Key Ways Hospital Design May Affect C-Section Rates

According to a new report published by Ariadne Labs and MASS Design Group, the physical design of a hospital’s birthing unit may affect its Cesarean section rate. Based on previous research, the team knew C-section rates can vary from 7 percent to 70 percent simply depending on the facility. As many as half of these C-sections are unnecessary and add surgical complications and increase costs. To begin to determine how much the physical layout of a hospital may impact C-section rates, the team chose 12 diverse childbirth locations — three birth centers and nine hospitals. They conducted site visits and phone interviews to develop facility profiles and compare the childbirth locations as quantitatively as possible.

Some of the findings of the report that highlight potential connections between design and efficiency include:

  • Higher room demand — or the annual delivery volume per labor delivery room — is associated with higher C-section rates and may contribute to overuse of the surgical procedure.
  • Facility size — or the deliveries per square foot of the unit — may be positively associated with higher C-section rates. The researchers noted that when a facility is too big, travel times between rooms can be detrimental to patient care or there is a loss of intimacy reported by patients.
  • The distance between patient rooms, the distance from workstations to patient rooms, and large patient rooms all can drive up treatment intensity resulting in increased rates of C-sections. Large rooms can also contribute to this problem, effectively adding to the distance between rooms.
  • Room standardization does not affect C-section rates. Despite logically increasing efficiency, the study suggests little to no benefit from creating the same environment from room to room.
  • Fewer collaborative spaces for staff may be associated with greater C-section rates. The researchers suggest more collaborative space allows for greater levels of motivation and accountability. However, they note an element of motivation and accountability comes from team culture — it could also lead to more patient monitoring and more C-sections.
  • The percent of unit space available for patients to “labor walk” or move around was associated with lower treatment intensity.

Source: “Seven Ways Hospital Design May Affect C-Section Rates” by Emily Rappleye, Becker’s Hospital Review Facilities Management, March 27, 2017.