Abstract
Over the past 2 decades, perinatal and neonatal health care has become less coordinated and more competitive in the United States. The impact at the state level has been the evolution of a fragmented, perinatal system with limited access and poorer outcomes. The evidence demonstrates lower mortality risk for very low-birth-weight infants born in designated tertiary centers. Regionalized systems of perinatal care are recommended to ensure that each mother and newborn achieve optimal outcomes. This article discusses the factors impacting implementation of this model at either the state or federal level as well as the incorporation of perinatal regionalization as part of the national agenda of health care reform.