Levels of Maternal Care: A Primer for MCH Programs

M. Kathryn Menard, MD, MPH Professor, Obstetrics and Gynecology

Division Director for Maternal-Fetal Medicine

Co-Director Center for Maternal and Infant Health

UNC School of Medicine

Past President (2012-13), Society for Maternal Fetal Medicine

U.S. Maternal Mortality

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Maternal Mortality Ratios in Selected

Countries over the Past 30 Years

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MATERNAL MORTALITY PER 100,00 LIVEBORN INFANTS

Source: NLWC from Center for Disease

Control and Prevention, National

Center for Health Statistics 1999-2006

> 18.0

13.0 -18.0

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Maternal Mortality

Maternal Morbidity

William Callaghan, CDC

CDC.gov

Severe Maternal Morbidity

Between 1998-1999 and 2008-2009 severe morbidity during delivery hospitalization increased ~75%

(7.4-12.9 per 1,000 deliveries)

Blood transfusions, acute renal failure, and aneurysms each more than doubled

Callaghan Obset Gynecol Nov 2012

Causes of Pregnancy related

mortality in the US, 1987-2009

Creanga, Journal of Women’s Health 2014

Risk Appropriate Perinatal care

Regionalized Perinatal Care

Since TIOP, the

conceptual framework for

regionalization of care of

the woman and newborn

has changed to focus

almost entirely on the

newborn

Annual Birth Volume

in U.S. Hospitals, 2008 N

UM

BER

S O

F H

OSP

ITA

LS

n = 3,265 Simpson KR, JOGNN 40, 2011

Levels of Maternal Care (LOMC)

• Uniform designations of LOMC that are

complimentary but distinct from levels of

neonatal care

• First ever ACOG/SMFM guidance that

establishes levels of care specific for the

pregnant woman

» An effort to ensure all birthing facilities “are

tooled to take good care of moms”

» Not about closing small hospitals, but about

preparing them

OB Care Consensus #2. February 2015

Levels of Maternal Care (LOMC)

• Inclusivity demonstrates by:

» Inclusion of Birth Centers

» Additional endorsement and support from

AABC, ACNM, AWHONN, Commission for the

Accreditation of Birth Centers, AAP, ASA,

SOAP

• Emphasizes role of Level III/IV (Regional)

Centers to support education and quality

improvement among their referring facilities

» Building a culture of collaboration