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 Pediatricians, 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 and testing of LOCATe.

The CDC, ACOG, SMFM, the National Perinatal Information Center (NPIC), and the Arizona Perinatal Trust (APT) are collaborating to expand on the work achieved with LOCATe by using the questionnaire as the initial step for information-gathering to support the verification program.

The verification process performed by LoMC is voluntary and would ideally involve birth facilities on a state-wide level. Facilities undergoing the verification process would first complete the LOCATe questionnaire and submit an application initiating a site review. A multi-disciplinary LoMC team would then work with the facility’s perinatal team and facility leadership to help them assess whether their maternal care capabilities are consistent with ACOG/SMFM Levels of Maternal Care. After the site review, the facility would receive a report and certificate of verification that is valid for three years.  This verification program is designed to verify levels of care for Levels I, II, III, and IV; it is not designed to verify care at birth centers.

Key Stakeholder Engagement

ACOG, SMFM, CDC, NPIC, and APT have collaborated to develop the Levels of Maternal Care verification program. During program implementation, it will be important to collaborate with additional individuals and organizations. These include:

  • Individual state departments of health

  • Regional and/or local departments of health, as applicable

  • Facility/local obstetric providers, including members of ACOG, SMFM, ACNM, AWHONN, AAFP, and others, as applicable

Current Program Status

As of March 2017, the verification process has been further developed and refined, and will be piloted by obstetric care facilities in states that have implemented LOCATe. In collaboration with the state health departments, ACOG and CDC have invited hospitals in Georgia, Illinois, and Wyoming to participate as pilot sites. Results from the pilot will be used to modify and improve the LoMC program before implementation on a larger scale.

 

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.

  

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