certain safety considerations:

* The midwife should have access from both sides, with provision of aplinth. “slip-proof” steps into and out of the pool should be provided,and the floor to the bath should be slip-proof.

* Grab rails and other aids should be provided to help the woman out ofthe bath.

* There should be access to hot and cold water. The midwife should beable to control the temperature of the pool water.

* There should be access to an emergency call button.* Occasionally, women need to be lifted out of the pool onto the bed or

a trolley. The provision of a hoist is a matter for local decision.

It is not necessary to provide a clinical wash-hand basin within the pool area if thebasin within the main birthing room area is suitably close by and there is noobstruction to access from the pool area.

A nitrous oxide/oxygen point may be provided, or portable cylinders may be used.


53 for use in Wales

Birthing pool, CLU birthing room Courtesy Queen Elizabeth Hospital NHS Trust

Photographer: Lisa Payne

Assisted bathroom(s) 1076All CLU units should have one assisted bathroom.

Bathroom: assisted: Design manual


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http://www.spaceforhealth.nhs.uk/Wales/manuals/bathroom-assisted-design-manual

Birthing room layouts and ergonomicevidence 351

1128Room layout options are provided for birthing rooms suitable for (a) single birthsand (b) twin/complex births. For further details of the space studies that informedthese layouts, see the separate ergonomic report (forthcoming).


55 for use in Wales

Activities 1030

Birthing room suitable for single births 1102The following activities may take place in this room:

1. non-birthing activities, for example relaxing, preparing refreshments,watching TV, baby feeding etc;

2. pre-birth activities, for example use of birthing ball, stool and mat;3. monitoring and recording activities;4. normal single birth;5. assisted single birth, including the scenario of both mother and baby

needing resuscitation and subsequent transfer of both out of the room;6. transfer of the baby from the room, from a wall-mounted resuscitaire,

using a mobile resuscitaire;7. clinical hand-washing;8. recovery.

Optional

* accessing and updating EPRs; where not provided within the room,these need to be available nearby from a touchdown base or similar. Itis generally assumed that paper records will be used.

Birthing room suitable for twin and complex births 1105The following activities may take place in this room:

1. non-birthing activities, for example relaxing, preparing refreshments,watching TV, baby feeding etc;

2. pre-birth activities, for example use of birthing ball, stool and mat;3. monitoring and recording activities;4. normal birth of twins;5. assisted birth of twins, including the scenario of both twins requiring

resuscitation and transfer out of the room, together with the motherexperiencing cardiac collapse and also requring resuscitation andsubsequent transfer out of the room;

6. use of one wall-mounted resuscitaire and one mobile resuscitaire(Note: space will allow for two mobile resuscitaires);

7. transfer of a baby out of room, from wall-mounted resuscitaire, usingadditional mobile resuscitaire;

8. clinical hand-washing;9. recovery.

Optional


56 for use in Wales

* accessing and updating EPRs; where not provided within the room,these need to be available nearby from a touchdown base or similar. Itis generally assumed that paper records will be used.


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Space studies 1031

1112

(4900) Length

(2100)

1000 for intubation

600

Minimum clear space forevacuation of mobile

resuscitaire

Mob

ile

resu

scita

ire

Activity space length


58 for use in Wales

The functional space required for birthing activities – that is, 4900 mm × 4200(single birth) or 4650 mm (twin birth) – has been verified by a series of spacestudies. The actual room area is the result of combining various functional activityspaces (for example, birthing, clinical hand-washing, storage and pool) into a roomdesign. Generally, access space is excluded from DH core space recommendations;however, the optional indicative designs illustrated show that a minimumallowance of 2 m² to access the room will be required to provide functioningspaces.

Where a birthing pool is required, an additional 9 m² has been recommended, basedon the space studies.

The recommendations set out here primarily relate to the key critical dimensionsrather than the area. The following sections aim to illustrate the key dimensionsand explain why they have been defined. Where local teams make differentassumptions, these critical dimensions may need to be changed.

Activity space widths


59 for use in Wales

Bed moved for active birth

Zone for active birth, mat etc

Ceilinghook

Vertical support rail

Cot

Cot

approx 850(450)

450 assume no access

Obs

Obs

Mid

Mid

Mid

Mid

Dre

ssin

gtrol

ley

Dre

ssin

gtrol

ley

CTG

CTG

2100

19

00

(42

00

)

(23

00

) b

etw

een

fix

ed u

nits

Single birth


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Zone for active birth, mat etc

Ceilinghook

Vertical support rail

Cot

Cot

approx 850(450)

900Space to access

storage

450 assume no access

Obs

Obs

Mid

Mid

Mid

Mid

Dre

ssin

gtrol

ley

Dre

ssin

gtrol

ley

CTG

CTG

2100

1900

(4650)

(2300)

bet

wee

n f

ixed

units

Twin birth

The room length of 4900 mm

The length of the room is greatly affected by the requirement to pull the mother'sbed away from the wall for her resuscitation and still allow sufficient space formoving a resuscitaire from the birthing room. A clear space of 2100 mm is


61 for use in Wales

required at the foot of the bed for transferring and evacuating an infant from a wall-mounted to mobile resuscitaire, when the bed has been withdrawn 600 mm forresuscitation of the mother (note the 600 mm assumes that intubation of the motherwill not be necessary).

The room width of 4200 mm was considered:

* acceptable for active birth at the side of the bed where the bed ismoved from its normal position, which was considered normalpractice;

* acceptable for all general birth activity, including the evacuation of aninfant in a mobile resuscitaire when the mother is being resuscitated;

* acceptable whether the resuscitaire was located at 45 deg in the corneror at 90 deg to the wall as shown;

* restrictive for twin births, requiring two resuscitaires, as the midwifedealing with the mother would be trapped by equipment.

The room width of 4650 mm was considered:

* acceptable for active birth by the side of the bed, with the bed in itsnormal position.

* acceptable for twin births, where two resuscitaires are required – afixed wall-mounted resuscitaire in one corner and a mobileresuscitaire in the second (note: it is assumed that the mobileresuscitaire is operated on battery power and bottled gas);

* acceptable whether the resuscitaires were located at 45 deg in thecorner or at 90 deg to the wall as shown.

Storage at the head of the bed

1. The storage zone shown at the head of the bed was only suitable forconsumables and small trolleys/CTG equipment. Note: storage spaceor consumables only amounts to three small storage boxes-worth(approximately 150H × 150W × 300L each) and space for a spare setof linen.

2. The size of the opening in the storage must allow easy access in anemergency.

Bed location and privacy 1113It is recommended that the bed is located around the corner from the door/entrancelocation of the room to assist in protecting the woman's privacy. The illustrationshows notional privacy zones within a room depending upon the bed location andthe use of a privacy screen.


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û

û

ü

Bed location/privacy


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Local storage 1657Storage space is required en-suite or nearby to the room for:

1. birthing mat;2. birthing stool;3. bean bag;4. wedge;5. fold-up bed (for partner/relative use only);6. light and stand (may be ceiling-mounted but this can be difficult to

make non-clinical);7. small and large trolley (may not require both);8. drip-stand;9. height-adjustable cot;10. mobile resuscitaire (for twin birth, or one per four rooms generally

when wall-mounted resuscitaire is included).

Also, but separately, assumed to be in a cupboard next to the bed:

1. monitors (fetal heart monitor/CTG, blood pressure etc);2. personal storage.

Area of local store = 3.75 m², or 5.4 m² with resuscitaire.

Average across four rooms = (3 × 3.75 plus 1 × 5.4)/4 = 4.16 or 4 m².


64 for use in Wales

approx 2500

Space for trolleys, cot, drip stands,exam light and equipment on shelves

Beanbag

Trolley

Cot

Drip stands

Shelf withbean bag etc

Space for mobileresuscitaire

appro

x 1200–1

400

1500

Fold

ing b

ed

Res

usc

itai

re

approx 1100

Local storage

Evacuation of the mother in the bed/door width 1115Evacuation of the mother was tested with two drip-stands (a) one either side of thebed and (b) both behind the bed, simulating bed-mounted drip stands; bothscenarios with four members of staff.


65 for use in Wales

* With drip-stands at the side of the bed and with two midwives partlybehind the bed, egress was achieved reasonably comfortably with a1700 mm clear opening doorway (effective clear width; ecw).

* With two midwives and two drip-stands behind the bed, egress wasachieved reasonably comfortably with a 1450 mm clear openingdoorway (ecw).

See 'Circulation and communication spaces' for the associated requirements forclear corridor widths outside of the room depending on the ecw of the dooropening.


66 for use in Wales

4900

4650 4200

1000

17003000 (2400 tested)

Door sizes


67 for use in Wales

4900

1000

14503250 (2600 tested)

4650

4200


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Room layout options 349

Single/twin birth – room layout options 1116The overall room area will be dependent on the relationship of associated spaces(clinical wash-hand basin, storage and en-suite) and whether additional space willbe required in order to access the room.

En-suite

46

50

42

00

Store/support

En-suite

Zone Single birth m² Twin birth m²

Birthing area 4.2 × 4.9 = 20.6 4.65 × 4.9 = 22.8

Clinical wash-hand basin 1.2 1.2

Total 21.8 (22.0) 24.0

Storage Average 4.0 Average 4.0

Note: this layout includes some compromise of functional space because of the privacy curtain.

46

50

42

00

Store/support

Store/support

Store/support

En-suite En-suite


Birthing area 4.2 × 4.9 = 20.6 4.65 × 4.9 = 22.8



69 for use in Wales

Access space 2.0 2.0

Total 23.8 (24.0) 26.0


Note: The total areas of 24 m² and 26 m², for single and twin birth respectively, have been included within the associated scheduleof accommodation, since the space compromise above was not considered acceptable for a baseline allowance.

46

50

42

00 Store/

support

Store/support

En-suiteEn-suite


Birthing area 4.2 × 4.9 = 20.6 4.65 × 4.9 = 22.8


Access space 4.0 4.0

Total 25.8 (26.0) 28.0


Single birth with pool – room layout options 1118The overall room area will be dependent on the relationship of associated spaces(clinical wash-hand basin, pool and en-suite) and whether additional space will berequired in order to access the room.


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En-suite

3000

31

00

42

00

Store/support

Birthingpool

Zone Single birth m²

Birthing area 4.2 × 4.9 = 20.6

Clinical wash-hand basin 1.2

Access space 3.3

Pool 3.0 × 3.0 = 9.3

Total 34.4 (34.5)

Storage Average 4.0

Note: 34.5 m² has been included in the associated schedule of accommodation. It is necessary to include access within the indicativeroom layout.


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42

00

Store

Birthingpool

En-suiteEn-suite

Zone Single birth m²

Birthing area 4.2 × 4.9 = 20.6

Clinical wash-hand basin 1.2

Access space 4.0

Pool 3.0 × 3.0 = 9.0

Total 34.8 (35.0)

Storage Average 4.0

Specific spatial/functional issues 1119This guidance assumes the use of a wall-mounted resuscitaire as a default situation.However, there will always be a requirement for access to a mobile resuscitaire fortransport, for when the wall-mounted unit requires maintenance or for twin births.It is recommended that when a wall-mounted resuscitaire is available in each room,a minimum of an additional two mobile resuscitaires should be available for everysix birthing rooms (ie one per three rooms).

The active birth area should:

* be discreetly positioned so that the area is not on view from the roomentrance;

* have the possibility of being located by a wall and include patient staffcall, entonox outlet, grabrails/hooks in the ceiling to provide supportfor women in labour.

The bedhead services for the mother must include oxygen, vacuum and entonoxsupply and a minimum of six electrical supply points, staff emergency call and


72 for use in Wales

patient staff call. Note: the tubes for oxygen and vacuum must be easily able toreach the mother when the bed is moved away from the wall for resuscitation etc(suggest approx 1500 mm distance between the outlets and the mother).Consideration must also be given to staff access to:

* switch on/and unplug equipment etc;* use of emergency call;* release or activate the bed brakes if they are located at the head of the

bed.

The clinical wash-hand basin should be near the entrance to the room (used onentry and exit) and be visible, by mother/partner etc, when used.


73 for use in Wales

In-patient spaces 1003

Antenatal and postnatal bed spaces 1085Single rooms are preferred for privacy and dignity reasons and to reduce noise(postnatally). Bed spaces for antenatal and postnatal care should ideally be co-located and the rooms should be suitable for both antenatal and postnatal care formaximum flexibility.

Standard single rooms are suitable for antenatal care and for postnatal careaccommodating twins. Project teams may wish to consider providing larger singlerooms for multiple births.

A variable-height baby’s cot(s) will be provided in rooms used postnatally. In theevent of an emergency, a mobile resuscitaire for the baby will be brought into theroom.

All single bedrooms should have en-suite WC, wash basin and shower facilities. Itshould be possible to push sani-chairs easily into WCs.

Single room, CLU. Courtesy Queen Elizabeth Hospital NHS Trust. Photographer: Lisa Payne


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Four-bed room, CLU. Courtesy Queen Elizabeth Hospital NHS Trust. Photographer: Lisa

Payne

Multi-bed spaces 1087Project teams may decide to include some multi-bed rooms for antenatal, postnataland transitional care. Some antenatal women may prefer the company of otherwomen but may not be well enough to visit the day rooms. Some postnatal womenmay prefer to be in the company of other new mothers. Multi-bed spaces may beespecially suitable for teenage mothers. Generally, these spaces should not exceedfour beds in one room.

Standard multi-bed spaces are considered sufficient for a cot, for mothers to sit andfeed their baby, and to accommodate visitors. All multi-bed rooms require en-suitesanitary facilities. The provision of baths and/or showers will be a project decision.En-suites should be directly accessible from inside the bedroom.

A degree of visual privacy can be provided by bed curtains. Disturbing noise frombabies crying and visitors is inevitable in these rooms. The provision ofacoustically absorbent materials for ceilings, walls and floors can reduce the noise.Hard surfaces should be avoided. Rooms should have closeable doors so thatmothers are not exposed to noises and light from outside their room, particularly atnight. Small comfortable rooms should be available nearby where privateconversations can take place.

Multi-bed room: Design manual


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http://www.spaceforhealth.nhs.uk/Wales/manuals/multi-bed-room-design-manual

Isolation facilities 1088Single rooms provide an effective facility for isolating patients with a variety ofHCAIs. However, in some circumstances it will be necessary to provide a higherlevel of isolation, particularly for those patients with airborne diseases or forimmuno-suppressed patients who may be at risk of infection from others. In thesecases, an isolation suite – which includes an entrance lobby, bedroom and en-suitebathroom – will be necessary.

Isolation facilities in acute settings

High dependency area 1089The birthing rooms and single bedrooms will generally be suitable for postnatalhigh dependency care. However, after giving birth, some mothers with suspectedcomplications will need more intensive monitoring than might be provided in thebirthing/postnatal area, usually for short periods. This guidance assumes that afour-bed space should be sufficient, but project teams will need to confirm that thisis appropriate for their local needs. Consideration may be given to equipping andservicing the spaces as for a theatre recovery area. Mobile monitoring equipmentcan allow privacy without compromising safety (such as for a woman who is inlabour).

Depending on the location of the theatres and the maternity unit, the highdependency area and the theatre recovery areas can be co-located.

Recovery spaces


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http://www.spaceforhealth.nhs.uk/Wales/topics/isolation-facilities-acute-settings

http://www.spaceforhealth.nhs.uk/Wales/node/151

http://www.spaceforhealth.nhs.uk/Wales/topics/recovery-spaces

Support spaces 350

Bereavement suite 1090A woman who has lost her baby should not be accommodated on a ward/bed roomwhere there are new mothers. A self-contained family suite(s) with en-suitefacilities should be provided, away from the birthing and in-patient areas, wherefamilies can grieve the loss of their baby. It consists of an hotel-type family roomwith a bed, comfortable seating, a low table, some personal storage, a beveragepoint and an en-suite facility. Access to a secluded garden space is very desirable.

Bereavement suite. Courtesy Queen Elizabeth Hospital NHS Trust. Photographer: Lisa Payne

Staff communications base 1092Staff communication and touchdown bases should be located to suit the layout inrelation to all in-patient rooms. The staff communication base should overlook theentrance to the suite of birthing rooms.

Staff communication bases are the centre for the patient-to-staff and a staff callsystem within the area and central monitoring equipment for radio telemetry(CLUs only). The base should incorporate a facility for transferring a nurse-to-nurse emergency call to another manned point. A suitable entry control system,with audio and video functions, as appropriate, will be provided. Touchdown basesare normally shared between four to six rooms.


77 for use in Wales

Staff communication base: Design manualTouchdown base: Design manual

Treatment room (optional) 1670If multi-bed areas are included, a treatment room should be provided. Ultrasoundexaminations could also be performed in this room using mobile equipment.

Day room(s)/transfer lounge 1675The provision of a day spaces(s) is desirable antenatally and postnatally to offerwomen a change of environment and opportunities for socialising. They can beflexibly used for dining, sitting or waiting. Postnatal day spaces should be largeenough to accommodate cots. Wherever possible, women and their families shouldhave access to gardens or courtyards during their stay. A day space may be used asa transfer lounge for mothers who are being transferred home under the care of acommunity midwife.

Day space. Courtesy Queen Elizabeth Hospital NHS Trust. Photographer: Lisa Payne


78 for use in Wales

http://www.spaceforhealth.nhs.uk/Wales/manuals/staff-communication-base-design-manual

http://www.spaceforhealth.nhs.uk/Wales/manuals/touchdown-base-design-manual

Day space. Courtesy Dartford and Gravesham NHS Trust. Photographer: Lisa Payne

Private rooms for expressing milk 1679In MLUs, mothers can express milk at their bedside. In secondary and tertiary levelunits, where babies may be transferred to a neonatal unit and perhaps stay inhospital after their mother has been transferred home, there is a need for small,attractive, private rooms with lockable doors for mothers to use for expressingbreast milk, using an electric pump provided by the unit. These rooms should belocated within either the postnatal area or the neonatal unit, or be easily accessibleto those areas, so that the mother does not have to be separated from her babywhile expressing. They require a chair and facilities for hand-washing. Access isneeded to a fridge, located in a secure area, for the exclusive use of expressedbreast milk. Sterilizing facilities are needed close by.

Milk kitchen/store/training room 1683Many healthcare providers no longer supply formula feeds. Mothers are expectedto supply them and make them up, so a preparation area is required where staff willdemonstrate the preparation of baby feeds on a domestic scale and mothers canprepare feeds. This room will include a small refrigerator, a sink with a drainer,storage facilities, and a clinical wash-hand basin.

Interview rooms 1688Within each unit, there should be a comfortably furnished room(s) for counsellingand interviewing. Rooms may be provided close to the postnatal facilities to


79 for use in Wales

accommodate “satellite services” such as registration of births and interviews withother specialists and agencies such as health visitors and social services.


Other support spaces 1697The following support spaces are required:

* Clean utility/preparation or clean supply room: According tohospital policy on supply and disposal and taking into account theintegral storage in the birthing rooms.

* Drug store: For central storage of pharmaceuticals and intra-venousfluids.

* Dirty utility: The room also serves as the temporary storage point andtesting area for specimens. Products of conception will be collectedand examined here. A set of scales may be needed to weigh theplacenta.

* Near-patient testing lab: A blood gas/pH analyser should beavailable in any unit undertaking continuous fetal heart ratemonitoring. Space is also required for the equipment required forbiochemical tests carried out during and after birth. This is normallylocated within the CLU birthing area, but may be shared with theneonatal unit.

* Kitchen/pantry: According to the policy for the meal provision formothers and staff.

* Bloodbank: The blood refrigerator/storeroom should be easilyaccessible from the birthing rooms.

* Resuscitation trolley: Emergency equipment should be parked whereit is easily accessible to birthing and bedrooms but does not obstructcirculation areas.

* Stores, including linen* Switchgear cupboard

UtilityRefreshments and rest

Staff facilities 1698The following staff facilities are required:

* Staff changing* Staff rest room with beverage bay* Seminar room

Office accommodation


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The provision of dedicated office space is only justified when they are in constantuse, and consideration should be given to the flexible use of space.

A medical/midwifery office is required to allow for administration duties andprivate discussion of problems by medical and midwifery staff. This should includetelecommunications facilities.

The change in medical workforce means that doctors will be working shifts ratherthan be on-call in hospital. A multidisciplinary office should be available in theunit or very close to it for obstetricians and anesthetists working a shift.

Provision of other office accommodation is project-specific. This may includeoffices for anaesthetists who do not have an office elsewhere, clinical mangers,consultant midwives etc. An administrative zone will be required for the Head ofMidwifery and other midwife consultants, with secretarial support. An indicationof requirements for single and multi-workstations is included in the schedules ofaccommodation.

Teaching accommodation is a project option and dependent on the size of the unit.

Sanitary spacesRefreshments and restOffices


81 for use in Wales




Obstetric operating theatresuite 352

1123A dedicated obstetric operating theatre suite is required. The functional andenvironmental design requirements and accommodation requirements of the suite,including support accommodation, are the same as for a general operating theatresuite.

The majority of consultant-led units (CLUs) will have two theatres. If the numberof births exceeds 6000 per year, three theatres may be required. Very small CLUsmay only require one theatre.

HBN 26 Volume 1: Facilities for surgical procedures

Functional relationships 1124The location of obstetric operating theatres is critical:

* Direct access, 24 hours a day, is required from all birthing facilitieswithin and from outside the CLU. That is, there should be easy accessfrom the main entrance and birthing rooms.

* Theatre(s) should also be close to the neonatal unit, for ease oftransfer of the baby, with good access to adult critical care facilities.

* Proximity to other specialist theatres, for example cardiac theatres,may need to be considered in tertiary centres.


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https://publications.spaceforhealth.nhs.uk/index.php?option=com_documents&Itemid=6&task=do_search&title=HBN+26&description=&pub_date=&isbn=&keywords=&locale=-1&documents=all

Spaces 353

Anaesthetic room 1699In an obstetric operating theatre suite, the anaesthetic is often administered in thetheatre, obviating the need for an anaesthetic room.

Inclusion of an anaesthetic room might, however, provide flexibility for a widerrange of uses. For example, an anaesthetic room may be used for the administrationof spinal/epidurals for elective caesarean section, and catheterisation, and thiswould offer a higher degree of privacy for the mother than the theatre. It istherefore included in the schedule of accommodation. It may be shared betweentwo theatres, but need not be directly accessible by both.

If an area is planned where a patient will wait for a theatre to be vacated, it musthave piped oxygen and suction. This guidance assumes that a recovery space oranaesthetic room will be used for this purpose.

Obstetric theatres 1701A general theatre space is appropriate for undertaking obstetric procedures.

In addition:

1. A resuscitation area for the baby is also required, which requires awarmer local environment. The high air flow/air changes within atheatre make it more difficult to keep a baby warm, becauseconvection currents cool the baby even when the theatre temperatureis high. The area may be provided immediately outside the theatre orwithin the theatre; if provided within the theatre, project teams shouldseek advice on appropriate engineering solutions.

2. Space is required for “parking” the transport incubator and neonatalventilation equipment in or close to the theatre.

3. The orientation of the table is important (with the mother’s headtowards the door).

4. Theatre lights should not reflect so that the woman (or her partner) cansee the operation as if in a mirror.

5. Many women having a caesarean section will have the induction ofanaesthesia carried out in this room. However, women often remainconscious during a caesarean section and may be accompanied by apartner. The colour scheme and lighting should therefore promote arelaxing atmosphere, but the lighting should not compromise clinicalfunctionality. It is essential that daylight simulating lighting isspecified in recovery areas and in theatres.


83 for use in Wales

Recovery spaces 1704Recovery rooms are essential wherever there is an operating theatre until a womancan be transferred back to her room.

The baby may also need a period of observation prior to deciding whether theyshould go to the neonatal unit or to the postnatal ward with the mother. An area isrequired close to where the mother is being kept for recovery and where themidwives can observe the baby. It should be warm and out of any draughts, withaccess to oxygen, air, suction and a power supply.

Recovery spaces


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http://www.spaceforhealth.nhs.uk/Wales/topics/recovery-spaces

Whole maternity unit staffaccommodation 354

370Staff accommodation should be designed to allow consultant medical staff andtheir secretarial support to communicate effectively both within and across clinicalspecialties, enabling them to deliver their clinical commitments effectively.

The facilities are as follows:

* office space for consultants and secretaries;* seminar facilities, with audio-visual services etc;* other facilities to accommodate teaching and research activities, to be

discussed with the client.

Clinical administrative spaces should be provided in a flexible environment with amixture of continuous use and hot desk spaces with associated quiet and breakoutspaces.

While it is important that members of specialist consultant teams have ready accessto their specific ward and operative areas, it is equally important that their officesshould have close proximity to each other, to offer better cover, to streamlinereferrals between specialties, and to allow close proximity to research facilities.These offices may be shared.

Electronic access to laboratory results should be available, along with access toexternal email and internet. A photocopier, shredder and private area for facsimileshould be easily available or within clinic. Staff areas should be secure, andconsideration should be given to the use of key pad/proximity sensor locks (orsimilar) to control access to staff areas.

OfficesGroup rooms


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Specific engineeringconsiderations 355

General engineering 362The scope of the services included relate to the local services required for thefunctioning of this unit. Midwifery-led units (MLUs) remote from an acute orcommunity hospital will additionally require suitable resilient engineering servicesinfrastructure including incoming electricity, water, gas and telecommunications/ITnetwork, together with main plant including boilers, switchgear etc.

Building services engineering

Sustainability and energy efficiency 364Since passive solar design should be employed to ensure that, as far as possible,areas such as wards, recovery units and offices are located where they can benefitfrom natural daylight, certain spaces within the unit, for reasons of privacy anddignity, will require the use of blinds at times.

Environment and sustainability

Ventilation 365In order to contain noise within birthing rooms and to provide adequate levels ofconfidentiality and low sound in other areas, the ventilation distribution ductworkshould be designed to minimise the transmission of sound from one area to anotherby suitable routing or separate distributions. Any ductwork “cross-talk” attenuatorsrequired should be designed and installed to avoid the harbouring of bacteria andfor ease of cleaning.

Each maternity theatre suite should ideally be served by its own air handling plant,provided with standby set-back control.

In birthing rooms and recovery areas where analgesic and anaesthetic gases areexhaled, the ventilation rate should be of sufficient capacity to control substanceswithin the appropriate occupational exposure limits (COSHH). In order to optimisethe ventilation efficiency to minimise the amount of ventilation required,consideration should be given to low-level extract at the bedhead in recovery areasand to proprietary scavenging systems in birthing rooms.

Ventilation

Air-changerates

Pressure(Pascals)

Supplyfilter

Noise(NR)

Temperature (°C)

Comments


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perhour

Birthingroom

Supply andextract

15 Negative

G4 40 18–25 In birthing rooms, the use of anaesthetic gas is controlled on demand bythe patient. This may result in significant leakage that – in order toreduce staff exposure – will need to be controlled by establishing a cleanair-flow path. A supply at high level at the foot-end of the bed withextract at low level at the head-end will provide such a path

HTM 03-01: Specialised ventilation for healthcare premises: Parts A and B

Hot and cold water systems 366Designers should consider the option of bidets or showers with flexible hoses (thatcan be used at low level) to be used in en-suites.

Prevention of backflow contamination of the water supply to fluid category 5should be provided where there is a risk of submerged inlets by flexible showerhoses in baths, wash-basins, WCs and bidets. Alternatively a system of hoserestraint rings could be employed.

A supply of cooled drinking water should be provided for in-patients.

Health Technical Memorandum 04-01 – ‘The control of Legionella, hygiene,“safe” hot water, cold water and drinking water systems’

Medical gases 367Nitrous oxide/oxygen is predominantly used in maternity facilities and not widelyused in other facilities. Therefore, it should be assumed that no such facility existswithin the main hospital and that a local bottle store and manifold room is to beprovided. This should be contained within a suitable external enclosure locatedadjacent to road access.

Number of medical gas terminal units, AVSUs and alarms

Oxygen Nitrousoxide

Nitrousoxide/oxygenmixture

Medicalair

Surgicalair

Vacuum Gasscavenging

Helium/oxygenmixture

Areavalveserviceunits(AVSUs)

Alarms

Birthingroom:

1 set per6–8rooms

Mother 1 0 1 0 0 2 0 0

Baby (percot space)

1 0 0 1 0 1 0 0

Operating suite:

1 set 1 set hp/lp


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Anaesthetist

1 1 0 1 0 1 1 0

Obstetrician

0 0 0 0 0 2 0 0

Paediatrician

1 0 0 1 0 1 0 0

Post-anaesthesia recovery(per bedspace)

1 0 0 1 0 1 0 0 1 set 1 set

In-patientaccommodation:

1 set forward unit

1 set

Singlebed

1 0 0 0 0 1 0 0

Multi-room, perbed space

1 0 0 0 0 1 0 0

Design flow for each terminal unit (litres per minute)

Oxygen Nitrous oxide Nitrous oxide/oxygen mixture

Medical air Surgical air Vacuum

Birthing room:

Mother 10 0 275 0 40

Baby (per cotspace)

10 0 0 40 40

Operating suite:

Anaesthetist 100 15 0 40 40 Max 130Min 80

Obstetrician 0 0 0 40

Paediatrician 10 0 0 40

Post-anaesthesiarecovery (perbed space)

10 0 0 40 40

In-patient accommodation:

Single bed 10 0 0 40

Multi-room, perbed space

10 0 0 40

Health Technical Memorandum 02-01 – ‘Medical gas pipeline systems’


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Electrical services 368Uninterruptible power supplies combined with isolated power supplies (medical IT(isolated from earth)) should be provided to serve obstetric operating theatres,recovery areas and other spaces such as birthing rooms where high levels ofintervention may be involved. This will incorporate local or plant-mountedcubicalised equipment with dual circuitry to outlets in pendants and bedheadtrunking.

Health Technical Memorandum 06-01 – 'Electrical services supply and distribution'

Bedhead services 369Allowance should be made for the introduction of television and radio systems inwaiting areas, to create a relaxing atmosphere, staff rest areas, and in locationswhere it would be beneficial in masking sound transfer.

In locations requiring multiple electrical, IT and medical gases, suitable trunkingsystems should be considered for containment of the services and outlets and toreadily facilitate the addition or repositioning of outlets as may be required. Thisconsideration should be balanced against the need in some areas (for examplebirthing rooms) to present a visually pleasing and non-clinical appearance.

Birthing rooms (single birth) should provide the following bedhead services:

* sufficient twin switched socket-outlets for the mother and baby;* nitrous oxide/oxygen (optional) and scavenging if provided;* oxygen, medical vacuum and medical air outlets;* bedhead luminaire switch;* nurse call;* staff emergency call;* socket for patient handset;* IT connection(s);* radio/TV headset connection;* telephone connection;* entertainment system (optional).

Appropriate provision should be made for multiple births with additional power, ITconnections and medical gas outlets for the introduction of a mobile resuscitaire.

A handset control should also be provided incorporating:

* nurse call button;* reassurance lamp;* luminaire switch/dimmer control;* radio/TV selector switch;* radio/TV volume control.

Call systems Power/data Entertainment


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Nurse call Staffemergencycall

Twin-socketoutlets

Telephone Data Patientmonitoringterminal

Television Radio

Birthing room:

Mother Yes Yes 4 Yes 6 Yes Projectoption

Projectoption

Baby (percot space)

Yes Yes 2 Yes 2 Yes Projectoption

Projectoption

Post-anaesthesiarecovery(per bedspace)

6 4

In-patient accommodation:

Single bed Yes Yes 4 Yes 4 Yes Yes

Multi-room,per bedspace

Yes Yes 4 Yes 4 Yes Yes

Bedhead services

Acoustics 7050The table below indicates the sound-insulation performance required for birthingrooms (dB DnT,w).


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Schedule and cost information 2259

Maternity schedules of accommodation 2230Schedules of accommodation are given in the attached file below for the followingservice examples:

1. 3500 births per annum: comprising 3000 births in a consultant-led unit(CLU) and 500 births in a midwife-led unit (MLU);

2. 6000 births per annum: comprising 5000 births in a CLU and 1000births in an MLU;

3. 9500 births per annum: comprising 8000 births in a CLU and 1500births in an MLU.

The examples provide information for an MLU co-located with a CLU and for astand-alone MLU. For MLUs co-located with community facilities, the scheduleindicates the required adjustment in the engineering allowance.

Maternity example schedules of accommodation.xls

7864

7865

7866


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