Appendix 4 - Maternity center facilities and equipment

The facilities and equipment listed are recommended by the World Health Organization (WHO). A more detailed description of surgical and medical supplies and facilities is found in WHO (1991a). The facilities and equipment listed here would be suitable for a maternity center in a catchment area of 100,000 people, with an expected 4,000 deliveries a year. Since outpatient facilities and equipment are commonly shared between general outpatients and various specialties, the requirements for space, equipment, and supplies for outpatients are not incluced in this appendix.

Space Requirements

Maternity ward

Three 8-bed rooms with 3 toilets per room
Treatment room
Equipment store
Bathrooms
Nurses' bay and station
Sluice room
Room for cleaners/domestic staff
Staff cloakroom plus 2 toilets
Pantry/ward kitchen
Corridor space
Trolley bay

Shower rooms

Labor and delivery suite
Labor/delivery room (for 6 8 beds)
Eclampsia room (optional)
Sluice room
Nurses' bay
Admission/examination and
preparation room
Side-room laboratory
Cleaners' room
Store for consumable items
Store for non-consumable items
Toilets
Shower room
Waiting area for relatives
Recovery room (for 4 6 beds)

Cleaners' room

Operating suite
Sterilizing room with store
Main operating room
Staff changing rooms, male and female	2
Trolley bay
Shower rooms, male and female	2
Items of Furniture and Equipment
Toilets, male and female	2
Scrub-up post
Anesthetic rooms
Office
Recovery room

Maternity ward (8-bed ward)

Beds	8
Chairs	8
Bedside lockers	8
Overbed tables (optional)	8
Washbasins	2
Mobile screens	3
Air-conditioner or fans (optional)
Toilets	3

Beds should be standardized a convenient size is 200 x 100 cm. Spring beds, initially comfortable, sag in the middle later. For this reason, the preference is for hoop iron mesh riveted to frames; such beds ventilate well and do not sag with age. The mattress should be about 10 cm thick.

Treatment room

Cupboard unit and work top	1
Wall cupboards	3
Shelves, hooks
Examination couch	1
Stool	1
Trolley	1
Bins	2
Paper-towel dispenser or equivalent	1
Wash-basin with elbow-operated taps	1
Autoclave or sterilizer (optional)	1
Stands for intravenous fluid drips	4
Sphygmomanometers	4
Binaural stethoscopes	4
Thermometers
Suction machine	1

Bathroom

Freestanding bath	1
Chair	1
Handrail	1
Hooks for clothes and towels

Shower room

Same as bathroom, except that shower replaces bath.

Sluice room

Bedpan drier	1
Bedpan washer	1
Bedpan sterilizer	1
Ventilated cupboard for specimens	1
Storage for specimen-testing equipment
Working space
Small sink	1
Wash-basin	1

Nurses' station

Table	1
Chairs	4
Trolley for patients' records	1
Storage for stationary
Wall cupboards	2
Refrigerator	1
Notice board	1
Cabinet	1
Bookcase	1
Wash-basin	1

Nurses' bay

Office table	1
Chairs	2
Dwarf wall (can be used as work-top)
Clock	1

Room for cleaners and domestic staff

Cleaning sink, domestic sink, draining board, locker, storage for brushes and brooms, bins, duster rack, cupboard for cleaning materials.

Staff cloakroom and toilets

Toilets	2
Wash-basins	2
Bins	2
Mirrors	2
Toilet-paper racks	2
Clothes hooks	3
Lockers

Pantry or ward kitchen

Water boiler	1
Boiling plate	1
Refrigerator	1
Cupboard for crockery and cutlery	1
Cupboard for snacks and beverages	1
Sink	1
Draining board	1
Working surface	1
Bins	2

Labor and Delivery Suite

Admission room

Examination couch	1
Wash-basin	1
Scrub-up units with elbow operated taps	2
Bin	1
Towels/paper towels
Stands for intravenous
fluid drips	3
Writing table	1
Chairs	2
Cupboard unit with work-top	1
Wall cupboards	3
Trolleys	2
Fetal stethoscope	1
Thermometer	1
Sphygmomanometer	1
Binaural stethoscope	1

Nurses' bay

Office table	1
Chairs	3
Dwarf wall (can be used as work-top)
Storage for stationary
Wall cupboard	1
Notice board	1
Cabinet	1
Bookcase	1
Wash-basin (optional)	1
Small refrigerator	1

Labor and delivery room

Delivery beds with rods and stirrups
for lithotomy position	8
Surgeon's stools	8
Wash-basins with elbow-operated taps	2
Trolleys	8
Cupboards for storage of sterile packs
for various forms of vaginal delivery	2
Bins	8
Wall clock with seconds hand	1
Thermometers	8
Sphygmomanometers	4
Binaural stethoscopes	4
Fetal stethoscopes	8
Mobile adjustable angled lamps	3
Neonatal resuscitation trolley or shelf	1
Oxygen cylinders
Cupboard for resuscitation equipment	1
Air-conditioner or fan (optional)	1
Suction machine (if not available in separate eclampsia room)	1

Eclampsia room (optional)

Same as for one-bedded delivery room with these additions:

Side railings for delivery bed	1
Suction machine	1

Sterilizing facility

Small autoclave or sterilizer (in labor room or other area)

1

Shower room, cleaners' room, sluice room

As described for maternity ward.

Side-ward laboratory

Laboratory sink	1
Wash-basin	1
Laboratory bench with writing space	1
Cupboards for reagents
Refrigerator (if needed for storage of blood and cross-matching requirements)	1

Store for consumables

Shelves, racks, cupboards

Store for non-consumables

Shelves, racks, hooks

Operating Suite

Main operating theater

Operating table	1
Operating stools	2
Ceiling-mounted shadowless lamp, with 5 lamps or bulbs	1
Pedestal-mounted shadowless lamp, run off storage batteries in emergencies	1
Trolleys for instruments	3
Stands for intravenous fluid drips	2
Air-conditioners (optional)	2
Cupboards, shelves, drums for linen
Diathermy apparatus	1
Swab rack
Containers for used swabs and instruments
Suction apparatus	1
Sterilizer, fuel operated
(35 x 38 cm, 139 liter)	1
Sterilizer drum (20 x 10 x 6 cm)	1
Kerosene stove	1
Forceps (Cheatle) 26.5 cm	1
Sterilizer forceps 20 cm	1
Neonatal resuscitation trolley (optional)	1

The operating table must be sufficiently sturdy to support the heaviest patient, and yet be movable, easy to tilt into the head-down position and easy to clean, and permit a patient to be placed in the lithotomy position. The trolley for surgical instruments is best made of stainless steel, with flat surfaces and no guard railings. The recommended shelves and cupboards are for storage of packs of sterile, autoclaved surgical instruments, wrapped individually and made into sets designed for particular operations. One set of cupboards should be located near where the anesthetic team is customarily stationed.

Sterilizing room and store

Small autoclaves, cupboards and shelves for sterile store, large tables for sorting and packaging, drums and changing and toilet facilities. The instruments to be autoclaved should have first been cleaned in their respective wards. The same applied to linen, which should be laundered before being sterilized. On the whole, in a district hospital setting small-capacity autoclaves are preferable. They take a shorter time to run than large-capacity autoclaves, and are therefore less damaging to soft items like linen and dressings. For this reason, it is more efficient to use a small autoclave several times a day than to use a large machine once daily. Proper maintenance of autoclaves is imperative.

Staff changing rooms

Lockers	2
Mirrors	2
Wash-basins	2
Towels
Shelves for dean gowns (scrub suits), masks and caps
Row of hooks
Mackintoshes	10
Large laundry baskets for gowns (scrub suits)
Shower rooms, male and female	2
Toilets, male and female	2

Trolley bay

Scrub-up post

Sink units with elbow- operated taps	2
Soap
Bowls containing antiseptic solution
Scrub-up hand brushes

Anesthetic room

Sink and drainer	1
Work-top	1
Cupboard for storage of
drugs and instruments	2
Writing table or shelf	1
Trolley	1
Anesthetic gases
Anesthetic machines
(EMO draw-over type)	2
Stool	1

Recovery room

Trolley(s)
Shygmomanometer	1
Stethoscopes	2

Office

Writing desk with cupboards
underneath	1
Chairs	3
Low table	1
Notice board	1
Crockery and cutlery for light refreshments
Small refrigerator	1