Ideal Labor Room Set up and PrerequisitesCHAPTER 1
INTRODUCTION
Labor room is a place for the care and admission of women in the process of childbirth. In conventional labor rooms, a pregnant woman is admitted to labor room at or near full dilation of cervix and is shifted to the postpartum ward after 2 hours. In labor-delivery-recovery (LDR) unit, a pregnant woman spends the duration of labor, delivery, and 4 hours postpartum in the same bed.
WHAT IS LABOR-DELIVERY-RECOVERY?
A birthing unit that is:
- Standardized
- Provides privacy and comfort
- Eliminates the need to shift mother in different stages of labor
- Includes all the support areas
- Catering to a mother exclusively during labor and immediate postpartum.
FOCUS AREAS IN LABOR ROOM DESIGNING
- Space and layout
- Equipment and accessories
- Consumables
- Human resources
- Practices and protocols
Location and Layout
Labor room should be located:
- In a designated maternity services area with a central nursing area preferably at ground floor for safety and comfort.
- There should be adjoining operation theater, neonatal intensive care unit (NICU), and high-dependency unit (HDU).
- The galleries and doors should be smooth and broad at all entry and exit points with large double doors for easy transit of large trolleys and personnel.
- There should be close connectivity to prelabor ward and cesarean operation theater.
Dimensions of Labor Room
- Consider present and potential of next 20 years of workload while designing.
- Even in single practitioner set up, consider space needed for managing life-threatening emergencies.
- Each LDR unit should have four laboring areas with one labor table each, one nursing area, two toilets, one newborn care unit, and two wash areas (Table 1).
Annexure for Labor Room
- Prelabor ward
- Emergency obstetric room
- Doctor/Staff room
- Scrub area
- Wash area
Prelabor Ward
- It should have 3–6 beds with bedside lockers, settees, and stools for attendants
- Intravascular (I/v) drip stands, oxygen cylinder/central oxygen with tubing and mask, suction machine should be available
- There should be adequate running space and appropriate toilet area.
Emergency Obstetric Room
Emergency obstetric room specification and need has been described in Table 2.
Scrub Area
- Two elbow-operated taps with running water having mixer and good drainage
- There should be place for soaps, antiseptic solution, and towel handle
- Facility of 10 liter geyser
- Hand washing protocol should be displayed.
Wash Area
Labor room can become messy with blood and body fluid spillage. A wash area in close connection to labor room will make rapid cleaning possible.
This should have:
- Place for taps
- Low set railings for drying
- Option for washing linen according to local needs
- Hooks for plastic aprons
There should be dirty utility area to store soiled instruments, linen, etc., and a clean utility area to store clean and autoclaved supplies.
Separate store-room is needed with adequate racks and cabinets to store supplies.
Doctors/Staff Room
- Allows area for rest and relaxation to the team
- Area should have sofa set, one small table, 2–3 chairs, and a bed for off-duty staff to have quick nap
- Personal lockers/cabinets should be provided
- There should be attached toilet with one western style WC and one wash basin
- Separate nurse's duty room should be designed
- A built-in shoe rack can allow shoe change into labor room shoes before entry.
Waiting/Registration and Triage
Waiting or registration and triage have been described in Table 3.
LABOR ROOM INTERIOR
- While designing labor room interior, keep in mind possible number and size of labor tables with adequate running space.
- Adequate sunlight in day through glazed glass makes a positive environment and also saves electricity.
- Place for all necessary equipment should be marked beforehand in consultation with anesthetist and neonatologist.
- Efficient utilization of space and free movement space for nursing staff between labor tables should be planned
TABLE 3 Difference between waiting area and triage. Waiting areaTriage- It should be at the entry of labor room complex and separate for regular in patient waiting
- Ambulance approach should be feasible
- Registration desk, seating area for 10 people and separate toilets for men and women
- Preferably at the entry for easy accessibility to patient and relatives
- Examination room for risk stratification with examination bed and provision for privacy
- A table for nurse, chairs and counter to store supplies
- Emergency calling bell
- The walls should be tiled, white/light colored with seamless joints extending up to the ceiling, and floor should have vitrified tiles or natural stones with seamless joints.
- Air-handling unit (AHU) in labor room complex to provides proper quality and conditioned air and should ensure six air changes/hour.
- In case AHU not feasible, proper ventilation should be planned and temperature should be kept below 25°C. Split AC can also be used.
- A granite counter running the full length of shortest wall of labor room should be built in, to keep equipment and supplies. The space below it can be used to store crash trolley.
- Autoclaved delivery tray, baby tray, episiotomy tray, normal drug tray, and emergency drug tray can also be stored here.
Lighting
Apart from ambient light, provision should be made for focus lights to be used during obstetric procedure.
Labor Table
- It may not necessarily be very costly or fashionable
- Good size and comfortable mattress is imperative
- Hydraulic/electronic/electric (best in maintenance) tables are available and should be chosen to allow quick change of position
- It should have side support railing, stirrups with knee and ankle support for lithotomy position
- An in-built I/V fluid stand and bucket place is preferred
- Labor table should be 3’ from side wall, 2’ from head end wall, and at least 6’ from the second table.
Newborn Care Area (NBCA)
- Placed within labor room area and designated for resuscitation of newborn
- Within easy reach of labor table with no obstruction
- Equipment needed: Radiant warmer, oxygen cylinder/concentrator, functioning resuscitation kit, prewarmed towels, shoulder rolls, mucus extractor, clock with second hand, and pediatric stethoscope
- Pediatric laryngoscope with endotracheal tubes of different size
- Low pressure suction
- Baby weighing machine
Equipment and Accessories
Equipment and accessories required for labor room are described in Table 4.
Necessary Instruments
Necessary instruments required for delivery and baby has been shown in Table 5.
Consumables
Consumables should be available in adequate quantity, at all the time and adequate supplies lasting for at least a month should be kept in store, taking into consideration the use of items over past 6 months.
Sterilization
- Independent sterilization facility for labor room is preferred
- Autoclave of two different size for quick and efficient working are recommended
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TABLE 4 Equipment for labor room. Life support equipmentEquipment for LRDesirable equipment- Boyles trolley with necessary accessories
- Pulse oximeter
- Cardiac monitor
- Oxygen generator with back up of oxygen cylinder, with accessories
- Suction machine
- Crash cart with emergency drugs and fluids, and others like extra endotracheal tubes, mouth gag
- Two good quality adult stethoscope
- Two BP apparatus
- Fetal Doppler-2
- Cardiotocography machine
- Small pulse oximeter
- Digital thermometer
- IV stands
- Sterile delivery sets according to workload
- PPH tray
- Cervical and vaginal exploration set
- Glucometer and urine examination sticks
- Syringe infusion pumps
- Epidural infusion for continuous labor analgesia
- Oxytocin infusion drip counters
- Kelly's pad
- Puncture proof container
- Hub cutter/needle destroyer
- MVA/EVA tray
- PPIUCD tray
(BP: blood pressure; EVA: electric vacuum aspiration; IV: intravascular; MVA: manual vacuum aspiration; PPH: postpartum hemorrhage; PPIUCD: postpartum intrauterine contraceptive device) TABLE 5 Instruments for delivery and baby. Instrument list for deliveryInstrument for baby- Cord clamps = 2/3
- Episiotomy scissor
- Needle holder, scissors
- Obstetric forceps of different sizes
- Ventouse
- Sponges-holding forceps, straight as well as angled
- Varying size of Sims speculum
- Anterior vaginal wall retractor
- Artery forceps/mosquito forceps/Allis forceps
- Adequate sponge holders (four at least)
- Ribbon gauze for packing
- Baby trays of adequate size
- Mucous extractor for suction
- Ambu bag for IPPR with masks of different sizes
- Baby laryngoscope with endotracheal tubes of different size
Others- Surgeon's and patient's gown
- Sterilized draping for conduct of delivery
- Adequate quantity of disposable cap, mask, plastic aprons, slippers/shoes in adequate numbers
- Sterile and autoclaved supplies including linen and instruments should be provided by central sterilization and supply department in large hospitals
- However, primary cleaning and decontamination should be done at source.
HUMAN RESOURCES
- Doctors
- Junior resident doctor round the clock
- Senior obstetrician on call and for management of laboring women
- Pediatrician on call/round the clock
- Anesthetic on call/round the clock
- Paramedical staff per laboring women
- One senior nursing staff trained in fetal and maternal monitoring
- Two–three junior nurses
- Attendants and trained paramedics as per need
Nurse to Patient Ratio for Labor and Delivery
Clinical setting and nurse to patient ratio has been described in Table 6.
DISPLAYS
Emergency phone number lists:
- Obstetricians/Registrars
- Anesthetist
- Pediatrician
- Blood bank
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All emergency protocols should be displayed:
- Partograph and maternofetal monitoring
- Hand washing
- Active management of the third stage of labor (AMTSL)
- Triage
- Biomedical waste management
- Essential newborn care
Labor room is a unique place. Knowledge, skill, and experience of obstetrician requires a well located, equipped, illuminated, and clean labor room and appropriate facilities to deliver appropriate care to laboring women.
BIBLIOGRAPHY
- Maternal Health Division (2018). Resource Package for Quality Improvement in LaQshya Program [online]. Available from: http://gmch.gov.in/sites/default/files/documents/Revised_material.pdf. [Last accessed on December 17, 2021].
- National Health Mission. (2016). Labor Room Guideline. cdr [Online]. Available from: https://nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/Labor_Room%20Guideline.pdf. [Last accessed on December 17, 2021]
- National Health Mission. (2013). Maternal and Newborn Health Toolkit [online]. Available from: https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=839&lid=377. [Last accessed on December 17, 2021]