ACOG/SMFM Levels of Maternal Care Obstetric Care Consensus (Revised 2019)

ACOG and the Society for Maternal-Fetal Medicine (SMFM) have revised the 2015 Levels of Maternal Care Obstetric Care Consensus (OCC) to:

  • Reaffirm the need for levels of maternal care, which includes uniform definitions, a standardized description of maternity facility capabilities and personnel, and a framework for integrated systems that addresses maternal health needs 
  • Clarify definitions and revise criteria by applying experience from jurisdictions that are actively implementing levels of maternal care
  • Reduce maternal morbidity and mortality by encouraging the growth and maturation of systems for the provision of risk-appropriate care specific to maternal health needs. This includes development of collaborative relationships between hospitals of differing levels of maternal care in proximate regions, which ensures that:

The ACOG/SMFM Levels of Maternal Care Obstetric Care Consensus (revised 2019) has received either endorsement or support from the following organizations:

  • American Academy of Family Physicians (support)
  • American Association of Birth Centers/ Commission for the Accreditation for Birth Centers (endorse)
  • American College of Nurse-Midwives (endorse)
  • Association of Women’s Health, Obstetric and Neonatal Nurses (endorse)
  • Society for Obstetric Anesthesia and Perinatology (endorse)

For clinical guidance, patient safety bundles, and external resources related to Levels of Maternal Care, please see our resource overview page.

View the webinar Levels of Maternal Care: Updated Guidance and Implementation to learn about updates to the 2015 ACOG/SMFM Levels of Maternal Care Obstetric Care Consensus, the importance of risk-appropriate maternal care as a key strategy to decreasing maternal mortality, and how Levels of Maternal Care has been implemented.




Levels of Maternal Care Definitions

Like the 2015 guidance, each level of maternal care reflects required minimal capabilities, physical facilities, and medical and support personnel. Each higher level of care includes and builds on the capabilities of the lower levels.

Regionalization and Access to Maternal Care

The Levels of Maternal Care OCC is intended to maintain and increase access to care by developing, strengthening, and better defining relationships among facilities within a region. 

Although geographic and local issues will affect systems of implementation for regionalized maternal care, this, in turn, should facilitate consultation and transfer of care when appropriate, allowing low- to moderate-risk women to stay in their communities and pregnant women with high-risk conditions to receive care in facilities that are prepared to provide the required level of specialized care. 

Levels of Maternal Care Verification Program

The Levels of Maternal Care verification program was developed by a multidisplinary core team in an effort to further support consistent interpretation of the 2015 guidelines. In addition to ACOG and SMFM, the core team includes representatives from:  

The verification program involves a comprehensive onsite review to verify the maternal level of care of a hospital in alignment with ACOG and SMFM guidelines. In developing the verification program, the core team also aimed to expand on the work achieved with the CDC Levels of Care Assessment Tool by using a hospital’s results as the initial step in the verification process.

ACOG pilot-tested the verification program in 14 facilities across three states (Georgia, Illinois, and Wyoming). A multidisciplinary team with expertise in maternal risk-appropriate care performed an onsite comprehensive review of the maternal services available in each facility, using the results from the CDC Levels of Care Assessment Tool as a pre-visit screening. 

This commentary, published by ACOG in January 2019, provides more information on the process in developing the verification program and lessons learned from the pilot. 

Texas Levels of Maternal Care Verification Program

ACOG also launched a program in Texas to provide survey services for Levels II, III, and IV hospitals that provide maternity care and require state designation, per a new Texas statute. 

Recognizing the critical importance of implementing a program that accounts for the geographic and health care diversity of the Lone Star State, ACOG involved Texas providers and key organizations in the state in its development. 

We also opened a Texas-based office and recruited more than 130 Texas-based obstetrician-gynecologists, maternal nurses, and maternal-fetal medicine specialists to serve as surveyors. ACOG conducted the first maternal survey in the state in July 2018. 

Learn more about ACOG’s Texas program.   




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