Delivery beds and gynaecology tables are not the same purchase. What positioning in the second stage demands of a bed, how infection control shapes the surfaces, why neonatal resuscitation is a layout decision, and where a district unit differs from a tertiary one.
A labour ward is judged on two intervals. How long it takes to get a woman from the labour room into the operating theatre, and how long it takes to get a baby who is not breathing onto a warm flat surface with a bag and mask over its face. Nearly every equipment decision in the unit either shortens those intervals or gets in their way, and a surprising amount of well finished furniture gets in their way.
Bangladesh runs maternity services at several levels and the equipment list is genuinely different at each one. Buying a tertiary specification for a facility with no anaesthetist on site at night spends money that the same facility needs for a working suction unit and a warmer that stays on during load-shedding.
| District level unit | Tertiary or medical college unit | |
|---|---|---|
| Delivery surfaces | Delivery beds that convert from labour to delivery position without moving the woman, plus one spare for peak load | The same, plus dedicated first stage beds and a separate high dependency area |
| Theatre access | One obstetric theatre, with the transfer route from labour room to theatre timed and rehearsed | Dedicated obstetric theatre immediately adjacent, plus capacity for elective work |
| Neonatal provision | A resuscitation surface with warmth and suction at every delivery point, and a kangaroo mother care corner | The same at every bedside, plus a special care newborn unit taking transfers |
| Examination | A gynaecology examination couch in the admission and assessment room | Several assessment rooms, with ultrasound inside the unit |
| Recovery | Postnatal beds with side rails and adjustable backrest | Postnatal beds plus high dependency beds for eclampsia and haemorrhage |
The whole argument for a proper obstetric bed rather than a gynaecology table is that a woman labours on it and delivers on it. The foot section retracts or detaches, the leg supports swing in, the back section raises, and none of it requires her to be lifted or walked across the room during the second stage. If a unit labours a woman on one surface and then transfers her to a delivery table, that transfer is happening at the worst possible moment in the process.
Bed height sets the working height for the accoucheur, for perineal repair afterwards, and for anyone doing a lateral transfer onto a trolley. Powered height adjustment is only useful if the control can be reached while gloved and while attending the perineum, so ask where the control sits and whether there is a foot control as well. A hand control clipped to the head end is a hand control nobody touches, and the unit ends up working at whatever height the bed was left at.
Confirm that Trendelenburg is available and, more importantly, how it is achieved. It is needed for cord prolapse and for shock, and a bed that offers it only through a manual crank at the foot end offers it too slowly to matter. Adjustable leg supports rather than fixed stirrups, rotating armrests, and the ability to drop the back flat in one movement all belong to the same list: things needed urgently, by one person, without help.
An electric obstetric bed in a facility with unstable supply needs battery backup or a mechanical override on the movements that matter, meaning height and back section. Ask what the bed does mid-movement when supply fails, and ask to watch a midwife operate the override rather than the engineer who installed it. If it takes a spanner, it does not exist.
A gynaecology table does a different job from a delivery bed, and the two are substituted for one another in tenders because they look similar in a photograph.
The working rule is short: if a woman will deliver on it, it is a delivery bed. If she will be examined on it, it is an examination or gynaecology table. Do not let a tender collapse the two into one line to save a heading.
A labour room is cleaned between every case, with chlorine, by staff who are in a hurry. The furniture either survives that and comes out clean, or it holds contamination somewhere nobody can reach in the few minutes available.
Neonatal resuscitation needs a firm flat surface at working height, warmth, suction, and a bag and mask, within reach of the delivery bed. It has to be within reach rather than down the corridor because of delayed cord clamping: current practice keeps the baby with the mother while the cord is still attached, which means the resuscitation surface comes to the bedside or sits immediately beside it.
General ward lighting is not adequate for perineal inspection or repair. A mobile examination light with adjustable brightness, a high colour rendering index and enough reach to illuminate from an angle that is not blocked by the person working is a small purchase that visibly changes the quality of repair. Add an electric suction unit per delivery point, an instrument trolley, a fixed sharps arrangement rather than one that is carried around, and an IV stand with a base wide enough that it does not tip when a bag is hung at full height.