Environmental and systems-based safety in the obstetric operating room: A narrative review

Cesarean delivery requires an operating room (OR) that supports maternal surgery and anesthesia while preparing for fetal-to-newborn transition and, when needed, concurrent maternal and neonatal resuscitation. This narrative review applies a human factors framework to noise, information displays, medication and equipment organization, layout, communication, ergonomics, and emergency preparedness. These factors are examined in relation to hearing the awake patient's concerns, recognizing maternal or fetal deterioration, accessing hemorrhage treatment, and coordinating newborn assessment without interrupting maternal care. Standardized layouts, structured communication, cognitive aids, and simulation may improve care processes, but evidence for their effects on maternal and neonatal morbidity varies, and some findings are extrapolated from non-obstetric surgery. Environmental safety initiatives should therefore assess both the reliability of cesarean care and patient outcomes, including maternal morbidity, newborn thermal status, and the maternal birth experience.