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Facility Design

Reimagining Approaches to Childbirth in Hospital and Birth Center Settings

Breedlove, Ginger, PhD, CNM, FACNM, FAAN; Rathbun, Lesley, MSN, FNP, CNM, FACNM

The Journal of Perinatal & Neonatal Nursing: January/March 2019 - Volume 33 - Issue 1 - p 26–34
doi: 10.1097/JPN.0000000000000376
Feature Articles

Few maternity care clinicians are aware of the current regulations that guide design standards for childbirth facilities in the United States or the regulatory history. There is considerable variance among state regulations as well as oversight of facility standards for healthcare settings. Understanding evidence-based recommendations on how facility design affects health outcomes is critical to reversing the rise in maternal mortality and morbidity. A variety of measures can be implemented that promise to improve user satisfaction, quality of care, and efficiency for all who engage in the childbirth environment. Recommendations for change include broader assessment to better understand how clinicians and consumers simultaneously maneuver within a complex system. Key metrics include evaluation of workflow within available space, patient acuity and census patterns, integration of evidence-based recommendations, and options that promote physiologic birth. For the changes to succeed, human centered design must be implemented and diverse clinicians and consumers engaged in all phases of planning and implementation. Exploring characteristics and outcomes of low-risk women who receive care in a freestanding birth center or the European alongside maternity unit provides opportunity to reimagine and address improvements for inpatient, hospital birth.

Grow Midwives, LLC, Shawnee, Kansas.

Corresponding Author: Ginger Breedlove, PhD, CNM, FACNM, FAAN, Grow Midwives, LLC, 13608 W 54th St, Shawnee, KS 66216 (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: July 28, 2018; accepted for publication: September 30, 2018.

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