The four levels of maternal designation consist of:

The four levels of maternal designation consist of: 1. Level I – Basic Care – The Level I maternal designated facility must: a. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high-risk patients who should be transferred to a facility that provides specialty or sub-specialty care. b. Capability to begin an emergency cesarean delivery within 30 minutes of the decision to do so. c. Mothers that are stable and likely to deliver before 35 weeks’ gestation or have a fetus that is likely to require specialty services and mothers who themselves are likely to require specialty services should be transferred prior to delivery, when possible. d. Proper detection and supportive care of known maternal conditions and unanticipated maternal-fetal problems that occur during labor and delivery. e. Care of postpartum conditions. f. Maintain a staff of providers certified to perform normal and operative vaginal deliveries and cesarean sections including obstetricians and family physicians with advanced training in obstetrics, providers certified to perform normal vaginal deliveries including certified nurse midwives, and registered nurses with training in labor and delivery, post- partum care or inpatient obstetrics. 2. Level II – Specialty Care – The Level II maternal designated facility must: a. Perform all Level I maternal services. b. Mothers that are stable and likely to deliver before 32 weeks gestation or have a neonate that is likely to require sub-specialty services, or mothers who themselves are likely to require sub-specialty services should be transferred prior to delivery, when possible. c. Access to maternal fetal medicine consultation and antenatal diagnosis technology including fetal ultrasound. 3. Level III – Subspeciality Care – The Level III maternal designated facility must: a. Manage complex maternal and fetal illnesses before, during and after delivery. b. Maintain access to consultation and referral to Maternal-Fetal Medicine specialists. 4. Level IV – Comprehensive Care – The Level IV maternal designated facility must: a. Provide all Level III capabilities as listed above. b. Maintain a full range of surgical and medical specialists including Maternal-Fetal Medicine specialists at the site. c. Facilitate maternal transport and provide outreach education.