Levels of Maternal Care is a strategy to reduce severe maternal morbidity and mortality by ensuring that high-risk patients receive care at hospitals that can meet their anticipated needs. It describes a hospital’s capabilities, physical facilities and medical and support staffing.
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine developed the classification system, and it has been endorsed by a wide range of groups including the American Association of Birth Centers; the American College of Nurse-Midwives; the Association of Women's Health, Obstetric and Neonatal Nurses and more.
Measuring levels of care in Massachusetts
In 2021, all 40 birthing hospitals in Massachusetts voluntarily completed a survey known as the Levels of Care Assessment Tool (LOCATe). It was developed by the CDC and has been used by 23 other states to determine each hospitals’ capacity to manage the spectrum of low- to high-risk births. Massachusetts also added questions to the survey to capture information on disparities in care and opportunities to increase health equity.
LOCATe assessment of Massachusetts birthing hospitals
The majority of hospitals were assessed at level I or II. 13% of hospitals were LOCATe-assessed below level I with no hospital at level III.
Discrepancies between self-assessment and LOCATe-assessment
Almost half of hospitals self-assessed at a level higher than their LOCATe-assessed level of care.
Next steps
As a part of this work, the Betsy Lehman Center, in collaboration with the Department of Public Health (DPH) and the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN), convened a Levels of Maternal Care Implementation Committee. The committee includes birthing hospitals, payers, community organizations, community health centers, transport service providers, and people with lived experience.
In November of 2023, the governor accepted recommendations from the committee that call for Massachusetts to take a regulatory approach to aligning levels of care with needs of families in the state, better educate the public about levels of care and help hospitals achieve their desired levels of care. The Betsy Lehman Center, DPH, PNQIN and this committee are currently developing proposed action steps to affect these changes.
