In February 2015, the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM) developed the document, “Levels of Maternal Care.” This consensus document was endorsed by the American College of Nurse-Midwives (ACNM), the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), the American Association of Birth Centers, and the Commission for the Accreditation of Birth Centers. In addition, the American Academy of Pediatrics, the American Society of Anesthesiologists, and the Society for Obstetric Anesthesia and Perinatology have reviewed the content and are supportive of the Levels of Maternal Care.

The Levels of Maternal Care Obstetric Care Consensus promotes the development of relationships between institutions with different levels of maternal care that are complementary but distinct from levels of neonatal care. This cooperative and multi-level approach supports pregnant women receiving maternal health care in facilities that best meets their individual needs.

By establishing levels of maternal care, ACOG and SMFM envision the following outcomes: 

  • Standardized definitions and nomenclature for facilities that provide each level of maternal care

  • Consistent guidelines according to each level of maternal care for use in quality improvement and health promotion

  • Equitable geographic distribution of full-service maternal care facilities and systems that promote proactive integration of risk-appropriate antepartum, intrapartum, and postpartum services

  • Uniform designations for levels of maternal care that are complementary but distinct from levels of neonatal care

In order to standardize a complete and integrated system of perinatal regionalization and risk-appropriate maternal care, a classification system was proposed for levels of maternal care that includes birth centers (as defined in the Birth Centers section of the Levels of Maternal Care document), basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). See Table 1 for definitions.

Table 1

Levels of Maternal Care Definitions


Why Is It Important to Define Levels of Maternal Care?  

Although maternal mortality in high-resource countries improved substantially during the 20th century, maternal mortality rates in the United States have worsened.



Assessing Levels of Care

In 2012, the CDC developed the Levels of Care Assessment Tool (LOCATe) to address a need identified by states and national partners for a simple tool that standardizes the assessment of maternal and neonatal care capabilities of facilities. LOCATe assesses a facility’s capability based on criteria published by the American Academy of Pediatrics, ACOG, and SMFM. The tool provides facilities with an overview of how their maternal and neonatal services are distributed and empowers stakeholders to lead data-informed discussions for improving systems of risk-appropriate care. The CDC has engaged several states in the implementation of LOCATe.

ACOG and SMFM, in partnership with the Centers for Disease Control and Prevention, Arizona Perinatal Trust, and National Perinatal Information Center, developed the Levels of Maternal Care verification program. The verification program expands on the work achieved with LOCATe by using the results as the initial step for information-gathering to support the Levels of Maternal Care verification program. The program involves a site visit by a multi-disciplinary team of maternal health care providers who work with an obstetric facility’s perinatal team and leadership to verify the level of care, using a new tool that aligns with the 2015 ACOG/SMFM Levels of Maternal Care Obstetric Care Consensus.  

Current Program Status

ACOG recently concluded pilot-testing of the verification program with 14 hospitals in three states. Based on results from the pilot, ACOG is currently refining the site visit process and updating the materials to conduct the verification program, including the site assessment tool. Once this process is complete, the materials needed to conduct a levels of maternal care verification program (a “toolkit”) will be available for implementation on a local, regional, or statewide basis. In addition to our national program, ACOG opened an office in Texas and will provide survey services for Levels II, III, and IV hospitals that provide maternity care. Learn more about ACOG’s Texas program.  

Collaborating Organizations

American College of Obstetricians and Gynecologists (ACOG)

Founded in 1951, the American College of Obstetricians and Gynecologists (The College) is the specialty's premier professional membership organization dedicated to the improvement of women’s health. With more than 58,000 members, the College is a 501(c)(3) organization and its activities include producing the College's practice guidelines and other educational material.

Society for Maternal-Fetal Medicine (SMFM)

The Society of Maternal Fetal Medicine (SMFM), established in 1977, represents more than 2,000 obstetricians with additional formal education and training in maternal-fetal medicine.  Its members specialize in treating high-risk, complicated pregnancies. The Society also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine.

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is one of the major operating components of the U.S. Department of Health and Human Services. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish this mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these threats arise.

Arizona Perinatal Trust (APT)

Established in 1980, the Arizona perinatal trust is a private-public partnership of hospitals, health care professionals, and state agencies throughout Arizona that are committed to an effective regionalized perinatal health care system through certification, perinatal education, and perinatal data review.

National Perinatal Information Center/Quality Analytic Services (NPIC/QAS)

NPIC is a nonprofit organization that seeks to improve perinatal health by providing expert analysis of large data sets, development of comparative benchmarking quality and utilization reports, evaluation of direct service programs, and project consultation and management to member neonatal care centers.



American College of Obstetricians and Gynecologists
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