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When expectant parents tour prospective hospitals and birthing centers, they may be focusing on the wrong things: a comfortable sitting room for family or special perks.

But the design of those facilities, often overlooked by prospective parents, could be what really affects the birth experience, and even increase a woman’s likelihood of having a caesarean section, according to recently published research.


When gauging hospitals and birthing centers, many prospective parents dwell excessively on amenities in the delivery rooms, said the report’s author, Dr. Neel Shah, an OB/GYN at Beth Israel Deaconess Medical Center in Boston. But there are “multiple ways that what is happening outside your room can end up impacting the care you receive.”

Among them:

  • Distance between labor delivery rooms. Of the 12 childbirth facilities studied, maximum distance between delivery rooms ranged from 9 feet to 242 feet. Those with the shortest distance between rooms were among those with the lowest C-section rates. Why? In part because, even though more privacy might be nice for patients, more distance increases the staff’s travel time.
  • Number of deliveries per room. If a facility has a relatively small number of rooms but a high number of deliveries, staff may need to move mothers through more quickly, thereby possibly increasing the likelihood of a C-section. Birth centers often seek to maintain a threshold of around 100 deliveries per room per year. At one looked at as part of the study it was 479.
  • Distance between the nursing station and patient rooms. Such stations often host monitoring equipment for fetal heart rates and a mother’s vital signs, and stretching the distance between the station and patient rooms could burden the medical staff and ultimately increase C-section rates. (Average distances in the facilities studied varied widely, from 23 feet to 114 feet.)

Expectant parents should widen their focus when they tour, said Shah, who works in Ariadne Labs, the research group led by Dr. Atul Gawande.


“Pay attention to the journey from where they check in, to the triage area, to the labor room,” he said. “Look at how the labor floor is laid out. Does it feel organized or is it cluttered? Where do the doctors and nurses work when they’re not in the room? Are these workstations close by or are there some rooms that look far away?”

“I would not advocate excluding a hospital simply because of the way it looks, but I think paying attention to the design may provoke questions that help you understand what your experience may be like.”

Hospital administrators, Shah said, often overlook these factors too.

“It is critical for health care administrators to involve clinicians in the design process to make sure the built environment supports rather than hinders their work,” he said. “It is surprisingly common for health care facilities to be designed with minimal input from the end-users.”

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