The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal–Fetal Medicine (SMFM) jointly released on July 25, 2019, updated guidance to better prepare hospitals to provide risk-appropriate maternal care. The guidelines, drafted in collaboration with the Centers for Disease Control and Prevention (CDC), appear in the August 2019 issue of Obstetrics & Gynecology and define personnel and capabilities for levels of maternal care.
The Obstetric Care Consensus on Levels of Maternal Care (LoMC) is part of ACOG and SMFM’s efforts to reduce maternal morbidity and mortality.
M. Kathryn Menard, MD, MPH, Vice Chair for Obstetrics at UNC OB-GYN and director of the Division of Maternal-Fetal Medicine, is one of the lead authors of LoMC.
“With levels of maternal care defined, hospitals can identify and fill gaps in capabilities and personnel to align with national standards. Regions and health systems can examine capabilities of their hospitals and define criteria for care locally with designated transfer of care based on risk. In addition, states can map geographic distribution of maternity care resources to identify and address gaps,” says Menard.
LoMC defines the required minimal capabilities, physical facilities, and medical and support personnel for each level of care, which include birth center, level I (basic care), level II (specialty care), level III (subspecialty care), and level IV (regional perinatal health care centers).
Menard also published an editorial, “Toward Achieving Risk-Appropriate Maternity Care: Maternal Morbidity Prediction,” in the same issue, providing insight into the need for risk-appropriate maternal care amid the rise in maternal mortality and severe maternal morbidity rates in the United States.
“Perhaps what is most needed is a highly reliable model that identifies women who can safely deliver in the birth setting of their choice,” she writes. “Predicting low risk and ensuring that all birthing facilities are prepared to respond to obstetric emergencies and have a collaborative relationship with a facility with a higher level of care will meet the needs of the majority of the population.”