Labor Room Guideline - NHM

1 April-2016 April-2016 (Updated)Shri C. K. MishraAS & MD (NHM), MoHFWDr. Rakesh KumarJS (RCH), MoHFWDr. Dinesh Baswal DC (MH), MoHFWDr. Veena DhawanAC (MH), MoHFWDr. Himanshu BhushanAdvisor (PHA), NHSRCDr. Bulbul SoodCountry Director, India, JhpiegoDr. Raman SardanaSr. Consultant Microbiology & Chairman Infection Control, Indraprastha ApolloHospitals, New DelhiDr. Pratima MittalHOD Obs/Gyn Safadarjang Hospital and Vardhman medical collegeDr. Poonam Varma Shiv KumarProf. & HOD, Dept of OBGY, MGIMS, SevagramDr. Somesh KumarDeputy Country Director, Head of Programs,India JhpiegoDr. Vikas YadavAssociate Director, maternal Newborn Health, Jhpiego Dr. MalalayHealth Specialist, UNICEFDr. Gagan GuptaHealth Specialist, UNICEFDr. Neeraj Agrawal Associate Director, Pre Service Education, JhpiegoDr.

2 Deepti SinghProgram Officer, JhpiegoDr. Alpesh Gandhi Vice President, FOGSI, 2013Dr. Seema R Garg CEO, SB Hospital & Healthcare Pvt LtdDr. Neelima Singh Faculty, Indian Institute Of Health and FamilyWelfare, HyderabadMohd. Shoeb AlamConsultant, Architect, UNICEFDr. Tarun Singh SodhaConsultant, MH, MoHFWDr. Pushkar KumarLead Consultant, MH, MoHFWDr. Rajeev AgarwalSenior Mgt. Consultant, MH, MoHFW Dr. Salima BhatiaSenior Consultant, MH, MoHFW Ms. Jenita KhwairakpamConsultant, MH, MoHFWLIST OF CONTRIBUTORS- Labor ROOM Health DivisionMinistry of Health & Family Welfare Goverment of India 1 Scenario 3: When new construction is not possible and no additional space is available for Labor rooms: Every effort should be made to ensure that Labor room space is re-organized as per these guidelines.

3 In all cases, the facilities should adhere to these guidelines for re-organization of equipment, consumables, human resources, practices and protocols. The guidelines for up-gradation of Labor rooms focus on five important areas as given below: Space and layoutEquipment and accessoriesConsumablesHuman resources Practices and protocolsThe document initially describes the space and layout organization for new construction or upgradation of Labor room complexes of various levels of delivery points, such as Sub-Center (SC) and Primary Health Center (PHC), Community Health Center (CHC), Area Hospital (AH), Sub-District Hospital (SDH), and District Hospital (DH). While space and layout re-organization/re-construction is ongoing, the facilities should start focusing on ensuring adequate equipment, consumables, and human resources in the Labor room as per these guidelines and introduce mechanisms for adherence to recommended practices and protocols preferably with tools such as Assessment Protocols & Safe Child Birth Checklist (SCC), and standardized case sheets as detailed in the MNH tool Health DivisionMinistry of Health & Family Welfare Goverment of India 2 Space and Layout Hire short term services of a registered architect in the district to assess the existing space of all delivery points and to draw specific plans for up-gradation of the Labor rooms.

4 Identify alternate/additional space for re-organizing/shifting the Labor room. If major renovations need to be carried out, shift the Labor room to an appropriate alternate space. Develop facility-specific plans for improving equipment, commodities, human resource, etc., simultaneously. Clearly lay down the SOPs for Labor room practices and technical protocols including infection prevention based upon these guidelines. Designate a technical officer for each facility who will take daily rounds to monitor adherence to these Labor room should be upgraded through the following process: Number of Labor Tables/bedsThe most important factor for defining the space and layout of the Labor room is the number of Labor beds in the facility. In this document, two types of Labor rooms are being recommended Labor rooms with Labor -delivery-recovery (LDR) room concept (a pregnant woman spends the duration of Labor , delivery, and 4 hours postpartum in the same bed) and conventional Labor rooms (a pregnant woman is admitted to Labor room only at or near full dilation of cervix and is shifted to the postpartum ward after 2 hours).

5 LDR concept is more client-centric and ensures better care, privacy, and comfort to the pregnant woman during Labor process. It also obviates the need for having additional waiting area or Labor area and associated services. It is being recommended that, if there is adequate space available without any significant resource constraints, all the DHs, AHs, SDHs, and FRU CHCs, and any facility with more than 500 deliveries in a month should be upgraded to have Labor rooms as per the LDR concept. Even Non-FRU CHCs with delivery load more than 100 deliveries per month can be considered for upgradation to have LDR units if space and resource availability permits. For the rest of the facilities, and in DH/AH/SDH/FRU CHC where space for LDR rooms is not available, the Labor rooms should be upgraded using the conventional Labor room concept.

6 maternal Health DivisionMinistry of Health & Family Welfare Goverment of India 3 The following table gives the recommended number of Labor tables per health facility as per delivery load:*The number given is for conventional Labor rooms. Even for these facilities, if LDR concept is being used, number of beds should be calculated using the formula given below. 20-99 Deliveries/month 2 CriteriaNumber of Labor table(s)<20 Deliveries/month 1 100-199 Deliveries/month 4* 200-499 Deliveries/month 6* >500 Deliveries/month To be calculated as per the given formula for LDR or Conventional Labor Room concept as applicable FRU CHC/AH/SDH/DH To be calculated as per the given formula for LDR or Conventional Labor Room conceptas applicable Formula to calculate the number of beds for LDR units:No.

7 Of LDR beds = {(Projected LDR events in a year)*(Average length of stay)}/ {(365)* (Occupancy rate)} Calculation: Step 1: Determine the number of LDR events in a year, the number of vaginal births per annum (projected number of births per annum plus the projected number of unplanned C-section births). Step 2: Take days or 16 hours (12 hours for Labor and delivery, 4 hours recovery, including the room clean-up) as the average length of stay. Step 3: 75% or is the recommended occupancy rate for health facilities. Step 4: Insert the numbers attained in the above steps, in the formula, and calculate the number of LDR beds example, LDR bed requirement for a hospital with 7200 projected deliveries (6120 normal deliveries1080 C-sections out of which 600 are unplanned C-sections) can be calculated as follows: Number of LDR events in a year: (6120+600) = 6720 Number of LDR beds required = (6720* )/ (365* ) = 16 beds Formula for calculating number of LDR units: As per specifications given in the next section, each LDR unit will have 4 LDR beds.

8 Thus the formula forcalculation number of LDR units will be as follows:Number of LDR units = (Number of LDR beds/4) rounded off to the next higher integer Example: In the above example, the number of LDR beds was 16. Hence, in this facility, the number of LDR units will be = (16/4) rounded off to next higher integer = 4. maternal Health DivisionMinistry of Health & Family Welfare Goverment of India 4 Formula to calculate the number of Labor beds/tables for conventional Labor roomsNo. of Labor beds = {(Projected Labor events in a year)*(Average length of stay)}/ {(365)*(Occupancy rate) Calculation: Step 1: Determine the number of Labor and delivery events in a year, the number of vaginal births per annum (projected number of births per annum plus the projected number of unplanned C-section births).}

9 Step 2: Take days or 8 hours (4 hours for pre-delivery preparations and delivery, and 4 hours for recovery and Labor room cleaning) as the average length of stay. Step 3: 75% or is the recommended occupancy rate for health facilities. Step 4: Insert the numbers attained in the above steps, in the formula, and calculate the number of Labor beds example, Labor bed requirement for a hospital with 7200 projected deliveries (6120 normal deliveries, 1080 C-sections out of which 600 were unplanned C-sections) can be calculated as follows: Number of Labor events in a year: (6120+600) = 6720 Number of Labor beds required = (6720* )/ (365* ) = 8 Labor beds Each Labor bed should be in a bed form with the following specifications: Adjustable side rails.

10 Facilities for Trendelenburg/reverse positions. Facilities for height adjustment (hydraulic pump preferably). Stainless steel IV rod. Mobility: swiveling castor wheels & brakes. Mattress should be in three parts and seamless in each part with a thin cushioning at the joints, detachable at perineal end. It should be washable and water proof with extra set and disposable draw sheet. Steel basins attachments. Calf support, hand grip, leg Health DivisionMinistry of Health & Family Welfare Goverment of India 5 Standardizing Space and Layout (LDR Complexes) LDR Complexes in CHCs, AHs, SDHs, and DHsHaving adequate space as per protocols for ensuring provision of recommended services, is one of the most important aspects of up-gradation of Labor rooms. For this purpose, wherever needed, Labor rooms should be newly constructed.