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Children, young people andmaternity services

Health Building Note 09-02:Maternity care facilities

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Health Building Note 09-02 Maternity care facilities

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Crown copyright 2013

Terms of use for this guidance can be found at http://www.nationalarchives.gov.uk/doc/open-government-licence/

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Preface

About Health Building NotesHealth Building Notes give best practice guidance onthe design and planning of new healthcare buildings andon the adaptation/extension of existing facilities.

They provide information to support the briefing anddesign processes for individual projects in the NHSbuilding programme.

The Health Building Note suite

Healthcare delivery is constantly changing, and so too are

the boundaries between primary, secondary and tertiarycare. The focus now is on delivering healthcare closer topeoples homes.

The Health Building Note framework (shown below) isbased on the patients experience across the spectrum ofcare from home to healthcare setting and back, using thenational service frameworks (NSFs) as a model.

Health Building Note structure

The Health Building Notes have been organised into a

suite of 17 core subjects.

Care-group-based Health Building Notes provideinformation about a specific care group or pathway butcross-refer to Health Building Notes on generic (clinical)activities or support systems as appropriate.

Core subjects are subdivided into specific topics andclassified by a two-digit suffix (-01, -02 etc), and may befurther subdivided into Supplements A, B etc.

All Health Building Notes are supported by theoverarching Health Building Note 00 in which the keyareas of design and building are dealt with.

ExampleThe Health Building Note on accommodation foradult in-patients is represented as follows:

Health Building Note 04-01: Adult in-patientfacilities

The supplement to Health Building Note 04-01 onisolation facilities is represented as follows:

Health Building Note 04-01: Supplement 1 Isolation facilities for infectious patients in acute

settings

Health Building Note number and series title Type of Health Building Note

Health Building Note 00 Core elements Support-system-based

Health Building Note 01 Cardiac care Care-group-based

Health Building Note 02 Cancer care Care-group-based

Health Building Note 03 Mental health Care-group-based

Health Building Note 04 In-patient care Generic-activity-based

Health Building Note 05 Older people Care-group-based

Health Building Note 06 Diagnostics Generic-activity-based

Health Building Note 07 Renal care Care-group-based

Health Building Note 08 Long-term conditions/long-stay care Care-group-based

Health Building Note 09 Children, young people and maternity services Care-group-based

Health Building Note 10 Surgery Generic-activity-based

Health Building Note 11 Community care Generic-activity-based

Health Building Note 12 Out-patient care Generic-activity-based

Health Building Note 13 Decontamination Support-system-based

Health Building Note 14 Medicines management Support-system-based

Health Building Note 15 Emergency care Care-group-based

Health Building Note 16 Pathology Support-system-based

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Other resources in the DH Estates andFacilities knowledge series

Health Technical Memoranda

Health Technical Memoranda give comprehensive adviceand guidance on the design, installation and operation ofspecialised building and engineering technology used inthe delivery of healthcare (for example medical gaspipeline systems, and ventilation systems).

They are applicable to new and existing sites, and arefor use at various stages during the inception, design,construction, refurbishment and maintenance of abuilding.

All Health Building Notes should be read in conjunctionwith the relevant parts of the Health TechnicalMemorandum series.

Activity DataBase (ADB)

The Activity DataBase (ADB) data and softwareassists project teams with the briefing and design of the

healthcare environment. Data is based on guidance givenin the Health Building Notes, Health TechnicalMemoranda and Health Technical MemorandumBuilding Component series.

1. Room data sheets provide an activity-based approachto building design and include data on personnel,planning relationships, environmental considerations,design character, space requirements and graphicallayouts.

2. Schedules of equipment/components are included foreach room, which may be grouped into ergonomically

arranged assemblies.

3. Schedules of equipment can also be obtained atdepartment and project level.

4. Fully loaded drawings may be produced from thedatabase.

5. Reference data is supplied with ADB that may beadapted and modified to suit the users project-specificneeds.

Note

The sequence of numbering within each subject area does not necessarily indicate the order in which the Health BuildingNotes were or will be published/printed. However, the overall structure/number format will be maintained as described.

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This Health Building Note covers the policy and servicecontext, and planning and design considerations formaternity care facilities.

It covers the following:

1 antenatal clinics, early pregnancy assessment units,

pregnancy (fetal and maternal) assessment units;2 birthing facilities and in-patient areas, including the

requirements for the routine care of neonates;

3 obstetric theatres.

It covers facilities provided in:

1 midwife-led units, often known as birth centres which may be located alongside a consultant-ledunit on an acute hospital site, co-located with acommunity healthcare facility, or exist as a stand-alone centre;

2 consultant-led units.

The guidance recognises that the services and facilitiesprovision will be different between CLUs and MLUs. Italso recognises that MLUs located alongside a CLU mayhave differences in provision to those that are separate.

Executive summary

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Contents

PrefaceAbout Health Building NotesThe Health Building Note suiteHealth Building Note structureOther resources in the DH Estates and Facilities knowledge series

Health Technical Memoranda

Health Technical Memorandum Building Component seriesActivity DataBase (ADB)

How to obtain publicationsExecutive summary1 Policy context 1

Key policy and standards2 Service context 2

Midwifery-led units (MLUs)Consultant-led units (CLUs)Antenatal care

Antenatal out-patient careUltrasound servicesEarly pregnancy carePregnancy (fetal and maternal) assessmentAntenatal in-patient care

BirthSurgical proceduresPostnatal/neonatal care

Postnatal careNewborn careTransitional care

Adult high dependency/critical careBereavement support

3 Whole maternity unit considerations 6Location of birthing facilitiesDesign considerations

InclusivitySecurityInfection controlRecordsStorage

4 Antenatal clinic 10Scope and size of provisionFunctional relationships

SpacesReception and waitingConsulting/examination roomsPregnancy assessment room (MLUs only)

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Interview roomsPreparation for parenthood room/relaxation classesPreparation for parenthood store (optional)Treatment room (optional)

Support spaces5 Ultrasound suite 14

Scope and size of provisionFunctional relationshipsSpaces

Reception/waitingUltrasound roomsInterview roomsWCsSupport spaces

6 Early pregnancy assessment unit 16

Scope and size of provisionFunctional relationshipsSpaces

Reception and waitingConsulting/examination roomsTouchdown baseUltrasound roomsInterview roomsSitting areaSupport spaces

7 Pregnancy (fetal and maternal) assessment unit 19Scope and size of provision

Functional relationshipsSpaces

Reception/sittingConsulting/examination roomsPregnancy assessment room/baysUltrasound roomsInterview roomsStaff communications baseSupport spaces

8 Birthing facilities (and associated in-patient facilities) 22Scope and size of provision

CLU functional relationshipsMLU functional relationshipsFront of house spaces

Reception and waitingTriage roomInduction suite

Birthing spacesBirthing roomsEn-suiteBirthing pool areas (optional)Assisted bathroom(s)Birthing room layouts and ergonomic evidence

In-patient spacesAntenatal and postnatal bed spacesMulti-bed spaces

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Isolation facilitiesHigh dependency area

Support spacesBereavement suite

Staff communications baseTreatment room (optional)Day room(s)/transfer loungePrivate rooms for expressing milkMilk kitchen/store/training roomInterview roomsOther support spacesStaff facilities

9 Obstetric operating theatre suite 37Functional relationshipsSpaces

Anaesthetic roomObstetric theatresRecovery spaces

10 Whole maternity unit staff accommodation 3911 Specific engineering considerations 40

General engineeringSustainability and energy efficiencyVentilationHot and cold water systemsMedical gasesElectrical servicesBedhead services

Acoustics12 Schedule and cost information 44

Maternity schedules of accommodationHealth Premises Cost Guides (HPCGs)Costing the example briefing schedulesEngineering space allowance

13 References 71Department of Health

Contents

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1.1 Maternity care is provided in several differenthealthcare settings, decided on a local basis bycommissioning bodies. This can be either on ahospital site, in the community or at home. Thereis an increasing call for woman-centred, user-friendly services offering choice and continuity of

care.1.2 Each setting should be designed so it is appropriate

for use by the family and the staff who areproviding care. Whatever the setting and model ofcare, the main objective is to provide for the safecare of both mother and baby in a comfortable,relaxing environment that facilitates what is anormal physiological process, enabling self-management in privacy whenever possible, andenhances the familys enjoyment of an importantlife event.

1.3 In all units, rooms should be designed to givewomen choice and control over their labour andbirth, to normalise the process and welcome familyparticipation.

1.4 The normality of the experience is a key driver,but appropriate facilities are needed forintervention when complications occur.

Key policy and standards

1.5 This guidance takes account in particular of thefollowing key standards and reports:

National Screening Committee Report

Standards for Maternity Care: Report of aWorking Party

Towards Better Births: A Review of MaternityServices in England

Intrapartum care: management and delivery ofcare to women in labour

National Service Framework for Children,Young People and Maternity Services

British Association of Perinatal Medicineguidance: Obstetric standards for the provision

of perinatal care Standards for hospitals providing neonatal

intensive and high dependency care andCategories of babies requiring neonatal care

Creating a Better Birth Environment: An audittoolkit

Are women getting the birth environment theyneed?

1 Policy context
http://www.screening.nhs.uk/englandhttp://www.rcog.org.uk/womens-health/clinical-guidance/standards-maternity-carehttp://www.rcog.org.uk/womens-health/clinical-guidance/standards-maternity-carehttp://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/healthcare-commission-maternity-reviewhttp://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/healthcare-commission-maternity-reviewhttp://www.nice.org.uk/CG055http://www.nice.org.uk/CG055http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006182http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006182http://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/hosp_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.bapm.org/publications/documents/guidelines/obs_standards.pdfhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006182http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006182http://www.nice.org.uk/CG055http://www.nice.org.uk/CG055http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/healthcare-commission-maternity-reviewhttp://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/healthcare-commission-maternity-reviewhttp://www.rcog.org.uk/womens-health/clinical-guidance/standards-maternity-carehttp://www.rcog.org.uk/womens-health/clinical-guidance/standards-maternity-carehttp://www.screening.nhs.uk/england

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Figure 1 Care pathway

2 Service context

ANTENATAL

SCREENING

EARLY

PREGNANCY

ASSESSMENT

TRIAGE

MLU LED

BIRTH

POST-PARTUM

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ROUTINE

NEONATAL CARE

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ANTENATAL CARE BIRTH POST-NATAL/NEONATAL CARE

PLANNED

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INCLUDING HIGH-DEPENDENCY CARE

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CARE

Midwifery-led units (MLUs)2.1 These units are managed and staffed by midwives

and are sometimes known as birth centres. Theymay be located alongside a consultant-led unit onan acute hospital site (see Consultant-led units),be part of a community healthcare facility, or existas a stand-alone facility. They are suitable forwomen expected to have an uncomplicated birth.Women can give birth in these units with little orno intervention. If complications arise they aretransferred to a CLU. Transfer to an acute hospital

is a key issue for MLUs that are separate from anacute hospital site. For MLUs adjacent to a CLU,their protocols for accepting mothers may beinfluenced by the proximity of the more specialistfacilities and staff.

2.2 The services provided within an MLU will varydepending on its location. If co-located withanother healthcare facility, the MLU may use theirantenatal and out-patient clinics. If stand-alone, itmay include these and other diagnostic services.Antenatal and outreach services will also be

provided in the community, in line with theNational Service Framework (NSF) for Children,Young People and Maternity Services(DH, 2003).

Consultant-led units (CLUs)2.3 These are secondary-level units, providing team-

based care. They are located on a hospital site andprovide antenatal out-patient and in-patientservices, birthing and postnatal care, with facilitiesfor neonatal care and access to adult critical carefacilities.

2.4 CLUs with perinatal centres provide team-basedcare for mothers with fetal or maternalcomplications. They will provide the same range of

services and require the same facilities as CLUs,with the addition of facilities for neonatal high-dependency and intensive care. Many of these unitswill be professorial/medical schools.

Antenatal care

Antenatal out-patient care

2.5 In the antenatal period, a pregnant woman usuallyattends for antenatal care and screening tests at asite that is as local and convenient as possible. This

may be at a GP surgery/community health centre,local birth centre, childrens centre, or an antenatalclinic in an acute hospital. She may also attend forparenthood and health education sessions in any of
http://www.dh.gov.uk/en/Healthcare/Children/NationalServiceFrameworkdocuments/index.htmhttp://www.dh.gov.uk/en/Healthcare/Children/NationalServiceFrameworkdocuments/index.htmhttp://www.dh.gov.uk/en/Healthcare/Children/NationalServiceFrameworkdocuments/index.htmhttp://www.dh.gov.uk/en/Healthcare/Children/NationalServiceFrameworkdocuments/index.htm

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these settings. If she requires more specialistantenatal care, she will be referred from thecommunity to an antenatal clinic in a CLU.See Chapter 4, Antenatal clinic.

Ultrasound services

2.6 Ultrasound examinations are an important elementof most antenatal screening and monitoring. Somewomen may require more than the routine twoultrasound examinations to assist in the diagnosisand management of complications of pregnancy,whereas others may require procedures underultrasound guidance for example amniocentesis.Ultrasound examinations are also important in themanagement of neonates, a factor that should be

considered when planning ultrasound facilities.

2.7 A large CLU will have dedicated ultrasoundfacilities, a proportion of which will be equippedfor invasive procedures. Some small units may nothave their own ultrasound facilties but will accessthe ultrasound facilities in the main imagingdepartment. See Chapter 5, Ultrasound suite.

Early pregnancy care

2.8 This guidance reflects the increasing provision forearly pregnancy management for women withcomplications in the first few months of thepregnancy, including spaces for screening andcounselling. Some women with complications maybe managed in the community. Others will be seenin the early pregnancy assessment unit (EPAU).This may be located in the maternity unit or withinthe gynaecology department.

2.9 Facilities are required for confirmation ofpregnancy by pregnancy test and ultrasound tocheck the viability of the pregnancy, gestational ageand that the pregnancy is intra-uterine. This is avery anxious time for women, and the facilitiesmust above all be easily accessible and designedwith these sensitivities in mind. See Chapter 6,Early pregnancy assessment unit.

Pregnancy (fetal and maternal) assessment

2.10 Women may attend a pregnancy assessment unit ina CLU for more detailed scanning or fetalassessment in late pregnancy. This is to assesspotential complications in later pregnancy withoutthe need for admission to the antenatal in-patientfacilities. The unit provides a full range of fetalmonitoring services, which includescardiotocography and ultrasound. Access is

required to laboratory facilities for biochemistryand haematology and urgent laboratory results. SeeChapter 7, Pregnancy (fetal and maternal)assessment unit.

Antenatal in-patient care

2.11 A pregnant woman may need to be admitted as anin-patient in a CLU for more detailed assessmentand monitoring. The stage of gestation must betaken into account some units now routinely takewomen from an early gestation for conditions suchas hyperemesis. A woman may need to stay on theantenatal ward for a few hours only, or untildelivery. A mixture of single rooms and multi-bedaccommodation can be provided. See paragraph

8.46, In-patient spaces.

Birth

2.12 Unless she has been previously admitted as anantenatal patient, a woman in labour will godirectly to the MLU or CLU. On arrival she will beassessed, ideally in a triage suite. This facility isincreasingly being used to assess women beforetransfer to birthing rooms, to reduce unnecessaryadmissions. All women in confirmed labour shouldbe admitted to a single birthing room with an en-

suite facility, which most will usually occupy for theentire period of their stay.

2.13 Women who are in hospital for induction of labourmay go to an induction suite/ antenatal ward andthen be transferred to a birthing room when thedelivery process commences. Those who go intospontaneous labour while an in-patient will betransferred to a birthing room at the onset oflabour, so that they have the same privacy aswomen in early labour at home.

2.14 The birthing rooms in an MLU will be set up anddesignated for straightforward births and will ofteninclude birthing pools.

2.15 In the case of any unexpected complicationsarising, the mother will be moved to a CLU withthe appropriate facilities and equipment. Thereshould be good telecommunication links withother units within the managed clinical networkand facilities for transfer and transportarrangements as and when required. Any MLU ona community hospital or isolated site will need

clear and unfailing transfer arrangements. Thereshould be a clear referral pathway for each unit.

2 Service context

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2.16 The birthing rooms in a CLU will be designed andequipped for birth that will encompass differentlevels of intervention, assistance and support. Theyprovide for a higher clinical function than is

required in an MLU. The appropriate concealment/storage of interventional equipment is important.

2.17 Whatever the setting and the type of care that thewoman is receiving, the environment should be asnon-clinical as possible with a comfortable, non-institutional ambience and should enable self-management in privacy whenever possible. In allunits, rooms should be designed to give womenchoice and control over their labour and birth, tonormalise the process and welcome familyparticipation. The social needs of higher-risk

groups should not be overlooked.

2.18 Partners and other supporters should be made tofeel welcome, and their presence should be a keyconsideration in designing facilities for birth. Thereshould be overnight accommodation for partnerswithin the rooms or within or close to the unit. Seeparagraph 8.9, Birthing spaces.

Surgical procedures

2.19 A woman will be moved to a dedicated obstetric

theatre if unanticipated problems arise or moreserious interventions are required than can beoffered in the birthing rooms. Arrangements mustbe in place for MLUs to transfer women to ahospital with the appropriate facilities. Accessroutes to the theatres for emergency caesareansections, both from within the unit and fromoutside, must be designed to ensure speed of accessand high levels of privacy for the mother.

2.20 Elective caesarean sections may also take place inthese theatres or in the main theatres. Women

usually go straight to theatre then to a single roomfollowing the procedure. See Chapter 9, Obstetricoperating theatre suite.

Postnatal/neonatal care

Postnatal care

2.21 This guidance recognises the general need for anincrease in single room provision in the postnatalperiod in order to enhance the experience andimprove privacy and dignity. Women will either

remain in the birthing room for their recoveryperiod and go straight home from it, or betransferred to the postnatal area, ideally to a singleroom. Womens preferences are generally not to

move but to stay in the same room until they aretransferred home. However, project teams shouldensure that there are sufficient postnatal bedsavailable in order to maximise the efficient use of

space at peak times. Women who have had acaesarean section will need to be accommodated ina bed in the postnatal bed area.

2.22 Multi-bed accommodation may be provided.

2.23 Where there have been complications, the motherand/or the baby may need extra care orintervention. The main philosophy of care is thatmothers and babies should stay together. Theproject team may decide to provide a well-babynursery to allow mothers to obtain rest; security

will be an important consideration. See paragraph8.46, In-patient spaces.

Newborn care

2.24 Every type of birthing unit, whether or not care ofsick babies is undertaken, must have clearlyestablished arrangements for the prompt, safe andeffective resuscitation and thermal care of babies,and for the care of babies who require continuingsupport, either in the birthing unit or by safetransfer elsewhere.

2.25 All birthing rooms should include:

an area designated and equipped forresuscitation of a newborn baby;

space at the bedside so that a healthy newbornbaby can be cared for alongside its mother;

the ability to care for a baby for short periods ina warm environment, for example duringneonatal examination, or for observation afterbirth. This will normally be achieved in a cotalongside the mother. Phototherapy may be

carried out here.

2.26 Healthy newborn babies, healthy pre-term babies,those born by assisted and operative procedures andbabies transferred from the neonatal unit will becared for in cots alongside the mother, wheregeneral maternal care and certain medical andnursing procedures will be carried out.

2.27 A neonatal unit is a facility for those newbornbabies requiring care that cannot be providedbeside the mother (see the BAPM Standards forhospitals providing neonatal intensive and highdependency care and Categories of babies requiringneonatal care (2001) for definitions of the levels ofneonatal care). A neonatal unit may be provided
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depending on the clinical network and localrequirements, equipped according to the level ofcare that the unit is designated to provide.Accessibility of neonatal units and parent facilities

is very important. See paragraph 8.9, Birthingspaces.

Transitional care

2.28 Transitional care facilities are increasingly beingprovided, where mothers can look after their baby/babies with supervision from midwives andneonatal professionals (for up to two weeks) priorto transfer home. These usually take the form ofgeneric multi-bed bays associated with thepostnatal beds.

Adult high dependency/critical care

2.29 Women who develop serious problems, for examplefulminating pre-eclampsia or eclampsia, majororgan failure, clotting disorders or severehaemorrhage, require prompt access to highdependency, intensive care and/or resuscitationfacilities. These women will need intensiveobservation, treatment and nursing care and mayrequire invasive cardiovascular monitoring.Provision will depend on the workload, casemix

and local circumstances. High dependency caremay be provided within the CLU, but critically illwomen requiring artificial ventilation will need tobe transferred to critical care facilities.

2.30 Every CLU, secondary and tertiary, must haveready access to high dependency and critical carefacilities on site. The provision required will relateto the number of births per year and needs to be

assessed locally for each project. In tertiary centres,the number of cases requiring high dependencycare can be more than 5% of the number ofdeliveries per year.

2.31 At an MLU remote from a hospital, temporaryhigh dependency care can be provided in thebirthing room. A paramedic ambulance would treatand stabilise the mother before transfer. Thereshould be recognised routes of access to critical carefacilities, together with equipment and staff for safetransfer. See paragraph 8.46, In-patient spaces.

Bereavement support

2.32 Access to appropriate facilities is very important forwomen and families who suffer bereavement at anystage of pregnancy.

Women attending the out-patient clinic, EPAUand pregnancy assessment facilities should haveaccess to quiet spaces for counselling in theevent of bad news.

The birthing suite and in-patient facilities

should include single bedroom(s), away fromthe birthing area and with a separate exit fromthe ward, for use in the event of a bereavement.

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2 Service context

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Location of birthing facilities

3.1 The consultant-led unit (CLU) should be locatedto enable 24-hour easy access for ambulances andcars. Women may arrive by ambulance, taxi or carand need to be dropped off at the entrance to theunit. Particular consideration is needed to ensurethat partners can park their cars easily and thenaccompany women into the building.

3.2 The CLU should be adjacent or close to themidwifery-led unit (MLU), if there is one, andhave good access to the neonatal unit. Adult highdependency and critical care facilities should beclose enough for direct transfers to take place, andclose enough for the mother to visit the baby orvice versa. Easy access to surgical and medicalconsultants is desirable to facilitate consultation.

3.3 Access to external spaces is important in all units.The location should protect other patients andvisitors in the hospital from the noise of women inlabour whether the windows are open or shut.Positioning of courtyards is important, since theseareas are used for relaxation or play.

3.4 Units should ideally not be sited near A&E ormental health units as these patients may wander,and security of the CLU/MLU is an importantconsideration.

3.5 A maternity unit should have its own separateentrance, because of the need for 24-hour accessand security control. The entrance to all unitsshould be designed and located to provide easyaccess and to provide a welcoming, non-clinicalenvironment. WC facilities should be provided inthis area. Entrance areas to larger units mayincorporate a caf facility.

3.6 It is essential that 24-hour immediate access forwomen in advanced labour is provided. On arrival,the means of communicating with staff and the

routes to the unit need to be immediately clearinside the entrance. Entrance via a deserted lobbyshould be avoided.

3.7 If an MLU is provided within a hospital, it shouldhave direct access for women and families separatefrom the access to the CLU. Ideally, it should havea dedicated entrance. There should be internalcommunication for ease of transfer if necessary, anda time-efficient access route between the two.

Reception area, Barts and the London NHS Trust

Photographer: Lisa Payne

3.8 Figures 2 and 3 illustrate the key relationships ofseparate and combined units.


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3 Whole maternity unit considerations

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3 Planning and design considerations

77

Entrance

US

PA = Pregnancy assessment

US = Ultrasound

NNU = Neonatal unit

PA

EPAUAdmin

Discreteexit

KEY

Link

Flex inroomuse

GynaeOPD

OPD

Entrance

Birthing rooms

Pre-/post-natal beds

Obstheatres

Main theatres

Gynae beds

Criticalcare

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CLU

MLU

Possible access

Birthingrooms

Ante-natal

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The MLU and CLU may be located onthe same site or a different site. Transferarrangements are key

Sup

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Obstheatres

Main theatres

Gynae beds

Criticalcare

NNU

CLU

MLU

Possible access

Birthingrooms

PA = Pregnancy assessment

US = Ultrasound

NNU = Neonatal unit

Sup = Support facilities

Figure 2 Combined CLU and MLU key functional relationships

Figure 3 Separate CLU and MLU key functional relationships

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Design considerations

Inclusivity

3.9 In calculating numbers of birthing pools, projectteams will need to take into account that certainethnic groups will not use pools.

3.10 General guidance on inclusivity is set out in HealthBuilding Note 00-01 General design principles(under Functional design issues).

Security

3.11 General security guidance is set out in HealthBuilding Note 00-01 General design principles(under Functional design issues) and in Health

Technical Memorandum 00 General engineeringprinciples (under Security).

3.12 Security is an issue of importance for staff, mothersand babies.

a. Babies born in hospital should be cared for in asecure environment to which access is restricted.

b. An effective system of staff identification isessential.

c. A robust and reliable baby security system

should be enforced, such as baby tagging,closed-circuit television, alarmed mattresses.

d. Strict criteria for the labelling and security ofthe newborn infant are essential.

3.13 The number of entry and exit points to the unitshould be reduced to a minimum. Public accessand egress should be limited to one door, whichshould be in the vicinity of and with good naturalsurveillance from the reception desk/staffcommunication base; although security should notsolely rely on the presence of staff/observation. The

use of centrally managed access control using oneof the following systems should be consideredessential: swipe card, proximity or biometricrecognition. Swipe cards are considered the leastsecure, with biometric recognition being the mostsecure. Digital code locks should be avoided.Where this is not possible, access/egress controls towards should be operated at ward level.

3.14 Overt and well-publicised CCTV cameras shouldbe installed at all entrances to the unit. Where theunit is only one department within a larger health

facility building, consideration should be given toinstalling CCTV at all exits from the building inorder to maximise the opportunity for detecting,

identifying and apprehending an abductor.Previous infant abductions have shown thatabductors generally plan their abductionsthoroughly, which includes visiting different

maternity units to establish security strengths andweaknesses. CCTV should ideally be monitoredand recorded at the security control room. Digitalrecording is now normal practice as it allows forinstant retrieval of images while the system is stillrecording and being used during an incident.

3.15 A system of electronic tagging of babies may beconsidered. See Safe and Sound: Security in NHSmaternity units (National Association of HealthAuthorities and Trusts, 1995) for furtherinformation. In some centres, controlled entry

using FM cards has been used in preference to babytagging, which has been difficult to control. Projectteams should consult their local security adviserwhen considering any electronic tagging system.

3.16 A separate, differently-coloured identificationbadge is commonly used to denote staff permittedaccess to young children and infants.

3.17 An integrated security system should link thebuilding/fire door alarm system to the babytagging, and CCTV systems to an appropriate

monitoring station.3.18 Signage should be displayed alerting users of the

security systems in place, for example CCTVcameras and baby tagging systems.

3.19 Security systems in place should not impedemovement of staff or safe transfer of mother orbaby in the event of an emergency.

3.20 The need to provide system security to deterpotential criminal behaviour and to reassure parentsshould be balanced with the need to create a

welcoming atmosphere on the unit.3.21 In birthing rooms, the woman should be able to

control access of visitors from the bedhead. Staffshould be able to override this from the staff base.

Infection control

3.22 Birthing pools and other equipment should bedisposed of or thoroughly cleaned and dried afterevery use, in accordance with local infectioncontrol policies. Local information and guidelinesregarding prevention of legionella build up in water

supply from seldomly used pools should beobtained from the local estates team and should be

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9

adhered to. See also Health Facilities Note 30 Infection control in the built environment.

Records

3.23 There is a statutory requirement in maternity careto provide contemporaneous records of all events,and records need to be kept for 25 years to supportany litigation claims. There should be storagefacilities to keep records traceable and secureagainst loss, damage or use by unauthorisedpersons. Archived records do not need to be kepton the unit itself, but should be accessible within24 hours.

3.24 Women carry their own notes in the antenatal and

postnatal period. In antenatal facilities some spaceis required for the storage of paper overviewrecords, while postnatal facilities require a retrievalsystem for re-filing full records.

3.25 Requirements for records storage need to take intoconsideration the development of electronic

records, and the space within units should bereduced accordingly. Project teams will also need totake into account initiatives such as the clinicalmessaging initiative and the Integrated Care

Record, which will replace the HospitalInformation System, the EPR and the IntegratedChildrens System.

3.26 Easy access for staff and confidentiality are keyconsiderations.

Storage

3.27 Over and above general storage requirements,which are dependent upon local supply and storagepolicies, maternity facilities require storage space

for a large volume of items such as birthing packs.See also Health Building Note 00-01 Generaldesign principles (under Supplies, storage anddistribution).

3 Planning and design considerations

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10

4.1 Within a hospital setting, the antenatal clinicshould be designed so that it has an identity of itsown and can function independently from thegeneral out-patients department. It should belocated on the ground floor, well signposted andwith a separate entrance that is easily accessible

from outside the hospital. This can be via the mainentrance to the maternity unit.

4.2 Antenatal clinics may also be used as gynaecologyclinics. There are likely to be local variations inwhere the early pregnancy assessment unit (EPAU)is located. The EPAU is usually separate from theantenatal clinic, but nearby to allow patients withunexpected problems on scanning to be referredeasily.

4.3 Attendance at an antenatal clinic is often a womansfirst introduction to a healthcare facility. The suiteshould appear attractive and user-friendly, with aquiet, relaxed atmosphere that will maintain thewomans confidence and dignity. The partner,friends or other family members, includingchildren, may accompany her. Waiting areas shouldbe planned with this in mind, with access to playareas, drinking water and WCs. Wall dcor shouldbe non-clinical in nature and not adorned withmedical diagrams.

Scope and size of provision

4.4 Specific clinical areas include:

a suite of standard/multidisciplinary consultingand examination (C/E) rooms;

interview rooms;

ultrasound rooms, which may be shared withthe EPAU.

4.5 The size of the antenatal clinic suite will depend onthe number of expected attendances per session, thenumber of proposed sessions, the number of

doctors and midwives, and the number ofeducation classes. Clinic sessions may be dedicatedto women with specific care needs, for examplediabetes, other medical conditions or pregnancy

complications, and this should be considered whendetermining the clinic size. An influential factor indetermining the number of sessions will be the levelof services provided in other facilities. Roomsshould be designed for maximum flexibility of use.

4.6 The schedules of accommodation are based uponestimated attendances/clinic sessions for the givennumbers of births.

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

4.8 Where stand-alone MLUs remote from the CLUare providing antenatal clinics and maternalassessment, they should include at least two C/Erooms and the ability to undertake ultrasoundscanning.

Functional relationships

4.9 C/E rooms should have easy access to ultrasound.The link to pathology services may be by way of apneumatic tube transport system. Near-patienttesting facilities may be provided within the unit,depending on local policy. There should be easyaccess to the birthing area and maternity in-patientbeds. See Figure 4and Chapter 3, Wholematernity unit considerations.

SpacesReception and waiting

4.10 The waiting area should have a welcoming andinformal atmosphere. Many pregnant women willbe accompanied by a friend or relative and mayhave small children with them. The area should beplanned so that it can be subdivided into separatewaiting spaces.

4.11 Within or adjacent to the waiting area, aninformation/resource space should be provided.This is likely to include a combination of printedand electronic media.

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4.12 If not conveniently located elsewhere, the followingfacilities should be provided:

WCs

Refreshment facilities

Childrens play area

Baby changing

Infant feeding

Wheelchair parking bay4.13 See also WCs in Health Building Note 00-02

Sanitary spaces and Entrance, reception andwaiting in Health Building Note 00-03 Clinicaland clinical support spaces.

Consulting/examination rooms

4.14 A general-purpose single-sided C/E room should beused, to increase flexibility of use. The C/E roomwill be large enough to accommodate electronicmonitoring and diagnostic equipment. Theexamination couch should be screened by a curtainto allow privacy. The couch needs to be accessibleon the right-hand side and at the foot. The design

and layout of the room should ensure that theprivacy and dignity of the woman is protected.Acoustic privacy is also important.

4.15 Blood-taking may be carried out in the C/E rooms(in line with the Childrens NSF preference), orseparate phlebotomy rooms may be provided,depending on local decision. The schedules ofaccommodation are based upon blood-taking beingcarried out in the C/E room.

4.16 Some C/E rooms may be larger to facilitate multi-disciplinary consultations. This will be a projectdecision.

4.17 See Consulting/examination room: single-sidedcouch access in Health Building Note 00-03 Clinical and clinical support spaces.

Pregnancy assessment room (MLUs only)

4.18 In a stand-alone MLU remote from a CLU, oneC/E room may be used to carry out pregnancyassessments. Ultrasound examinations will notusually be carried out in an MLU unless anantenatal clinic or pregnancy assessment clinic isassociated with it. Portable equipment may be used.

4 Antenatal clinic

C

CounsellingR = Reception/Waiting/

Child play

C = Consultation

G = Group room/Parentcraft

Staff link

Patient flow/link

Admin

Stores

Antenatalclinic

R

G

Entrance

Ultrasound

Ultrasound

Figure 4 Antenatal clinic functional relationships

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4.19 See Consulting/examination room: single-sidedcouch access in Health Building Note 00-03 Clinical and clinical support spaces.

Interview rooms

4.20 Depending on the size of the unit, rooms may beused flexibly for counselling, parental education,staff training and meetings. However, ideally,dedicated facilities should be provided so that thereis always a space available when required.

4.21 The locations of rooms used for counselling shouldbe discreet, and exit routes from them should notpass through public or waiting areas. These roomsshould provide a non-clinical environment fordiscussion with people who may be distressed.Privacy is essential.

4.22 See Interview room: 4 places and Interview room:7 places in Health Building Note 00-03 Clinicaland clinical support spaces.

Preparation for parenthood room/relaxationclasses

4.23 Local community facilities are often used for thisactivity. If provided in the hospital it should beused flexibly. The location should facilitate easyaccess for people in the evening and at weekends.It should not create any security issues and shouldideally be located within a 24-hour functioningunit. The room should provide enough space toaccommodate at least ten couples (plus facilitators),with room to move freely and use birth balls, matsand other equipment. This room will also be usedfor relaxation classes.

4.24 Equipment used in classes will include: mats;cushions; birthing aids such as balls; comfortablechairs; display boards for posters; a flipchart standand sheets; audiovisual equipment (OHP/video/DVD); and a whiteboard. Ceiling hooks and ropesmay be provided for use with slings. Computer(s)with Internet access should also be available.

4.25 It is important to be able to control the lighting,and have access to fresh air and cool drinking water.Ideally there should be access to tea and coffee-


12

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

Elizabeth Hospital NHS Trust Photographer: Lisa Payne

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

Elizabeth Hospital NHS Trust Photographer: Lisa Payne

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making facilities. There should be access to WCfacilities close by.

4.26 See Group rooms in Health Building Note 00-03

Clinical and clinical support spaces.

Preparation for parenthood store (optional)

4.27 The preparation for parenthood store may belocated within or adjacent to the preparation forparenthood room. The door should be lockable forthe safekeeping of valuable teaching aids. Storage isrequired for mats, bean bags, pillows, balls etc.

Treatment room (optional)

4.28 A treatment room may be required for diagnostic

and clinical procedures, which may includespecimen collecting and cardiotocography (CTG).A couch and two chairs should be provided, alongwith an adjustable examination lamp. A clinicalwash-hand basin is required. Adequate space isrequired for mobile surgical trolleys, andmonitoring and diagnostic equipment.

4.29 See Treatment rooms in Health Building Note00-03 Clinical and clinical support spaces.

Support spaces

4.30 The following support spaces are required, but maybe 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)

4.31 See Health Building Note 00-02 Sanitary spacesand Utility, Refreshments and rest, Offices andFacilities management in Health Building Note00-03 Clinical and clinical support spaces.

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5.1 Imaging procedures may be required for thediagnosis of complications in the postnatal periodor for the management of newborn babies.Although suitable portable imaging equipmentshould be available within a Consultant-led unit(CLU) and within easy access of the neonatal unit,

it is assumed that most women requiringultrasound imaging procedures will have theseperformed in the main imaging department.


5.2 The accommodation requirements will depend onlocal factors including the number of deliveries in aparticular unit, the casemix, the ultrasoundscanning policy for the population served by thatunit, and whether portable ultrasound equipmentis used. An ultrasound scanning room can cope

with approximately 5000 mixed routineexaminations per year. This guidance is based onthe provision of a minimum of two scanning roomsin a CLU to allow invasive procedures, for exampleamniocentesis, to be performed while routinescanning continues in the other room.

5.3 The wider introduction of nuchal translucencyacross the NHS will have an impact on the numberof ultrasound rooms required in a unit. Theseexaminations take longer to perform and slowdown the throughput in clinics.


5.4 Where a dedicated ultrasound suite is providedwithin a larger unit, it should be located within, orclose to, the antenatal clinic. It should be close tothe C/E rooms and reception, with easy access torecords. WCs should be provided immediatelyadjacent to ultrasound rooms. There should be easyaccess from the pregnancy assessment facilities.Consideration should be given to access from in-patient areas, depending on local policy.

5.5 See Chapter 4, Antenatal clinicand Chapter 3,Whole maternity unit considerations.

Spaces

Reception/waiting

5.6 Women will be directed to the ultrasound suitefrom the reception desk in the antenatal clinic.Waiting space is required close to the ultrasoundrooms (this may be shared with the antenatalclinic). The number of seats required will dependupon the estimated throughput of women. Coldwater drinking facilities will be required.

Ultrasound rooms

5.7 A standard treatment room with black-out and adimmable lighting system is appropriate for theprocedures carried out in this clinic. Anexamination light should be provided. Privacy forwomen dressing and undressing is essential. Seatingis required for the sonographer and the womansescorts. In accordance with current policy,instruments will be sent to central sterilizingfacilities.

5.8 See Treatment rooms in Health Building Note00-03 Clinical and clinical support spaces.

Interview rooms

5.9 Interview rooms for counselling should be locatedadjacent to the ultrasound rooms to avoid families

having to walk through busy circulation areas. Twoexit/entry doors may be considered.

5.10 See Interview room: 4 places and Interview room:7 places in Health Building Note 00-03 Clinicaland clinical support spaces.

WCs

5.11 WC facilities should be provided immediatelyadjacent to ultrasound rooms. One WC is requiredper scanning room; one should be an accessibleWC. Additional WCs should be available in the

waiting area.

5.12 See WCs in Health Building Note 00-02 Sanitary spaces.


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Support spaces

5.13 Support facilities are required as for the antenatalclinic, with which they may be shared:

Clean utility

Dirty utility

Disposal hold

Cleaners room

Staff changing

Staff rest room/beverage bay

Offices

Stores

Specimen collection/pneumatic tube (optional)

5.14 See Health Building Note 00-02 Sanitary spacesand Utility, Offices and Facilities managementin Health Building Note 00-03 Clinical andclinical support spaces.

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6.1 Within a Consultant-led unit (CLU), a dedicatedearly pregnancy assessment unit may be requiredwith its own reception and waiting area. This maybe co-located with the gynaecology clinic/ward,with which it may share certain facilities. Forreasons of privacy and dignity, patient spaces in a

dedicated EPAU should be physically separate fromthe antenatal clinic and the pregnancy assessmentunit.


6.2 Specific clinical areas include:

C/E room(s) (pre-scanning);

ultrasound room(s), although ultrasoundfacilities close by may be used;

interview room(s) (post-scanning).

6.3 The number of C/E and scanning rooms willdepend upon the number of women attending persession. There will also be a percentage ofemergency assessments to consider. The schedule ofaccommodation is based upon estimatedattendances/ clinic sessions for the given numbersof births.


6.4 A key consideration in its location is ease of

accessibility for staff. It should also be within easyreach of the in-patient beds and the operatingtheatre suite. Women who need to be admittedovernight will be transferred to an in-patient area.

6.5 There should be good links to pathology facilitiesand the blood transfusion service. WCs should beimmediately adjacent. Easy access is required to restfacilities and counselling facilities.

6.6 See Figure 5and Chapter 3, Whole maternity unitconsiderations.

Spaces

Reception and waiting

6.7 The waiting area should have a welcoming andinformal atmosphere. Many pregnant women willbe accompanied by a friend or relative and mayhave small children with them. The area should beplanned so that it can be subdivided into separatewaiting spaces.

6.8 Within or adjacent to the waiting area, aninformation/resource space should be provided.This is likely to include a combination of printedand electronic media.

6.9 The waiting area may be shared with thegynaecology clinic.


WCs: located conveniently for the waiting area,C/E rooms and the ultrasound rooms. Theseinclude a wheelchair-accessible WC. Theyshould not be directly overlooked by the waitingarea.


Childrens play area

Baby changing

Infant feeding

Wheelchair parking bay

6.11 See WCs in Health Building Note 00-02 Sanitary spaces and Entrance, reception andwaiting in Health Building Note 00-03 Clinicaland clinical support spaces.


6.12 Blood-taking may be carried out in the C/E rooms(in line with the Childrens NSF preference), or

separate phlebotomy rooms may be provided; thisis for local decision. See Consulting/examinationroom: single-sided couch access in Health BuildingNote 00-03 Clinical and clinical support spaces.


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Touchdown base

6.13 A midwifery/nurse touchdown base is required forregular observation of women, and co-ordinationof movements to theatre and in-patient areas. See

Touchdown base in in Health Building Note00-03 Clinical and clinical support spaces.

Ultrasound rooms

6.14 A standard treatment room with black-out and adimmable lighting system is appropriate for theprocedures carried out in this clinic. Anexamination light should be provided. Privacy forwomen dressing and undressing is essential.

6.15 Seating is required for the sonographer and thewomans escorts. In accordance with current policy,instruments will be sent to central sterilizingfacilities. See Treatment rooms in in Health

Building Note 00-03 Clinical and clinicalsupport spaces.

Interview rooms

6.16 One or two interview rooms should be provided fordiscussion post-scanning. See Interview room:4 places and Interview room: 7 places in HealthBuilding Note 00-03 Clinical and clinicalsupport spaces.

Sitting area

6.17 A small waiting/sitting area is required; privacy andquiet are essential.

Support spaces

6.18 The following may be provided separately or sharedwith other units that may be co-located, dependingon the overall design:

17

6 Early pregnancy assessment unit

R = Reception/waiting

FEM

A

EPAU

Gynae

EntranceR

To Path lab To A&E

To Daysurgery

Blood-transfusion

service

Staff link

Patient flow/link

Counselling

Sitting

Discreteexit

Consult/exam

Ultrasoundscanning

Admin/staff amenities

Gynaecology/OPD ward

Figure 5 Early pregnancy assessment unit functional relationships

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Patient beverage and snack preparation facilities

Clean utility

Dirty utility: There should be easy access for

women who often bring their own urinespecimens for checking. It should be adjacent tothe WC facilities so that women can alsoprovide specimens for investigation within easyreach of the test room.

Disposal hold

Cleaners room

Staff changing


Offices: A medical/midwifery office is requiredwithin the pregnancy assessment unit to allowfor administration duties and private discussionof problems by medical and midwifery staff.

This should include telecommunicationsfacilities.

Stores

Specimen collection/pneumatic tube (optional)

6.19 See Health Building Note 00-02 Sanitary spacesand Refreshments and rest, Utility, Offices andFacilities management in Health Building Note00-03 Clinical and clinical support spaces.


18

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19

7.1 Local policy will determine the functionalrequirements, and the opportunity for sharingfacilities will depend on the size of the unit and thetiming and organisation of clinics.


7.2 Facilities are required for C/E, ultrasound,phlebotomy, amniocentesis (invasive testing) andcontinuous CTG. These may take the form ofindividual rooms and/or multi-bay spaces.Reclining chairs and possibly beds should beprovided, with access to ultrasound facilities withinor adjacent to the unit.

7.3 The level of provision of pregnancy assessmentfacilities will depend on the number of patients andappointment times and the number of healthcareprofessionals available to work in the unit.

7.4 The schedule of accommodation for an assessmentunit is based upon estimated attendances and clinicsessions for the given numbers of births.


7.5 The pregnancy assessment unit should ideally belocated close to the birthing facilities. It would thenhave access to emergency laboratory facilities. If thesame workforce is shared between the antenatalclinic and the pregnancy assessment unit, the

proximity of the two units is desirable.


Spaces

Reception/sitting

7.7 The waiting area should have a welcoming andinformal atmosphere. Many pregnant women willbe accompanied by a friend or relative and may

have small children with them. The area should beplanned so that it can be subdivided into separatewaiting spaces.

7.8 Within or adjacent to the waiting area, aninformation/resource space should be provided.This is likely to include a combination of printedleaflets, videos and selected websites.

7.9 The waiting area may also be used as a sitting area,where women can sit comfortably and relax duringthe assessment. This combined facility should beprivate and separate from the circulation areas. Itshould include comfortable seating, entertainmentservices and access to refreshments.


WCs


Childrens play area

Baby changing

Infant feeding

Wheelchair parking bay

7.11 See WCs in Health Building Note 00-02 Sanitary spaces and Entrance, reception andwaiting in Health Building Note 00-03 Clinicaland clinical support spaces.


7.12See Consulting/examination room: single-sidedcouch access in Health Building Note 00-03 Clinical and clinical support spaces.

Pregnancy assessment room/bays

7.13 These are multi-use rooms with reclining chairs forperforming CTGs. Sufficient space should beprovided by the recliners for using the CTGmonitor and mobile ultrasound machine. Curtainsshould be provided round each area.

Ultrasound rooms

7.14 These may be dedicated facilities or shared with theantenatal clinic if co-located. See Treatment rooms

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20

Ultrasound

Pregnancyassessment

Consult/exam

Counselling

R

R = Reception/sitting/beverage bay

FEMA

FEMA Birthing

Ultraso

und

Admin/staff amenities

Entrance

Triage

Birthing area

Figure 6 Pregnancy (fetal and maternity) assessment unit functional relationships

Pregnancy assessment bay Two-bay layout

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21

in Health Building Note 00-03 Clinical andclinical support spaces.

Interview rooms

7.15 These may be dedicated facilities or shared with theantenatal clinic if co-located. See Interview room:4 places and Interview room: 7 places in HealthBuilding Note 00-03 Clinical and clinical

support spaces.

Staff communications base

7.16 This is the central communications hub of a unit, abase at which midwives may receive, read or giveinstructions and record information in the recordsheld there. It should be centrally located and easilyidentified by staff and visitors. It may be locatednear the clean utility room. The staff base should bewired as the centre for the help call system withinthe area and central monitoring equipment for

telemetry if used.7.17 There should be good communication links,

including telephones and IT. A computer terminaland associated equipment with a link to laboratoriesand EPR and PACS will be required. The securityof records and noise associated with equipmentshould be considered.

7.18 Work stations for the computers will be needed, thequantity dependent on local policy.

Support spaces

7.19 The following may be provided separately or sharedwith other units that may be co-located, dependingon the overall design:

Patient beverage and snack preparation facilities:may be adjacent to the reception/sitting area

Clean utility

Dirty utility: There should be easy access forwomen who often bring their own urinespecimens for checking. It should be adjacent tothe WC facilities so that women can alsoprovide specimens for investigation within easyreach of the test room

Disposal hold

Cleaners room

Staff changing


Offices: A medical/midwifery office is requiredwithin the pregnancy assessment unit to allowfor administration duties and private discussionof problems by medical and midwifery staff.This should include telecommunicationsfacilities

Stores

Specimen collection/pneumatic tube (optional).

7.20 See Health Building Note 00-02 Sanitary spacesand Refreshments and rest, Utility, Offices andFacilities management in Health Building Note00-03 Clinical and clinical support spaces.

Separate C/E room in a Consultant-led unit

(CLU)

All images above Courtesy Queen Elizabeth

Hospital NHS Trust


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22

8.1 This Health Building Note describes facilitiesrequired in all types of maternity unit for:

a. direct admission of women;

b. observation and assessment of pregnant women;

c. uncomplicated labour and births;

d. complicated labour and births (Consultant-ledunits (CLUs) only);

e. operative obstetric procedures (CLUs only);

f. resuscitation of the baby;

g. observation and recovery of infants;

h. observation and recovery of mothers;

j. partners, relatives and friends;

k. medical, midwifery, nursing and other staff;

m. clinical training of midwifery, nursing andmedical staff.


8.2 The number of antenatal beds, birthing rooms andpostnatal beds will be a local decision based on anumber of factors. The aim is to provideappropriate care for women and babies close tohome. Project teams should consider the model ofcare, current practices and any perceived changes

planned over the short, medium and long term.The following are key considerations:

the size of the population served, including anytertiary referrals;

the demographic trends that will influence thenumber of deliveries in the area;

the existing and predicted work trends inrelation to any clinical developments;

whether or not the unit will attract womenarriving by ambulance;

whether or not the unit will attract transfer in ofmothers and babies from other units (that is,tertiary referrals);

whether or not the maternity services are likelyto be reorganised/ relocated in the foreseeablefuture;

whether or not the unit has undertaken anyworkforce study (for example Birth Rate Plus)that is likely to change the way care is delivered.

8.3 Length of stay is variable in all stages of thematernity care pathway. When planning a unit,length of stay should be considered in the contextof the model of care.

CLU functional relationships

8.4 In-patient accommodation should be easilyaccessible from, and within a short distance of, thehospital entrance. Antenatal and postnatal areasshould be co-located for flexibility and they should

not be located adjacent to gynaecological facilities.See Figure 7.

MLU functional relationships


Front of house spaces

Reception and waiting

8.6 The reception desk should be located to enable allvisitors entering or leaving the unit to bemonitored. See Entrance, reception and waiting inHealth Building Note 00-03 Clinical and clinicalsupport spaces.

Triage room

8.7 A two-sided C/E room may be required for theinitial medical examination and midwiferyassessment of newly-arrived women, depending onlocal policy. There should be easy access to WCs,

ideally en-suite, otherwise close by. SeeConsulting/examination room: double-sidedcouch access in Health Building Note 00-03 Clinical and clinical support spaces.

8 Birthing facilities (and associated in-patientfacilities)

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8 Birthing facilities (and associated in-patient facilities)

23

CLU Hospital

24-houraccess

R

As

Anaesoffice

Obstheatres

Criticalcare

As = Assessment

R = Reception

NeonatalunitPost-

natal bedsAnte-natal bed

Birthing rooms

Planned and emergency (from outside unit) C-sections

Supportfacilities

Admin/staff

amenities

MLU

Reception

24-hour access

Note: may belocated in CLU

Antenatal

clinic

Staffcom.

base

Assessment

Birthingrooms

Access tooutsidespace/garden

Transfer to secondary/tertiary care

Discreet route

Admin/staff

amenities

Stores

MLU

OR

Possibly primary care

Figure 7 CLU functional relationships

Figure 8 MLU functional relationships

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24

Induction suite

8.8 A four-bed bay with en-suite toilet and showershould be provided for women who are admitted

for induction of pregnancy. The number of bedswill be based on demand. They will be equipped asa standard four-bed bay. They should be locatedclose to the birthing rooms. See Multi-bed roomin Health Building Note 00-03 Clinical andclinical support spaces.

Birthing spaces

Birthing rooms

8.9 The key principles for the design of birthing rooms

are:a. ensuring the safety of mothers and babies;

b. offering people privacy, dignity, comfort andfreedom of movement;

c. enabling staff, equipment and services to beavailable to women in one place, that is,without them being moved;

d. being functionally suitable for all activities thatwill take place in them;

e. providing flexibility in their use both on a short-term basis and as needs and policies develop;

f. reducing the risk of cross-infection.

g. providing access to water during labour torelieve pain.

Key recommendations

8.10 All birthing rooms should include the following:

a. en-suite sanitary facilities;

b. convenient storage for the mothers holdall andbelongings;

c. access to facilities to make hot drinks and tocold water;

d. local storage within or adjacent to the room forstorage of equipment, sterile packs etc out ofsight until required. Storage facilities will befitted out to meet project-specific storagerequirements;

e. provision for partners to stay at night. Thelayouts and space definitions in this guidanceassume that this is achieved using a fold-up bed,which can be stored within the local store forthe room. The other available options either

permanently take up space in the room or, iffolded back into the wall, may reduce theflexibility in the use of the room;

f. a wall-mounted baby resuscitaire with oxygen,air and vacuum outlets, and, if a multi-birthroom, space for additional mobile resuscitairesto be brought into the room (which will requireadditional medical gas outlets and socket-outletsif not running off battery and bottled supplies).The location of the wall-mounted resuscitaire islikely to be influenced by and/or to influencethe location of access to the en-suite and/or thebirthing pool area, and should be away fromdraughts;

g. medical gas outlets (including oxygen, nitrousoxide/oxygen and vacuum) at the bedhead forthe mother. The nitrous oxide/oxygen outletshould be accessible to women using a variety ofbirthing aids and a variety of positions withinthe room. To assist with achieving a non-clinicalenvironment these services can be concealeduntil required.

h. twin socket-outlets. Some outlets should also beprovided in the store to be available for chargingequipment;

j. if Electronic Patient Records are in use, a trolleyin the room, as required. A small writing surfacemay be required depending on local policy;

k. a clinical wash-hand basin.

8.11 A series of ergonomic studies was carried out intobirthing room design during the preparation of thisguidance. The range of activities from the moststraightforward to the most complex births wasinvestigated, and the space required for eachactivity measured.

8.12 Based on these studies, two room sizes have beenused within the schedule of accommodation andare illustrated in the room layouts: a room intendedfor single birth and a room suitable for twin/complex births. The schedule of accommodationassumes that 20% of the birthing rooms in aConsultant-led unit (CLU) will be the larger sizebut that all the birthing rooms in a Midwifery-ledunit (MLU) will be sized for single birth. Seeparagraph 8.22, Birthing room layouts andergonomic evidence.

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Birthing room set up for high-risk birth

Birthing room in adjacent MLUCourtesy Dartford and Gravesham NHS Trust


Bedhead services

All: Courtesy Queen Elizabeth Hospital NHS Trust Photographer: Lisa Payne

Mobile resuscitaire set up for high-risk birth Wall-mounted resuscitaire set up for high-risk

birth

Birthing room set up for low-risk birth

Both: Courtesy Queen Elizabeth Hospital NHS Trust


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En-suite

8.13 This guidance assumes that all en-suite facilitiesinclude a bath. Where a shower is required, thisshould be included separately within the room andnot located over the bath. The bath need not befree-standing, but this will be a project decision.The areas defined in the schedule ofaccommodation assume that it is not free-standing.

8.14 Studies have shown that womens preference forbidets varies considerably (National ChildbirthTrust Creating a Better Birth Environmenttoolkit, 2003). Where these are to be provided, thespecification of the fitting should meet therequirements for bidets in Health Building Note00-10 Part C Sanitary assemblies. The schedule ofaccommodation assumes that bidets are not

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

En-suite facilities

Courtesy Barts and the London NHS Trust


En-suite facilities

Queen Elizabeth Hospital NHS Trust


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

Courtesy Barts and the London NHS Trust

http://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environmenthttp://www.nct.org.uk/professional/birth-environment

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provided. See also Bathrooms in Health BuildingNote 00-02 Sanitary spaces.

Birthing pool areas (optional)

8.15 Birthing pool areas, where provided, should be anintegral part of some birthing rooms. The numberof these will be a project decision. When not in use,they can be curtained off from the main room. Thearea needs non-slip flooring suitable for wet areas,and this flooring usually extends a little way intothe main room.

8.16 There are a number of birthing pools on themarket. They vary in shape, size, and means ofgetting in and out, and offer different sitting

positions. In selecting a model, it is important toassess it in respect of the ergonomic implications ofthe midwifes activities as well as the womans inparticular, the positions they will be adopting whileassisting the mother and in accessing the drainagecontrols.

8.17 Several different models of fixed pool are availablein this country and from Europe. Manufacturersinstructions regarding installation, routinemaintenance and disinfection must always befollowed, and local operational policies should be

in place. In particular, regular flushing is requiredto avoid stagnation of water if the pools are notused regularly. Filtration systems should be checkedwith the manufacturer. Cleaning regimes should beagreed locally with the infection controlrepresentative.

8.18 There are certain safety considerations:

The midwife should have access from bothsides, with provision of a plinth. Slip-proofsteps into and out of the pool should beprovided, and the floor to the bath should be

slip-proof.

Grab rails and other aids should be provided tohelp the woman out of the bath.

There should be access to hot and cold water.The midwife should be able to control thetemperature of the pool water.

There should be access to an emergency callbutton.

Occasionally, women need to be lifted out ofthe pool onto the bed or a trolley. The provisionof a hoist is a matter for local decision.

8.19 It is not necessary to provide a clinical wash-handbasin within the pool area if the basin within the

main birthing room area is suitably close by andthere is no obstruction to access from the pool area.

8.20 A nitrous oxide/oxygen point may be provided, or

portable cylinders may be used.

Birthing pool, CLU birthing room

Courtesy Queen Elizabeth Hospital NHS Trust


Assisted bathroom(s)

8.21 All CLU units should have one assisted bathroom.See Bathroom: assisted in Health Building Note00-02 Sanitary spaces.

Birthing room layouts and ergonomic evidence

8.22 Room layout options are provided for birthingrooms suitable for (a) single births and (b) twin/complex births. For further details of the spacestudies that informed these layouts, see the separate

ergonomic report (forthcoming).

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Activities

Birthing room suitable for single births

8.23 The following activities may take place in this

room:

a. non-birthing activities, for example relaxing,preparing refreshments, watching TV, babyfeeding etc;

b. pre-birth activities, for example use of birthingball, stool and mat;

c. monitoring and recording activities;

d. normal single birth;

e. assisted single birth, including the scenario of

both mother and baby needing resuscitationand subsequent transfer of both out of theroom;

f. transfer of the baby from the room, from a wall-mounted resuscitaire, using a mobileresuscitaire;

g. clinical hand-washing;

h. recovery.

Optional

j. accessing and updating EPRs; where notprovided within the room, these need to beavailable nearby from a touchdown base orsimilar. It is generally assumed that paperrecords will be used.

Birthing room suitable for twin and complex births

8.24 The following activities may take place in thisroom:

a. non-birthing activities, for example relaxing,preparing refreshments, watching TV, baby

feeding etc;

b. pre-birth activities, for example use of birthingball, stool and mat;

c. monitoring and recording activities;

d. normal birth of twins;

e. assisted birth of twins, including the scenario ofboth twins requiring resuscitation and transferout of the room, together with the motherexperiencing cardiac collapse and also requring

resuscitation and subsequent transfer out of theroom;

f. use of one wall-mounted resuscitaire and onemobile resuscitaire (Note: space will allow fortwo mobile resuscitaires);

g. transfer of a baby out of room, from wall-mounted resuscitaire, using additional mobileresuscitaire;

h. clinical hand-washing;

j. recovery.

Optional

k. accessing and updating EPRs; where notprovided within the room, these need to beavailable nearby from a touchdown base orsimilar. It is generally assumed that paper

records will be used.

Space studies

Figure 9 Activity space length

8.25 The functional space required for birthing activities that is, 4900 mm 4200 (single birth) or4650 mm (twin birth) has been verified by aseries of space studies. The actual room area is the

result of combining various functional activityspaces (for example, birthing, clinical hand-washing, storage and pool) into a room design.

(4900) Length

(2100)

1000forintubation

600

Minimum clear space forevacuation of mobile

resuscitaire

Mobile

resu

scita

ire

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Generally, access space is excluded from DH corespace recommendations; however, the optionalindicative designs illustrated show that a minimumallowance of 2 m2to access the room will be

required to provide functioning spaces.

8.26 Where a birthing pool is required, an additional9 m2has been recommended, based on the spacestudies.

8.27 The recommendations set out here primarily relateto the key critical dimensions rather than the area.The following sections aim to illustrate the keydimensions and explain why they have beendefined. Where local teams make differentassumptions, these critical dimensions may need to

be changed.Activity space widths

Figure 12 Single birth option 3

Figure 15 Twin birth option 3

The room length of 4900 mm

8.28 The length of the room is greatly affected by therequirement to pull the mothers bed away from thewall for her resuscitation and still allow sufficientspace for moving a resuscitaire from the birthing

room. A clear space of 2100 mm is required at thefoot of the bed for transferring and evacuating aninfant from a wall-mounted to mobile resuscitaire,when the bed has been withdrawn 600 mm forresuscitation of the mother (note the 600 mm

Bed moved for activebirth

Zone for activebirth, mat etc

Ceilinghook

Vertical support rail

Cot

Cot

approx 850(450)

450 assumeno access

Obs

Obs

Mid

Mid

Mid

MidD

ressin

g

trolle

y

Dress

ing

trolley

CTG

CTG

2100

1900

(4200)

(2300)betweenfixedunits

Zone for activebirth, mat etc

Ceilinghook

Vertical support rail

Cot

Cot

approx 850(450)

900Space to access

storage

450 assume

no access

Obs

Obs

Mid

Mid

Mid

MidD

ressin

g

trolle

y

Dressin

g

trolle

y

CTG

CTG

2100

1900

(4650)

(2300)between

fixedunits





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assumes that intubation of the mother will not benecessary).

The room width of 4200 mm

8.29 This was considered:

acceptable for active birth at the side of the bedwhere the bed is moved from its normalposition, which was considered normal practice;

acceptable for all general birth activity,including the evacuation of an infant in amobile resuscitaire when the mother is beingresuscitated;

acceptable whether the resuscitaire was locatedat 45 deg in the corner or at 90 deg to the wall

as shown;

restrictive for twin births, requiring tworesuscitaires, as the midwife dealing with themother would be trapped by equipment.

The room width of 4650 mm

8.30 This was considered:

acceptable for active birth by the side of thebed, with the bed in its normal position.

acceptable for twin births, where two

resuscitaires are required a fixed wall-mountedresuscitaire in one corner and a mobileresuscitaire in the second (note: it is assumedthat the mobile resuscitaire is operated onbattery power and bottled gas);

acceptable whether the resuscitaires were locatedat 45 deg in the corner or at 90 deg to the wallas shown.

Storage at the head of the bed

8.31 The storage zone shown at the head of the bed was

only suitable for consumables and small trolleys/CTG equipment. Note: storage space orconsumables only amounts to three small storageboxes-worth (approximately 150H 150W 300Leach) and space for a spare set of linen.

8.32 The size of the opening in the storage must alloweasy access in an emergency.

Bed location and privacy

8.33 It is recommended that the bed is located aroundthe corner from the door/entrance location of the

room to assist in protecting the womans privacy.The illustration shows notional privacy zones

within a room depending upon the bed locationand the use of a privacy screen.

Figure 16 Bed location/privacy

Local storage

8.34 Storage space is required en-suite or nearby to theroom for:

a. birthing mat;

b. birthing stool;

c. bean bag;

d. wedge;

e. fold-up bed (for partner/relative use only);

f. light and stand (may be ceiling-mounted butthis can be difficult to make non-clinical);

g. small and large trolley (may not require both);

h. drip-stand;

j. height-adjustable cot;

k. mobile resuscitaire (for twin birth, or one perfour rooms generally when wall-mountedresuscitaire is included).

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8.35 Also, but separately, assumed to be in a cupboardnext to the bed:

a. monitors (fetal heart monitor/CTG, blood

pressure etc);b. personal storage.

8.36 Area of local store = 3.75 m2, or 5.4 m2withresuscitaire.

8.37 Average across four rooms = (3 3.75 plus

1 5.4)/4 = 4.16 or 4 m

2

.

Evacuation of the mother in the bed/door width

8.38 Evacuation of the mother was tested with two drip-stands (a) one either side of the bed and (b) bothbehind the bed, simulating bed-mounted dripstands; both scenarios with four members of staff.

With drip-stands at the side of the bed and withtwo midwives partly behind the bed, egress wasachieved reasonably comfortably with a 1700mm clear opening doorway (effective clear

width; ecw).

With two midwives and two drip-stands behindthe bed, egress was achieved reasonablycomfortably with a 1450 mm clear openingdoorway (ecw).

8.39 See Health Building Note 00-03 Circulation andcommunication spaces for the associatedrequirements for clear corridor widths outside ofthe room depending on the ecw of the dooropening.

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

approx

12001400

1500

Folding

bed

Resuscitaire

approx 1100

4900

4650 4

200

1000

17003000 (2400 tested)

4900

1000

14503250 (2600 tested)

4650

4200

Figure 18 Local storage 2

Figure 17 Local storage 1

Figure 19 Door size 1 Figure 20 Door size 2

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Room layout options

Single/twin birth room layout options

8.40 The overall room area will be dependent on the

relationship of associated spaces (clinical wash-handbasin, storage and en-suite) and whether additionalspace will be required in order to access the room.

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