Perinatology is a specialty that involves the medical care and treatment of an infant and
mother immediately prior to, during, and following childbirth. This time in most people’s
lives is the happiest time they will ever spend in a hospital. This chapter will focus on the
environments and technologies experienced by mother and child before, during, and after
birth.
The hospital labor and delivery (L&D) environment has changed considerably over
recent years because of technological advances; however, most of the environmental
changes in this area have been aesthetic. The aesthetic changes are the ones considered
most comforting for the patients. The environmental changes associated with the neonatal
intensive care unit (NICU) and pediatric intensive care unit (PICU) tend to be more
general. However, given the focus on patient care, efficiency, and safety, these changes
and redesigns are quite effective. In this case, the patient can be a child ranging from a
premature infant to a young adolescent.
Gaining an understanding of the area and its function is much like understanding the
schematics of a medical system or device. The various areas have defined floor plans.
Thoroughly understanding associated patient flow is crucial in the planning, design, and
implementation stages of an L&D unit. Once an understanding of the floor plan is gained,
it is important to consider the required support areas. Just as important as the floor plan
for the functionality of the area, the support areas of the given location are critical to provide
effective and timely care to the patient. The individual room layout and configuration
(even within the same department, such as L&D) can vary considerably.
Furthermore, in addition to differences among individual patient rooms, the various clinical
and support areas can vary as well. Within the various room layouts, the equipment
orientation and storage is discussed.
The facility should be designed to support the varying services and equipment needs of
each clinical area. The important and highly visible technology of infant security systems,
their implementation, and integration into the existing facility infrastructure are discussed
in this chapter. The complex interrelationship among data communications, clinical facility
infrastructure, and medical device technologies is discussed as well. Medical gases
and vacuum systems vary in the clinical areas, depending on the procedures performed in
the rooms. Other utilities concerns are climate control and electrical power distribution.
The various medical device technologies in perinatology areas range widely in complexity
and criticality. Their use depends on the needs of the patient and the clinical services
provided (Schreiner, 1981). The medical technologies described in this chapter (e.g.,
monitors, radiant warmers, and ventilators) require technical support information for their
effective utilization. Some emerging technologies discussed include the electronic medical
record and advanced apnea-monitoring devices.
The Changing Environment of Childbirth
Until the early 20th century, childbirth was the domain of women. Pregnant women gave
birth at home, generally with other women attending the birth. Anesthetics and pain medications
were not used. By the 1940s and 1950s, women flocked to hospitals to give birth,
under the care of male physicians. In the hospital, the common practice was to anesthetize
women during labor to minimize or eliminate any pain during childbirth. The expectant
father was relegated to the waiting room to shield him from the “gruesome reality” of
childbirth. During that time in France, Dr. Ferdinand Lamaze developed “childbirth without
pain” (now known as the Lamaze method) based on his observations of women in the
Soviet Union giving birth without anesthesia. The Lamaze method gained popularity in
the United States after Marjorie Karmel wrote of her childbirth experience using Lamaze
in the 1957 book, Thank You, Dr. Lamaze. By the 1970s, “natural childbirth” was in
vogue. Although most women continued to deliver in hospital settings, couples were