In Brief: From basic upgrades to major remodeling projects, hospitals can take different approaches to meeting patients’ evolving expectations for the birthing experience.
Since pregnant people started delivering babies in healthcare facilities in the early 1900s, labor and delivery facilities have been continuously evolving—and with that, trends and fads have come and gone (and come back again). As early as the 1920s, the majority of babies in the US were delivered in hospitals, thanks to the notion of a painless birth that began to emerge with anesthetic techniques. From then forward, the use of midwives, home births, and water births have enjoyed phases of popularity. More recently, hospitals have had to decide whether to build labor, delivery, and recovery (LDR) or labor, delivery, recovery, and postpartum (LDRP) units.
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Organizations planning for emerging trends in the birthing experience have to account for unit sizing, the look and feel of the space, the environment of care and the way it contributes to patient safety and quality, and nursing and other staff needs. Patients take notice of their hospital facilities, and while their decision for a birthing facility may be based primarily on insurance access and where their doctor attends births, patients also choose a facility based on the expectation that it will include certain comforts and amenities.
As a result, we see that the use of terms such as spa- or hotel-like are now commonplace in descriptions of hospital birth centers. And features that were was previously considered luxury items—like a soaking bathtub—are now becoming standard amenities. Meeting patient expectations on such amenities is key to maintaining obstetrical volumes as patients shop for places that offer their desired birthing experience.
Birth rates have been on a downward trend, and while the latest data shows a small increase, they are not expected to return to prior levels. In addition, a growing number of labor and delivery units across the country are closing, providing both opportunities and challenges for hospitals and health system to ensure that they can meet the needs of their community.
With the market focusing increasingly on amenities, leaders of obstetric facilities need to take stock of their care environments. Health system finances are constrained, and facilities should consider updates or upgrades that will help them be competitive while also fitting within their available capital budgets.
Upgrading Your Facilities
When it comes to enhancing the patient experience, staying modern in the amenities race, and ensuring that current room size is adequate, consider the following:
- Thoughtful design for the newly expanded family, including modern interior finishes, comfortable furniture, and easy-to-navigate layout
- Space for a spouse, partner, family, and friends, including a comfortable space for a support person to sleep overnight (e.g., a couch that converts to a bed)
- In-room amenities such as refrigerators, space for breast milk and breast pumps, coffee machines, and a space to sit and eat
- If not all rooms can accommodate upgrades, then a tiered room package in which patients can pay for added amenities may be a good option.
- Double beds, or nonhospital beds
- Space for portable water birth tubs; since water birth is a trend that ebbs and flows, a portable tub can support patient’s wishes without permanent renovation or dedicated space
For a Minor Remodel
If you’re not in a position to knock down walls, shut down the unit, or enact complex phasing plans, alternatives for minor remodeling projects are available. Consider uses for excess capacity and evaluate upgrades such as:
- Spa tubs in the room for relaxation and pain relief during labor (distinct from a birthing tub)
- Methods to minimize noise and enhance lighting in the room
- Acoustically, that means reducing noise coming in from the corridor and staff workstations (call systems, other ongoing births, etc.) as well as minimizing the machine beeps in the room.
- Regarding lighting, it includes appropriate access to daylight during the day, outdoor artificial light at night, lighting for specific procedures and medical needs, and soft interior lighting.
- Designated space to meet staff needs such as gathering areas, locations to recharge, and functional areas like lactation rooms
- Space near labor rooms to accommodate the role of doulas, midwives, and other alternative support systems as organizations focus on an expanded care team
- Signage, wayfinding, and incorporation of local languages
- Kitchenettes and laundry on antepartum floors
- Focus on design that supports high-quality care, with ample supplies in appropriate locations and minimal variation on the unit
For a Major Remodel
If your organization has the resources for a major remodel that would require temporarily closing parts of the unit or restructuring its layout, consider:
- Expanding room size, or combining rooms to create a few “suites” with family sitting areas (e.g., couches, TVs) in a separate space from the delivery area.
- Creating space for the NICLET (or couplet) model whereby the family and NICU baby can spend the postpartum recovery together.
- Adding a family lounge where the family can access a coffee bar, get fresh snacks, sit at a table for a meal, and get a break from the patient room.
- Evaluating the proximity of your L&D ORs to your delivery rooms and relocating them to improve patient safety and care quality.
- Colocating the NICU and specialty care nursery (SCN) when possible.
- Optimizing the patient experience and operations of OB triage efficiencies and space use.
- Ensure OB triage and the L&D unit are easy for patients to find and access during all hours of the day.
- Depending on the facility and size of the program, this may include creating a separate entrance to OB triage with a simple pathway to the L&D unit.
- Focusing upgrades to improve patient, family, provider, and staff comfort.
In addition to staff feedback, a visual inspection, and facilities assessments, look at your patient comments and HCAHPS ratings for clues as to the challenges your hospital faces that may be facility related. Survey your providers for their assessment of the facility and take their suggestions into account. Like the staff, they spend a lot of time on the unit and have valuable feedback on its usability and challenges. Regardless of the type of remodel you’re contemplating, consider the overall look of the facility, as it is likely to be photographed, videoed, and shared on social media—one trend that’s unlikely to fade anytime soon.
Flexibility for the Future
Each facility should consider its market and long-term strategy in planning for renovations, as well as the ability to respond to anticipated future trends. Do you expect more low- or high-risk patients? What does the future hold for midwifery and maternal-fetal medicine at the organization? Align the design with your 5- or 10-year strategy and ensure it informs the overall direction of facility changes.
Keeping flexibility as a principle in design will help ensure long-term usability given future trends. Increasing consumerism is likely to be the norm, and making the obstetric unit an attractive, comfortable space—in addition to providing the highest-quality services—will be imperative to long-term success.
Edited by: Matt Maslin
Published November 2, 2022