United States, Maximizing Risk-Appropriate Care for Mothers and Newborns

Coordinated perinatal health care systems are important for improving the health of mothers and newborns.  Discussions of how to organize perinatal services into geographic regions to provide access to risk-appropriate technology and services began in the 1960s.   In 1976 the March of Dimes led a collaborative effort and issued Toward Improving the Outcome of Pregnancy that proposed a model system for regionalized perinatal care, including definitions of levels of care.  This system of ensuring geographic distribution of sophisticated levels of care improved outcomes for high-risk neonates.  In 2010, the third volume of Toward Improving the Outcome of Pregnancy (TIOP III) focused on enhancing perinatal health through quality, safety and performance initiatives.  A cross-cutting theme and recommendation in TIOP III calls for standardizing the regionalization of perinatal services, including developing standard definitions and guidelines across the U.S. for levels of maternal and infant care that are consistently utilized. 

Progress to optimize risk-appropriate maternal and newborn care is being made at the regional and state levels through a Collaborative Improvement & Innovation Network (CoIIN) in Health and Human Services Regions IV and VI.  This CoINN Strategy Team on perinatal regionalization is taking a geographically-targeted approach to maximize risk-appropriate care for mothers and newborns.