Maternal deaths related to childbirth in the United States have been rising in the past decade. According to a 2014 report published in The Lancet, the maternal mortality rate in the U.S. is now more than double the rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.
To address this trend, ACOG and the Society for Maternal-Fetal Medicine (SMFM) recently issued Levels of Maternal Care, the first consensus document establishing levels of care for perinatal and postnatal women. It is the second document in the joint ACOG and SMFM Obstetric Care Consensus series.
Levels of Maternal Care proposes a classification system for facilities that are separate but related to the current designations for neonatal care. The system provides facilities with a label reflective of their ability to provide maternal care:
- Birth centers
- Level I – Basic Care
- Level II – Specialty Care
- Level III – Subspecialty care
- Level IV – Regional Perinatal Health Care Centers
The system will help promote regionalized care, allowing women at higher levels of risk to seek out a healthcare facility that is best prepared to meet their unique needs. The document calls on each facility to determine its classification level and to implement a process for identifying and transferring women to higher levels of care when needed.
We’ve seen great success with a similar model, proposed in the 1976 March of Dimes report “Towards Improving the Outcome of Pregnancy,” but it focused primarily on improving neonatal outcomes. ACOG and SMFM hope the new classification system will complement the current neonatal framework and, ultimately, have the same impact on maternal mortality.
I’m proud that Levels of Maternal Care has been endorsed by many of ACOG’s peer health organizations, including 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 communicated their support for the document.
Implementing this system will require the cooperation of all of these groups, as well as the extended medical community. Collaboration among all women’s healthcare providers will help us improve maternal safety and ensure we have more deliveries resulting in a healthy baby and a healthy mother.
About John C. Jennings, MD
John C. Jennings, MD is the president of ACOG through April 2015. He is professor of ob-gyn at the Texas Tech University Health Sciences Center at the Permian Basin. Dr. Jennings was in private practice in San Angelo, TX, for 12 years before entering academic medicine. He has served as head of gynecology and program director of ob-gyn at Wake Forest University in Winston-Salem, NC; professor and program director of ob-gyn at the University of Texas Medical Branch in Galveston; chair and program director of ob-gyn at TTUHSC at Amarillo; and regional dean of the school of medicine at TTUHSC at the Permian Basin.