Design Brief- Stand Alone Midwifery Led Birth Centre

Purpose of a stand alone midwife led birth centre

Fundamentally the purpose of a midwife led stand alone birth centre is to allow
low risk birthing mothers to be given the choice of using such a facility as an
alternative to either a home birth or giving birth in an acute hospital maternity
setting (either the main obstetrics ward or a co-located midwife led birth centre).
In terms of exercising choice it is difficult to say where a co-located midwife led
birth unit stands in the minds of women given its particular position close to the
main obstetrics unit.

The NSF for Children (2004), states that women should "have easy access to
supportive, high quality maternity services, designed around their individual
needs and those of their babies". It goes on to state that women should be able
"to choose the most appropriate place to give birth from a range of local options
including home birth and midwife led units". It does not distinguish between
stand-alone midwife led birth centres based in the community and services co-
located alongside obstetrics led maternity units.

It has been shown that for women without identified complications there is no
evidence that hospital birth is any safer than those in midwife led birth centres.
Similarly there is the suggestion that routine involvement of clinicians in the care
of low risk women does not appear to improve perinatal outcomes. Therefore it
can be argued that one of the key benefits of having a midwife led birth centre is
that it supports the normalisation of birth with less intervention, which leaves the
main consultant led maternity unit to deal with those cases where there is clinical
evidence of benefit to the mother and/or baby for specific intervention.

Currently the majority of births in England take place in obstetric units where
doctors and midwives work as a team and the full range of interventions can take
place if needed, including induction, use of forceps, ventouse (a suction cap
attached to the baby’s head) to assist labour, or caesarean section. However,
many of the women who give birth in obstetric units plan and experience a
‘normal birth’, which does not require care from a doctor. Women may choose
this setting either because they are reassured that the interventions are available
should they require them or because it is the unit nearest to their home and there
was little or no other choice. (Healthcare Commission, 2008)

7.1 Design Brief- ‘Stand Alone’ Midwifery Led Birth Centre

Midwifery Led Birth Centres embrace a social model of maternity care, where
pregnancy and birth are viewed as normal physiological processes and where
midwives are the ‘lead professional’ for intrapartum care. They aim to provide the
same philosophy of care as for those women who deliver their babies at home
without the need for complex support or analgesia. The ambiance of the Centre
should be like ‘home’ with only the basic equipment and/or drugs required. Midwifery

G Gadd –interim project manager august 2009

Led Birth Centres do not provide medical interventions (e.g. caesarean sections,
induction, epidurals) nor have medical staff presence. Women in the Midwifery Led
Birth Centre will have labour, delivery, birth and postnatal in the same room where
they will remain after the birth of their baby until transfer home within 6 hours.

There will be clear admission criteria for the Midwifery Led Birth Centre to ensure that
only low risk women who meet these criteria are admitted to the Centre for the birth
of their babies. There will be a clear transfer policy in place for the transfer of women
from the Stand Alone Midwifery Led Birth Centre to the Delivery Suite at City Hospital
if complications arise and transfer becomes necessary.

The Midwifery Led Birth Centre will consist of three ‘low tech’ en-suite delivery rooms
set up, furnished and equipped to promote normal birth with no medical intervention.
One of these delivery rooms will be set up and equipped as a water birth room but it
will also be possible to accommodate portable birthing pools in the other delivery
rooms within the Centre.

7.2 Hours of service – Sandwell Midwifery Led Birth Centre

The Sandwell Birth Centre must be operational 24 hours, 7 days a week.

It is expected that each pregnant woman will typically be accompanied by a partner
who may be present throughout or join them at some point. Provision should also be
made for the pregnant woman to be accompanied by two small children who may be
present throughout the labour.

Provision is required for a minimal number of relatives to wait separately at some

time. Relatives will be encouraged to visit for only short durations; minimal facilities
will be required for visitors including a WC and a small work top vending machine.

7.3 Patient Flows – Sandwell Birth Centre

Women may arrive to the Birth Centre by ambulance car or taxi and may arrive in a
wheel chair, an ambulance trolley or on foot.

The reception area must be welcoming and as non institutional as possible and
provide a range of seating and toilets.

Adequate signage and directions must be clearly displayed.

The birthing rooms should be easily accessible from the reception and waiting areas.
All birthing rooms will be single occupancy with the average length of stay being 12
hours. En-suite sanitary facilities will be directly accessible from each birthing room.

The access and security arrangements will need careful consideration as women and
visitors will often be present at all hours. Access / egress must be controlled whilst
ensuring visitors are welcomed and feel able to arrive and leave as required.

The Birthing Centre must be situated in an area which allows easy access for
emergency ambulance transfer to the City Hospital site.

G Gadd –interim project manager august 2009

7.4 Goods flows – Sandwell Birth Centre

The services within the Birth Centre will require support services including domestic,
catering and portering services, plus supplies and waste disposal. Provision should
enable the clinical staff to access support facilities without leaving the suite.

7.5 Security and Observation – Sandwell Birth Centre

Throughout the accommodation, window openings should be restricted to 100mm14

for reason of security and to discourage intruders. The Suite must be secured to
prevent unauthorised access and/or egress. Staff access will be gained via an
automated access control system. Others needing access to the area will be
screened with audiovisual equipment controlled at staff base and reception
.
7.6 Manual Handling - Sandwell Birth Centre

Pool rooms should be positioned to facilitate ease of access and support bars, steps
and have safe, anti slip floors. Doors need to permit access by delivery bed.

Permanent ceiling mounted patient lifts should be available in each room. The lift
should be powered. Sharing the facility between rooms will not be discouraged if the
design allows. Don’t agree with this – we will be caring for low risk women and hoists
are not are chosen method of pool evacuation.

7.7 Proposed Accommodation – Sandwell Birth Centre

The Birth Centre will comprise of the following key facilities:

7.7.1 Reception and Waiting Room

A reception area with sub wait for 5 should be provided in close proximity
/immediately adjacent the entrance to the Birth Centre. The reception area should
include a small parking bay for a wheelchair should a patient require it on arriving at
the facility.

The waiting area should have an allowance of space for the woman’s children to play
and a small vending area suitable for a table top vending unit.

Toilet facilities suitable for disabled people should be provided. The toilet should
contain a baby change unit.

A baby feed room should be provided for small children to bottle fed by the woman or
their family.

7.7.2 Birthing Rooms

a) En-Suite Birth Rooms x 2:

The entrance to the rooms must accommodate women who are ambulant and
wheelchair users, parents with small children in pushchairs/buggies and clinical beds.

G Gadd –interim project manager august 2009

Access to both sides of the bed should be possible with room for a and baby cot and
a wide range of equipment. Storage within the room to conceal this equipment will
make the room more welcoming.

These rooms will have nurse call panels and piped gases, as detailed in section 7.8.
Large equipment will be hidden from view, giving the room a clean and uncluttered
homely appearance.

Rooms should be warm and have natural ventilation with some adjustments to
windows and window fans included.

All rooms should be decorated with soft shades of colours, not clinical in appearance
and have relevant multicultural images that make them feel welcoming, control of
lighting and use of music will be integral to providing the most conducive environment
for normal birth. The specification for the room design should be agreed with the
clinicians prior to commencing detailed design.

Lighting should be flexible to accommodate a range of situations so should

incorporate star light ceilings, wall lights, dimmer switches and very bright
procedure/examination lights which will be portable.

Each Birth Room requires soundproofing, edges of doors and all corners must be
protected from knocks and bumps with rubber or plastic edging strips.

Furniture must be comfortable for pregnant women and should not be too low. Each
Delivery Room will have baby warming facilities, birth mat, birth ball and birth stool
available in the room. Ropes and bars for active birth located throughout the labour
area. A mobile saddle stool will also be available and a recliner chair for partner. This
equipment will be free standing but will need to be purchased as part of scheme.

Textiles should comply with Infection control and fire safety regulation. Floor
coverings must be easy to clean, non slip and match the décor.

If resuscitation of infants is required it will be done on a baby changing station with a

changing mat using bag and mask with a resuscitaire and transport incubator
available nearby if necessary. This equipment is to be stored and charged within the
clinical store area

There will be facilities for the birthing partner to rest with the woman and her baby
using a fold out double bed/ sofa bed. Facilities should also be made available for up
to two small children accompanying the pregnant woman.

Portable PC’s will be available in the room so that midwives do not have to leave the
room for data input.

Pictures and signage should also be welcoming with relevant multicultural images
that make them feel welcoming; the specification for the room design will be required
from Division and relayed to the Project Manager during the pre project meeting once
the scheme has been agreed

The two rooms should have facilities to allow the use of portable birthing pools. A
temperature controlled tap is required in each room suitable for the location of a
birthing pool. Drainage should be available to dispose of the large amount of
contaminated water used in the birthing pools.

G Gadd –interim project manager august 2009

Access and egress to the room needs to allow for the provision of:

 Birthing mattresses / birthing stools / squatting ropes

 Portable birthing pools
 Baby bassinette
 Resuscitaire when required
 IT mobile computer stand
 Generic side room furniture / soft furnishings
 Space should be sufficient to accommodate lateral transfer to an electric
 Bed / trolley for transfer if required
 Emergency call system
 Gases
 Hand washing facilities using Rada No Touch controls and compliant with
HTM64
 Dignity curtains
 Relative and patient seating
 En suite facilities Rada No Touch controls

NB. Egress to the room needs to allow for transfer via ambulance to the Acute
Hospital Obstetric Delivery Unit in the event of an emergency.

b) En Suite Water Birth / delivery Room x1:

The requirements are as for the en suite birth rooms as above and in addition:

 Provision of birthing mattress / stool / birthing ball

 Birthing pool compliant to health and safety requirements
 Room for manual handling equipment when required for use Portable.

The En Suite Water Birth Room should be suitable for disabled access and use.

c) En – suite facilities:

En Suite facilities should be on an individual room basis. The en-suite facilities

should form a wet room facility.

En Suite facilities should comprise:

 Toilet
 Wash hand basin.
 Shower facility.
 Non slip flooring.
 Emergency and routine call bell system.
 Wheelchair access (lots of women faint when they get up post delivery!!!)

Plumbing must be sufficient to allow for the drainage of large volumes of

contaminated water from the portable birthing pools via portable pumps and hoses.
It will not be appropriate to drain pools via wash basins due to hygiene requirements.

G Gadd –interim project manager august 2009

d) Patient Transfer Room:

Chaired facility for 3 women with room for 3 bassinettes for babies
Beverage area

This areas should also be used as a sitting/dining room.

e) Interview/Counselling Room

A room should be provided that allows patients and prospective patients a space for
confidential discussions with staff members. During the course of the birth the room
could also be used as a quiet/relaxation space away from the delivery rooms.

f) Resuscitaire storage

An area should be provided that allows a resuscitaire and incubator to be stored

discretely but directly adjacent the birthing rooms.

g) Beverage bay (staff/ patient),

A kitchenette is required to serve beverages and light food to patients. The space
should include a fridge, chest freezer, toaster, microwave, dishwasher, zip tap hydro
tap, stainless steel sink with single drainer and suitable levels of storage in the form
of base units and wall mounted units.

7.7.3 Clinical Support Facilities:

 Clean utility
 Dirty utility – to include macerator, sluice and fridge for human waste products
(i.e. placenta)
 Equipment / clinical storage area
 Linen store for clean and dirty linen. It is assumed at this stage that the room
should be sufficiently sized for a weekly top up and collection of dirty linen
 Domestic services store

7.7.7 Staff Facilities

Office facilities will be required containing suitable workstations for four members of
staff.

A secured rest area will be required, with suitable catering facilities for staff.

Staff will require a change area with lockers, toilet and shower facilities

7.8 Building Support Services

All rooms will have call bells and emergency bells.

All delivery rooms will have piped medical gases to supply oxygen and entonox.

Suction will need to be provided via mobile units.

G Gadd –interim project manager august 2009

In the event of power failure the building will require backup power for the duration of
the power cut. The heating will need to be maintained throughout any power failure.

G Gadd –interim project manager august 2009