Iowa Administrative Code › Agency 641 - Public Health Department › Chapter 150 - Iowa Regionalized System of Perinatal Health Care › Rule 641-150.7 - Levels of Maternal Care

Current through Register Vol. 47, No. 3, July 24, 2024
The levels of maternal care include basic obstetrical care
				Level I, specialty care Level II, subspecialty care Level III and regional
				perinatal health care Level IV. The levels reflect the overall evidence for
				risk-appropriate care in a hospital through the availability of appropriate
				personnel, physical space, equipment, technology, and organization. Each level
				reflects the minimal capabilities, provider type and functional criteria
				required.
(1)
Level I maternal
			 care hospital.
a.
Provider
			 of basic obstetrical care.
ALevel I maternal care hospital provides
			 care to women who are low risk and are expected to have an uncomplicated
			 birth.
b.
Capabilities.
A Level I maternal care hospital has the
			 following capabilities:
(1) To perform
			 routine intrapartum and postpartum care that is anticipated to be
			 uncomplicated. Care of uncomplicated pregnancies includes the ability to
			 detect, stabilize and initiate management of unanticipated maternal, fetal or
			 neonatal problems that occur during the antepartum, intrapartum, or postpartum
			 period until the patient can be transferred to a facility that provides
			 specialty maternal care.
(2) To
			 begin an emergency cesarean delivery within a time interval that best
			 incorporates maternal and fetal risks and benefits with the provision of
			 emergency care.
c.
Types of health care providers.
A Level I maternal care
			 hospital will have:
(1) Maternity care
			 providers, including certified nurse-midwives, family practice physicians, or
			 obstetrician-gynecologists, available to attend all births.
(2) Every birth attended by at least two
			 professionals, including the primary maternal care provider and a person
			 competent to provide neonatal resuscitation and postnatal care to stabilize the
			 infant.
(3) Adequate numbers of
			 registered nurses available who have completed orientation and demonstrated
			 competence in the care of obstetric patients, including women and fetuses,
			 consistent with Level I care criteria and who are able to stabilize and
			 transfer high-risk women and newborns.
(4) Nursing leadership with expertise in
			 perinatal nursing care.
(5) A
			 provider with privileges to perform an emergency cesarean delivery, available
			 to attend all deliveries. The provider may be a general surgeon, an
			 obstetrician-gynecologist, or a family practice physician with
			 certification.
(6) A provider of
			 anesthesia services available to provide labor analgesia and surgical
			 anesthesia.
d.
Functional criteria of support services.
Support services
			 include, but are not limited to, access to obstetric ultrasonography,
			 laboratory testing, and blood bank supplies at all times. A Level I maternal
			 care hospital will:
(1) Have protocols and
			 capabilities in place for:
1. Massive
			 transfusion,
2. Emergency release
			 of blood products (before full compatibility testing is complete),
3. Management of multiple component
			 therapy.
(2) Ensure
			 optimal care of all pregnant women by having formal transfer plans established
			 in partnership with a higher-level receiving hospital. These plans will
			 include:
1. Risk identification,
2. Determination of conditions necessitating
			 consultation,
3. Referral and
			 transfer, and
4. A reliable,
			 accurate, and comprehensive communication system between the participating
			 hospital and the transport team.
(3) Have education and quality improvement
			 programs to maximize patient safety, provide such programs through
			 collaboration with facilities with higher levels of care that receive
			 transfers, or both.
(4) Have data
			 collection, storage and retrieval to support quality improvement.