(B-0510) Maternity Unit
(B-0510) Maternity Unit
(B-0510) Maternity Unit
Revision 5.0
12 April 2012
Australasian Health Facility Guidelines
INDEX
INTRODUCTION 4
Preamble 4
Introduction 5
Policy Framework 5
Description of the Unit 6
PLANNING 12
Operational Models 12
Planning Models 14
Functional Areas 15
Functional Relationships 17
DESIGN 18
Access 18
Parking 18
Disaster Planning 18
Infection Control 19
Environmental Considerations 19
Space Standards and Components 20
Safety and Security 21
Finishes 22
Fittings and Fixtures 23
Building Service Requirements 24
COMPONENTS OF THE UNIT 26
Standard Components 26
Non-Standard Components 26
APPENDICES 29
Schedule of Accommodation 29
Functional Relationships 34
Checklists 35
REFERENCES AND FURTHER READING 36
Further Reading 36
References 37
INTRODUCTION
Preamble
510.001.000 This Health Planning Unit (HPU) has been developed for use by project staff (architects,
502251 planners, engineers, project managers and other consultants) and for end users, to
facilitate the process of planning and design.
It is intended to assist with the planning and design of a unit that will be fit for purpose in
accordance with its designated service delineation / capability and defined catchment
population.
510.001.005 This HPU an update of the Maternity HPU developed for NSW Health and issued for
502252 Australasian use in 2006. Its development has been informed by an extensive background
research and consultation process.
510.001.010 It should be read in conjunction with the Australasian Health Facility Guidelines (AusHFG)
961080 generic requirements and Standard Components described in:
- Part A - Introduction and Instructions for Use;
- Part B - Section 80 - General Requirements;
- Part B - Section 90 - Standard Components;
- Part C - Design for Access, Mobility, OHS and Security;
- Part D - Infection Prevention and Control; and
- Part E - Building Services and Environmental Design.
510.001.015 EXCLUSIONS
961081
The following services and facilities may be established in major teaching / tertiary
women’s centres but are excluded from this HPU:
- reproductive /infertility units;
- clinical genetics units; and
- birthing centres (as differentiated from a Maternity Unit).
510.001.018 TERMINOLOGY
961083
‘Maternity’ encompasses the disciplines of obstetrics and midwifery and is used to
represent both. ‘Obstetrics’ is generally only used in references.
In the context of this HPU, the term ‘birthing room’ has been used to describe a room
designed to support any woman through labour, birth and the early postnatal period.
‘Birthing Centre’ refers to a discrete unit, usually midwife-managed and led, providing for
more natural 'at-home' style antenatal care, birth and immediate postnatal care for
women accepted into the programme. In the context of this HPU, it is assumed that
Birthing Centres are located on a healthcare campus so that more intensive midwifery and
obstetric care are readily available should an emergency arise. Birthing Centres, however,
are not described in detail in this HPU and no schedule of accommodation is provided.
The original version also gave a schedule of accommodation for an obstetric operating
unit. These details are also omitted. Refer to Part B: HPU520 Operating Unit, Australasian
Health Facility Guidelines (AHIA, 2010).
Introduction
510.002.000 GENERAL
502253
Maternity is the branch of health care which provides services for the management of
pregnancy including pre-conception counselling and care; onset of labour and birth; the
postnatal period and parenting; and immediate care of the newborn. It encompasses the
total needs of the pregnant woman and her family, including the physical, educational and
psycho-social requirements, irrespective of the care setting.
Policy Framework
510.003.000 GENERAL
502254
Policies for the provision of healthcare services are formulated in accordance with the
following principles:
- appropriate service models that ensure a comprehensive service network throughout
state and regional health jurisdictions;
- safe and effective care that minimises both staff and patient risks;
- provision of a safe and efficient environment that minimises risk to all users of the
facility;
- deployment of resources in a fair and cost effective manner to optimise health
outcomes; and
- development and support for enhanced information systems to monitor, plan and
evaluate healthcare services.
Policy frameworks recognise the diversity of the community and that special groups within
communities often require specific consideration to meet their needs and to enhance the
effectiveness of any services provided.
510.003.020 Overarching policies include the Disability Discrimination Act 1992, Act No. 135 of 1992 as
961086 amended (Australian Government, 2013).
510.004.040 AMBIENCE
961095
Overall unit / centre design should recognize the pivotal role of the parents and other
family members as part of the whole process of pregnancy, birthing and post-natal care.
Planning and design should:
- create a welcoming environment in all parts of the Maternity Unit;
- provide adequate space and facilities for families;
- allow for privacy and encourage physical infant contact;
- provide quiet facilities for counselling, grieving and care planning;
- provide retreat facilities for patients and staff; and
- facilitate patient to staff and staff to staff communications.
PLANNING
Operational Models
Maternity care may be accessed via clinics located at hospitals, community health centres
or GP practices and the model selected may depend on the risk factors inherent in the
pregnancy noting that risk factors may change rapidly.
Planning Models
510.007.000 LOCATION
961109
In order to provide easy access for ambulances, taxis or private vehicles for women in
labour, a ground floor location is preferred for the Birthing Unit (and Birth Centre). Such a
location would additionally facilitate access to hospital grounds and verandas for the
mothers and their supporters. If this cannot be achieved, direct lift access to the Unit is
recommended and access to a secure courtyard is desirable.
Units should be located to avoid:
- disturbing sounds, both on-site and off-site such as ambulance sirens traffic, trains
etc.;
- disturbing views such as cemeteries, mortuaries or their entries; and
- problems associated with prevailing weather conditions. It is preferable for patient
accommodation to have a north-east aspect.
The functional needs of the unit however should take priority over other location needs.
The Birthing Unit and Birth Centre should ideally be located to maximise or provide
quietness, outlook and outdoor access during long periods of labour for both mother and
supporters. Access to outdoor areas is of particular importance for units in rural areas with
high aboriginal populations who are not used to being confined indoors. However, privacy
remains a priority.
510.007.005 Planning should consider the proximity of 24 hour and 8 hour operational zones. Locate
961110 units so that staff are not working in isolation nor have to traverse unoccupied areas at
night. The positioning of units should optimise the capacity for staff to observe and assist
each other. See Part C: Design for Access, Mobility, OHS and Security, Space Standards and
Dimensions, Australasian Health Facility Guidelines (AHIA, 2010)for further information.
Functional Areas
should be provided.
Clinical support areas for antenatal beds may be shared with the postnatal zone,
depending on the functional relationships and unit size.
Functional Relationships
510.009.000 The Maternity Unit has functional relationships with the following units / services relevant
961118 to their level of service delivery:
- community maternity services;
- universal newborn health screening service;
- emergency unit;
- Birthing Centre;
- imaging - particularly obstetric ultrasound;
- anaesthetic services;
- operating rooms - for emergency and planned surgery (Levels 1 – 4 in South Australia
with a centre managing 4,000 births needs a designated obstetric theatre);
- special care nursery and neonatal intensive care unit;
- ICU and HDU for sick women;
- ambulance transport bay/s for retrieval services (NSW Newborn and Paediatric
Emergency Transport Service);
- helipad, where provided, for retrieval teams including the Flying Doctor Service;
- gynaecological inpatient beds;
- general hospital support services; and
- pathology and pharmacy services.
DESIGN
Access
510.010.000 The Assessment Unit, Birthing Unit and Birth Centre require 24 hour access. A direct and
502287 dedicated entry with drop-off parking for cars, taxis and ambulances is preferred. Delivery
by ambulance should not be via the emergency department. The Birth Centre ideally
should have its own entry with internal links to the main Birthing Unit and Operating Unit.
If these Units do not have dedicated entries, specific arrangements will need to be made
for after-hours access.
Access during normal hours should be via the reception area. After-hours access for
expectant mothers and their supporters should be via the birthing area. After-hours policy
may allow restricted access to partners / support persons of mothers in the in-patient area
and parents of neonates in the neonatal special care area.
Planning should minimise the number of night entrances and ensure that staff and the
public can access the unit at entrances adjacent to car parks to limit the time outside of
the facility at night.
Swipe card or key pads at access points should be considered as they provide a more
secure, cost effective access control.
Parking
Disaster Planning
510.012.000 Each component of the Unit will have operational plans and policies detailing the response
502289 to a range of internal and external emergency situations. During planning and design
phases consider issues such as the placement of emergency alarms, the need for
uninterrupted power supply (UPS) to essential clinical equipment and electronic sensor
taps, services such as emergency lighting, telephones, duress alarm systems and
computers and the emergency evacuation of patients, many of whom will require
assistance.
Refer to Part B: Section 80 General Requirements, Australasian Health Facility Guidelines
(AHIA, 2010) and Part C: Design for Access, Mobility, OHS and Security, Space Standards
and Dimensions, Australasian Health Facility Guidelines (AHIA, 2010) for further
information.
510.012.005 Particular attention is required to the means of evacuation for mothers in advanced
961119 labour, and evacuation of babies to avoid separation from their mothers.
Infection Control
510.013.000 GENERAL
961120
The following aspects of planning and design contribute to the implementation of
effective infection prevention and control measures and are relevant within the context of
this HPU:
- hand hygiene facilities;
- isolation rooms (if applicable);
- linen handling;
- separation of ‘clean’ and ‘dirty’ work flows;
- storage;
- waste management; and
- surface finishes.
Refer to Part D: Infection Prevention and Control, Australasian Health Facility Guidelines
(AHIA, 2015) and individual jurisdiction policies and guidelines.
Environmental Considerations
510.014.000 ACOUSTICS
502294
Acoustic treatment is essential in the Birthing Rooms to allow the mother to vocalise as
desired during labour without worrying about disturbing others.
Crying babies, especially at night, can be a major source of distress to others, particularly
mothers recovering from surgery or other conditions e.g. pre-eclampsia, for whom noise
may be detrimental to their condition.
One of the prime considerations in the Nursery is the amount of noise created by crying
babies, monitors, suction pumps, ventilators, etc. Methods of sound dampening should be
carefully considered, but should not interfere with observation and ease of access
between the Nursery and staff / support areas.
Refer to Part C: Design for Access, Mobility, OHS and Security, Space Standards and
Dimensions, Australasian Health Facility Guidelines (AHIA, 2010) for further information.
510.014.010 PRIVACY
502297
Ensure that doors to birthing rooms when opened do not expose the labouring woman to
view by others outside the room.
510.014.020 ARTWORK
961122
Care should be taken in the selection of artwork to ensure no distress to parents who have
very sick newborns or who have experienced neonatal death or abnormality.
510.014.025 SIGNAGE
961123
The orientation of people to and within healthcare facilities, and even safety and security
issues are greatly assisted or hampered by the quality and location of signage which may
be directional, used as a means of identification and/or statutory.
All signage should be easily understood by staff and the general public whether patients or
visitors, and where necessary and appropriate, languages other than English should also
be used.
Any signposting, or other initiatives put in place, should be considered from the
perspective of out-of-hours use. Certain access points may be locked out of office hours or
after visiting hours. Directions indicated through signposting should, therefore, be
evaluated in this context.
Refer to AusHFG Part C: Section 750, Signage and TS2: Wayfinding for Healthcare Facilities,
Issue 5th Ed (NSW Health, 2008).
510.014.030 In particular, signage for access to the Assessment Unit, Birthing Unit and Birth Centre
961124 should be easily identified to avoid confusion.
510.015.005 ERGONOMICS
502299
Maternity Units should be designed and built in such a way that patients, staff, visitors and
510.016.005 SAFETY
502303
Facility planners and designers should enhance safety through choices regarding the
design, methods of construction, materials used, and the choice of fittings, fixtures and
equipment.
510.016.010 SECURITY
502304
Facility planners and designers should enhance security by incorporating the principles of
territorial reinforcement, surveillance, space management and access control into design
decisions.
Minimise entry and exit doors to all areas with newborn babies to minimise the risk of
illegal removal of babies. All access to and egress from the unit should be controlled. CCTV
monitoring of Unit entry and exit doorways and hallways should be considered. The use of
reed switches, electric locking and video intercom on external doors and entries should be
considered. Swipe card readers may be required to both sides of internal doors, to allow
access for authorized staff.
Specific security procedures should be developed and implemented.
The staff station should be located at the main entrance to allow staff to monitor access
and egress. Attention should be paid to reception desk security and a duress alarm
system.
Good visibility from the staff station to nursery is required.
The number of relatives / visitors admitted in the area should be controlled by either
restricting the number of relatives / visitors attending at any one time and/or restricting
visiting hours to set times.
Courtyards, where provided, should be securely screened / fenced and adequately
monitored (from Staff Station, CCTV, etc.).
Finishes
510.017.000 GENERAL
961127
Finishes in this context refers to walls, floors, windows and ceilings.
Refer to Part C: Section 710, Space Standards and Dimensions, Australasian Health Facility
Guidelines (AHIA, 2010) for further details.
510.018.000 DEFINITION
502308
The Room Data and Room Layout Sheets in the Australasian Health Facility Guidelines
define fixtures and fittings as follows.
- Fixtures: Items that require service connection (e.g. electrical, hydraulic, mechanical)
that include, but are not limited to hand basins, light fittings, medical service panels
etc. but exclude fixed items of serviced equipment; and
- Fittings: Items attached to walls, floors or ceilings that do not require service
connections such as curtain and IV tracks, hooks, mirrors, blinds, joinery, pin boards
etc.
Refer to Part C: Section 710, Space Standards and Dimensions, Australasian Health Facility
Guidelines (AHIA, 2010)and to the Standard Components - Room Data Sheets (RDS) and
Room Layout Sheets (RLS), Australasian Health Facility Guidelines (AHIA, 2015) for further
detailed information.
Also refer to Part F: Section 680 Furniture Fittings and Equipment, Australasian Health
Facility Guidelines (AHIA, 2010) regarding fixtures, fittings and equipment.
facilities and therefore taps should be large enough to fill the bath quickly before the
water cools to an uncomfortable temperature and outlets should be large enough to
ensure rapid emptying should the need arise.
Spa jets should not be included as spa outlets are unable to be cleaned adequately from
an infection control perspective and ceiling hoists or lifters should be considered.
510.019.000 GENERAL
961129
In addition to topics addressed below, project staff may also refer to:
- Part E: Building Services and Environmental Design, Australasian Health Facility
Guidelines (AHIA, 2010) and
- TS11 - Engineering Services and Sustainable Development Guidelines (NSW Health,
2013).
510.019.025 LIGHTING
961134
Colour-corrected dimmable lighting is essential in all patient areas where high dependency
care is provided, i.e. birthing / assessment rooms and birthing room en suites and
bathrooms, all nurseries and baby bathing / examination / resuscitation areas.
510.020.000 Standard Components (SC) refer to rooms / spaces for which Standard Components -
502312 Room Data Sheets (RDS) and Room Layout Sheets (RLS), Australasian Health Facility
Guidelines (AHIA, 2015) have been developed and are available on the AusHFG website.
Their availability is indicated by “Y” in the SC column of the Schedule of Accommodation.
Standard components are provided to assist with the development of a project. Their use
is not mandatory and if used they can be edited to be project specific.
Refer to AusHFG Part B: Section 90, Standard Components for the text and to separately
itemised Standard Components - Room Data Sheets (RDS) and Room Layout Sheets (RLS),
Australasian Health Facility Guidelines (AHIA, 2015).
Non-Standard Components
510.021.000 Non-standard components are unit-specific and provided in accordance with specific
502313 operational policies and service demand. The following non-standard components are
described below:
- Assessment Room and Assessment / Induction Room;
- Bay – Neonatal Resuscitation;
- Bay – New Weighing / Assessment;
- Newborn Bathing Room / Examination / Treatment Room;
- General Nursery; and
- Breastfeeding Room.
Considerations
Inclusion of a General Nursery requires consideration to be given to staffing requirements
to ensure appropriate supervision of babies in the Nursery at all times. Infection control
issues also need to be considered.
APPENDICES
Schedule of Accommodation
510.022.000 A schedule of accommodation is shown below and lists generic spaces for this HPU. Please
961139 note that in the schedules:
- SC refers to standard component (drawings and data sheets);
- (o) indicates the component is optional; and
- "Y" refers to whether available in these guidelines.
Ensuite - Standard Yes 4x5 8x5 Reduce if only bed bays planned.
Store - Equipment Yes 1x4 1x6 Space for CTG, Ultra sound machines.
Bay – Handwashing Type B Yes 1x1 1x1 At Unit Entry with PPE.
Store – General Yes 2x8 4x8 Shared space between birthing rooms
for CTG, cribs with discreet access from
birthing and entry corridor.
Bay – Newborn Weighing / Assessment 1 x 1 (o) 1 x 1 (o) May be performed in Birthing Room.
Office - Clinical / Handover Yes 1 x 15 1 x 20 Provide hot desks for visiting staff e.g.
community midwives, medical staff,
allied health.
Store – Drugs Yes 1 x 5(o) 1 x 5(o) May be included in sterile stock store
with appropriate security or part of
clean utility.
Cleaner's Room Yes 1x5 1x5 May be shared with Ante/ Postnatal.
Bay – Handwashing Type B Yes 1x1 1x1 At Unit Entry with PPE.
1 Bed Room - Standard Yes varies x 15 8 x 15 Level 3/4 beds may be included in the
Postnatal Ward.
1 Bed Room - Special Yes varies x 18 2 x 18 Level 3/4 beds may be included in the
Postnatal Ward.
Bay – Handwashing Type B Yes 1x1 1x1 At Unit Entry with PPE.
1 Bed Room - Standard Yes varies x 15 17 x 15 May be used as Class S/Type 4 Isolation
Room. Level 3/4 beds may be shared
with the Antenatal Ward.
1 Bed Room - Special Yes varies x 18 2 x 18 Bariatric, double bed, multiple births,
wheelchair may be accommodated in
these rooms.
Store – General (Rental baby capsules) 1 x 6(o) 1 x 9(o) Optional - due to jurisdictional
protocols and guidelines.
Cleaner’s Room Yes 1x5 1x5 May be shared with Birthing Unit.
510.022.035 STAFF AREAS AND AMENITIES – ANTENATAL AND POSTNATAL INPATIENT UNITS
961146
These facilities may be shared between Antenatal and Postnatal Units, decentralised to
each Inpatient Unit, or a combination of both, depending on Unit bed numbers and
functional relationships. Some rooms may also be shared with the Birthing Unit,
depending on Unit size and functional relationships. Reference should be made to the
relevant jurisdiction’s office accommodation policies.
Workstations Yes varies x 4.4 varies x 4.4 for midwives. As per staff
or 5.5 or 5.5 establishment.
Toilet - Staff Yes 1 x 3(o) 2 x 3(o) Optional – may be part of staff change
rooms.
Store – Photocopy / Stationery Yes 1x8 1x8 May be shared with Birthing Unit.
Functional Relationships
Checklists
References
510.026.000 - ABCB, 2015, Building Code of Australia (BCA) (ABCB, 2015), Building Code of Australia
961148 (BCA), Australian Building Codes Board, Canberra ACT.
- AHIA, 2010, Part C: Design for Access, Mobility, OHS and Security, Space Standards
and Dimensions, Australasian Health Facility Guidelines (AHIA, 2010), Australasian
Health Facility Guidelines, Australasian Health Infrastructure Alliance (AHIA), Sydney,
NSW.
- AHIA, 2010, Part E: Building Services and Environmental Design, Australasian Health
Facility Guidelines (AHIA, 2010), Australasian Health Facility Guidelines, Australasian
Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2010, AusHFG Part B: Section 90, Standard Components, Australasian Health
Facility Guidelines, Australasian Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2010, Part B: Section 80 General Requirements, Australasian Health Facility
Guidelines (AHIA, 2010), Australasian Health Facility Guidelines, Australasian Health
Infrastructure Alliance (AHIA), Sydney NSW.
- AHIA, 2015, Part D: Infection Prevention and Control, Australasian Health Facility
Guidelines (AHIA, 2015), Australasian Health Facility Guidelines, Australasian Health
Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2010, Part C: Section 730, Human Engineering, Australasian Health Facility
Guidelines (AHIA, 2010), Australasian Health Facility Guidelines, Australasian Health
Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2010, Part C: Section 710, Space Standards and Dimensions, Australasian Health
Facility Guidelines (AHIA, 2010), Australasian Health Facility Guidelines, Australasian
Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2015, Part C: Section 790, Safety and Security Precautions, Australasian Health
Facility Guidelines (AHIA, 2015), Australasian Health Facility Guidelines, AHIA, Sydney,
NSW.
- AHIA, 2010, AusHFG Part C: Section 750, Signage, Australasian Health Facility
Guidelines, Australasian Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2010, Part F: Section 680 Furniture Fittings and Equipment, Australasian Health
Facility Guidelines (AHIA, 2010), Australasian Health Facility Guidelines, Australasian
Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2014, Part B: HPU 390 Intensive Care - Neonatal Special Care Nursery,
Australasian Health Facility Guidelines (AHIA, 2014), Australasian Health Facility
Guidelines, Australasian Health Infrastructure Alliance (AHIA), Sydney, NSW.
- AHIA, 2015, Standard Components - Room Data Sheets (RDS) and Room Layout Sheets
(RLS), Australasian Health Facility Guidelines (AHIA, 2015), Australasian Health Facility
Guidelines, AHIA, North Sydney, NSW.
- AHIA, 2010, Part B: HPU520 Operating Unit, Australasian Health Facility Guidelines
(AHIA, 2010), Australasian Health Facility Guidelines, AHIA, Sydney, NSW.
- Australian and New Zealand College of Anaesthetists, 2009, Recommendations of
Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and
Other Anaesthetising Locations - Interim Review 2008 (Australian and New Zealand
College of Anaesthetists, 2009), Australian and New Zealand College of Anaesthetists,
Sydney, NSW.
- Australian Doula College, 2015, Australian Doula College (website) (Australian Doula
College, 2015), Australian Doula College, Kensington, NSW.
- Australian Government, 2013, Disability Discrimination Act 1992, Act No. 135 of 1992
as amended (Australian Government, 2013), Disability Discrimination Act 1992,
Commonwealth Government of Australia, Canberra, ACT.
(Standards Australia, 2010), AS/NZS 1428:2010 Design for Access and Mobility (Set),
Standards Australia, Sydney, Australia.
- Thomas, N, 2004, The Reproductive Rights of Women with Disabilities (Thomas, N,
2004), Women with Disabilities Australia (WWDA), Lenah Valley, TAS.
- Yelland et al, 2009, A National Approach to Perinatal Mental Health in Australia:
Exercising Caution in the Roll-out of a Public Health Initiative, Medical Journal of
Australia (Yelland et al, 2009), Medical Journal of Australia, Medical Journal of
Australia, Sydney, NSW.