The American Congress of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, and other physician groups that focus primarily on the health care of pregnant women have reached a first-ever consensus about how to classify the care that women receive. For both perinatal and postnatal care, a classification system has been proposed to help designate the kinds of services that specific facilities can provide and make it easier for women to seek out appropriate care before, during, and after pregnancy.
Why Designations Are Important:
Designations are applied to institutions in an effort to stratify care and thus ensure that women from all walks of life are receiving precisely the kind of health services that they require. Such designations not only help to ensure that appropriate and timely care is delivered, but also keep medical costs down, reduce rates of medical error, and improve long-term health outcomes.
What Are the Proposed Designations?
A total of five levels of maternal care would be recognized under the plan if it is put into effect. Those levels are defined as follows.
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Birth Center – Birth centers would provide care to women in low-risk, routine scenarios during uncomplicated, single-baby, term pregnancies. They would not handle operative or cesarean deliveries.
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Level I Facilities – Level I facilities would handle low-risk pregnancies and would be able to provide routine postpartum care. Such facilities could handle everything from endometriosis treatment to uncomplicated postpartum care.
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Level II Facilities – Level II facilities would handle high-risk pregnancies and would have attending obstetricians on service at all times. They would also have access to physicians specifically trained for high-risk deliveries, though they need not be onsite at all times.
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Level III Facilities – Level III facilities would handle pregnancies with very high risk and would have subspecialists onsite at all times. They would serve as regional referral centers for the most severe maternal and fetal complications.
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Level IV Facilities – Level IV facilities would have the most advanced physicians and equipment available. They would be required to have ICU facilities for both mothers and infants as well as the ability to care for rare and complex complications associated with pregnancy. For example, a Level IV facility in Houston would draw from populations in San Antonio, Corpus Christi, and Austin, TX.
Past Models : The new recommendations stem from success in existing health care specialties where having designations has produced better care and reduced complications. Such designations lay the groundwork for a comprehensive review of the health care in a region and make it easier for those who plan health care on a large scale to ensure that populations have access to all levels of care necessary.