Language Translation
  Close Menu

Perinatal Levels of Care

In September 2019, legislation titled Perinatal Hospital Services went into effect. It requires all hospitals that offer obstetric and neonatal care to be certified as Level I, Level II, Level III or Level IV, based on the services they offer.

The Level of Care certification will give pregnant women and their doctors information to help them choose the facility that is best for them. This will be especially critical for women in high-risk pregnancies. A study by the American Academy of Pediatrics shows that states with levels of care certifications have lower numbers of infant and maternal deaths and illnesses. A description of Indiana levels of care is shown in the chart below.

Levels of care for Indiana hospitals and birth centers
Level I Obstetric and neonatal facilities caring for women with uncomplicated pregnancies and providing basic newborn care to physiologically stable infants.
Level II Hospitals providing care to appropriate high-risk maternal patients and special care to infants who are moderately ill with problems expected to resolve rapidly.
Level III Hospitals equipped to care for complex maternal medical conditions and obstetric complications as well as infants requiring neonatal intensive care.
Level IV Hospitals providing comprehensive medical and surgical care to the most acutely ill and medically complex mothers and infants.

The rules established by the Indiana Department of Health (IDOH) that determine how healthcare facilities are certified can be found here.

All delivering facilities, no matter what level of care they provide, must be equipped and prepared to stabilize and transfer maternal and neonatal patients to the level of care appropriate to their medical condition.

The levels of care rule also require all Indiana birth centers to be accredited by the Commission for the Accreditation of Birth Centers before September 13, 2021.

Please note that the vast majority of patients can receive appropriate care at Level I facilities. The decision to place a mother or baby in a higher level of care facility should be made by the medical care provider and patient. This is one of the many reasons it is so important for pregnant women to seek obstetric care within the first trimester of pregnancy. If you or someone you know needs to find a doctor or health care provider, call MOMS Helpline at 844-624-6667 for a referral.

If you are unable to find the hospital closest to you on the list of certified hospitals below, it is not an indication that the hospital does not provide obstetric or neonatal services or is unable to care for you or your baby. It may only mean that the Department of Health has not reached this hospital yet for initial certification. Please contact the hospital or obstetric or pediatric care provider in your area to seek care and guidance on the hospital most appropriate for you and your health needs.

The history of levels of care in Indiana

The Indiana Department of Health (IDOH) began work on levels of care requirements in 2015, long before the State legislature passed the levels of care bill. The IDOH began developing standards of care based on the requirements of the American College of Obstetrics and Gynecology (ACOG), the American Academy of Pediatrics (AAP), the Association of Women’s Health and Obstetric Nurses (AWOHN) and other medical professional organizations.

In 2017, the IDOH completed a gap analysis of each of Indiana’s 86 birthing hospitals. These surveys revealed any gaps between the level of care the facility currently provides and the level of care it aspires to provide. IDOH surveyors (Registered Nurses with obstetrics and neonatal experience) review the facilities in the following categories:

  • facility capabilities,
  • equipment and technology,
  • medications
  • policies and procedures,
  • personnel.

This analysis identified any gaps in the care offered at each facility. This information will help hospitals seek a suitable certification.

The IDOH has begun certification surveys as facilities apply according to their desired level of care. The IDOH expects it may take through 2022 to certify all delivering facilities. After initial certification, facilities will be placed on a 3-year certification cycle.

Perinatal Levels of Care Facilities

Indiana Birth Centers

Accredited Birth Centers

Information for Clinicians