As maternal health grows increasingly complex, one principle remains clear: not every hospital is equipped to care for every pregnant patient.
From rural clinics to high-acuity urban centers, facilities differ in their resources, expertise, and ability to manage complications. This reality demands a structured approach that matches patient risk with hospital capabilities—a model known as Maternal Levels of Care (MLoC).
Developed by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), MLoC creates a standardized, tiered framework for risk-appropriate maternal care across healthcare systems.
What Are Maternal Levels of Care?
The MLoC model is a tiered classification system that designates hospitals based on their personnel, infrastructure, and ability to manage maternal complications.
The goals of MLoC include:
- Ensuring low-risk pregnancies deliver in hospitals equipped for routine care.
- Directing high-risk pregnancies to facilities with advanced critical care, subspecialists, and emergency resources.
- Aligning maternal care systems with neonatal levels of care, already in use for decades.
This approach is backed by The Joint Commission, the CDC, and state perinatal collaboratives to improve patient outcomes and resource allocation.
The Four Levels of Maternal Care
Level I: Basic Care
For healthy, low-risk pregnancies.
Capabilities:
- Care by certified nurse-midwives, family physicians, or general OB/GYNs.
- Basic emergency services for unexpected events (e.g., postpartum hemorrhage).
- Access to anesthesia, labs, and stabilization protocols for transfers.
Level II: Specialty Care
For moderate-risk patients (e.g., mild hypertension, diet-controlled gestational diabetes).
Capabilities:
- 24/7 OB/GYN physician coverage and obstetric anesthesia.
- Access to blood products and advanced imaging.
- Formal transfer agreements for higher-level care when needed.
Level III: Subspecialty Care
For high-risk pregnancies and complex maternal conditions.
Capabilities:
- Maternal-fetal medicine (MFM) specialists and critical care consultations.
- ICU-level obstetric support with advanced diagnostics.
- 24/7 MFM and anesthesia availability.
- Expertise in managing placenta accreta, severe cardiac disease, and other major complications.
Level IV: Regional Perinatal Center
For the most complex maternal and fetal conditions.
Capabilities:
- Full adult subspecialty access (cardiology, nephrology, hematology, etc.).
- Dedicated obstetric ICU and critical care teams.
- Periviable birth management and perimortem cesarean capability.
- Regional outreach, simulation training, and transport coordination.
Why Maternal Levels of Care Matter
1. Improved Patient Outcomes
- Ensures high-risk patients receive care in facilities equipped for complex emergencies.
- Reduces maternal mortality and morbidity through timely interventions.
2. Efficient Use of Resources
- Keeps high-acuity beds available for those who need them most.
- Supports safe transfer protocols for rural and community hospitals.
3. Promotes Equity in Maternal Health
- Closes gaps in access, ensuring pregnant individuals in all regions receive appropriate care.
4. Accountability and Verification
- The ACOG/SMFM Maternal Levels of Care Verification Program, with The Joint Commission, helps hospitals assess readiness and achieve formal designation.
How to Implement MLoC in Your Facility
- Assess your current level using the CDC’s LOCATe tool.
- Identify gaps in personnel, protocols, or emergency preparedness.
- Establish partnerships with higher-level centers for transfer and back-transport.
- Train staff using AIM safety bundles and simulation drills.
- Apply for MLoC verification to improve transparency and quality.
Case Study: A Rural Hospital’s Success
A Midwestern community hospital conducted a self-assessment and made key improvements:
- 24/7 OB anesthesia coverage.
- Telemedicine consults with maternal-fetal medicine specialists.
- Updated postpartum hemorrhage protocols using AIM bundles.
After achieving Level II verification, the hospital reduced unnecessary transfers and improved confidence in managing moderate-risk pregnancies locally.
Resources for MLoC Implementation
- CDC LOCATe Tool
- AIM Patient Safety Bundles
- ACOG/SMFM Maternal Levels of Care Guidelines
- The Joint Commission Maternity Care Certification
Final Thoughts
Maternal Levels of Care are more than just designations, they are a commitment to safe, equitable, and efficient maternity care.
By aligning facility capabilities with patient risk, we can ensure that every pregnant person receives care in the right place, at the right time, by the right team.
Through self-assessment, strategic partnerships, and interdisciplinary training, hospitals can transform maternal care systems—improving safety for patients everywhere.
