Clinical Practice: New Maternal Care Designations Outlined in Joint ACOG-SMFM Guidance

ACOG and SMFM published the first-ever consensus guidance establishing levels of care specific to pregnant women. Levels of Maternal Care, the second landmark document in the joint ACOG-SMFM Obstetric Care Consensus Series, proposes a classification system that would promote regionalized care, allowing pregnant women at high risk to receive care in facilities that are prepared to meet their specific needs. (The first in the series was Safe Prevention of the Primary Cesarean Delivery.)

The guidance recommends uniform designations for levels of maternal care that complement but are distinct from levels of neonatal care. Each designation is based on a facility’s ability to manage various levels of maternal care:

  • Birth Centers, Level I (Basic Care)
  • Level II (Specialty Care)
  • Level III (Subspecialty Care)
  • Level IV (Regional Perinatal Healthcare Centers)

Each healthcare facility should have a clear understanding of its own classification, as well as a well-defined threshold and system for transferring women to facilities that offer higher levels of care, if needed.

The success of these new designations depends on close collaboration between obstetricians, nurses, anesthesiologists, consultants, maternal-fetal medicine subspecialists, and other healthcare providers. Moreover, higher-level facilities, such as Level III (Subspecialty Care) and Level IV (Regional Perinatal Healthcare Centers) facilities, are responsible for providing perinatal regional leadership. This includes facilitation of maternal referral and transport from lower-level facilities, outreach education for facilities and healthcare providers in the region, and analysis and evaluation of regional data.

Levels of Maternal Care has received endorsement and support from an extensive number of multidisciplinary peer health organizations. This includes endorsement by the American Association of Birth Centers; the American College of Nurse-Midwives; the Association of Women’s Health, Obstetric and Neonatal Nurses; and the Commission for the Accreditation of Birth Centers. Separately, the leadership of the American Academy of Pediatrics, the American Society of Anesthesiologists, and the Society for Obstetric Anesthesia and Perinatology have reviewed and expressed support for the recommendations.

To learn more about the Levels of Maternal Care collaboration and for information about other guidelines published in the February issue of Obstetrics & Gynecology (the Green Journal), please see the press release “Women’s Health Experts Recommend Obstetric Care Designations to Improve Maternal Care.” 


American College of Obstetricians and Gynecologists
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Mailing Address: PO Box 96920, Washington, DC 20024-9998