NSW role delineation and maternity service levels
The NSW Health Guide to the role delineation of clinical services, is a service planning tool that assists in describing the complexity of services required for the needs of the population. Local Health Districts are responsible for determining the appropriate distribution and role of services for health care facilities within the network of services in the Local Health District. The process of delineation is part of the process which responds to the needs of the population and takes into account the clinical networks within the Local Health Districts.
Role delineation levels are determined for a range of services provided at a health facility including: emergency, medical, surgical, maternity, integrated community and hospital, community based services, as well as support services such as pharmacy, diagnostic imaging and pathology. The process determines the support services, staff profile, safety standards and requirements to ensure that clinical services are provided safely and with appropriate support. The NSW Health Guideline Maternity and Neonatal Service Capability Framework (GL2016_018) outlines the criteria for each maternity service level listed below in conjunction with requirements for a range of support services.
Level 1:
Provide antenatal and postnatal care for women with no identified risk factors or those
identified as Category A.
Ambulatory antenatal care usually provided by
general practitioners (GPs) or midwives through a shared care model.
No planned birthing (intrapartum) or neonatal nursery care.
Postnatal care provided by midwives usually
in the home.
Level 2:
As for Level 1. In addition, provide intrapartum care from ≥37+0 weeks gestation to women with no identified risks or risks identified as Category A.
May provide care to women with risks identified as Category B in consultation with a suitably qualified clinician in the relevant Tiered Maternity Network.
Antenatal care provided in either a shared care arrangement with GPs/GP obstetricians or by midwives in consultation with
medical officers within their Tiered Maternity Networks when required.
[NB: These limits are intended as a guide only and do not replace clinical judgement.]
Level 3:
As
for Level 2. In addition, antenatal, intrapartum and postnatal care for women with risks identified as Category B following consultation and development of a management plan with a suitably qualified clinician within the Tiered Maternity Network.
Collaborative care is provided by midwives, GP obstetricians and/or specialist obstetricians where present.
Intrapartum care for women from ≥37+0 weeks gestation, including induction of labour, vacuum and forceps births.
Provide Common and Intermediate obstetric procedures (e.g. planned Lower Segment Caesarean Section (LSCS) ≥39 weeks gestation).
[NB: These limits are intended as a guide
only and do not replace clinical judgement. Patient selection should be determined following robust preadmission assessment.]
Level 4:
As for Level 3. In addition, antenatal, intrapartum and postnatal care for women ≥34+0 weeks gestation with no risk factors, or with risks identified as category A or
B, and some women with risks identified as Category C (in consultation with the specialist obstetrician or maternal-fetal medicine specialist within the Tiered Maternity Network).
For women ≤34+0 weeks gestation well defined linkages for consultation and/or referral must be in place with a delineated higher level maternity and neonatal service.
Provide selected Major obstetric procedures (see Appendix 1: NSW Health Guide to the role delineation of clinical services).
Collaborative care is provided by midwives, junior medical officers, GP obstetricians and obstetricians.
Level 5:
As for Level 4. In addition, antenatal, intrapartum and postnatal care for women ≥32+0 weeks gestation with no identified risk factors; those with risks identified as
category A or B; and the majority of women with risks identified as Category
C.
Provide Major and selected Complex Major obstetric procedures (see Appendix 1: NSW Health Guide to the role delineation of clinical services).
Collaborative care is provided by midwives, junior medical officers, obstetricians and maternal-fetal medicine specialists and neonatologists.
Level 6:
As for Level 5. In addition, provide care for all women regardless of gestational
age or clinical risk.
Provide Complex Major obstetric procedures (see Appendix 1: NSW Health Guide to the role delineation of clinical services)
Tiered Maternity Network:
Identified NSW Health maternity and neonatal networks for consultation, patient referral and/or transfer to a higher level of care, are specified in NSW Health Policy Directive Tiered Networking Arrangements for Perinatal Care in NSW PD2020_014.
Level of consultation and referral (patient risk) – see NSW Health Maternity - National Midwifery Guidelines for Consultation and Referral PD2020_008
When a variance from normal is identified in a woman’s care (e.g. medical conditions, pre-existing gynaecological disorders or previous obstetric history), patient risk is described in terms of the level of consultation required, categorised as follows:
Category A – Discussion with a colleague; midwife, medical practitioner and/or other health care provider; and/or
Category B – Consultation with a medical practitioner and/or other health care provider; and/or
Category C – Referral of the woman or her infant to a medical practitioner for specialist care).
Note: Minimum Levels of support services as well as definitions of risk and staff details are outlined in NSW Health Guide to the Role Delineation of Health Services (2019).
Reference
NSW Health. 2019 Guide to the Role Delineation of Health Services. Available at https://www.health.nsw.gov.au/services/Publications/role-delineation-of-clinical-services.PDF