Community Birth Partnership Initiative

A Strategy To Improve Outcomes

The mission of CMQCC’s Community Birth Partnership Initiative (CBPI) is to improve health outcomes during pregnancy and birth by increasing the quality and whole-person safety of hospital transfer processes, when a transfer is needed for a community birth. The Initiative also seeks to enhance integration between perinatal care systems that have traditionally worked in isolation from each other in California. 

The Initiative is built upon critical concepts and strategies in the newly published update to CMQCC’s Toolkit to Support Vaginal Birth and Reduce Primary Cesareans and is grounded in health equity, shared decision making, and respectful care. Although birth at home or in community birth centers is generally safe for low-risk women, studies show that newborns face a higher risk of death compared to hospital births, especially if complications occur and access to hospital care is delayed, highlighting the critical need for timely, respectful, and well-coordinated transfer procedures.

CBPI is supported by funding from Skyline Foundation.

Background: Two Unprecedented Crises

It is common knowledge now that the United States carries the distinction of having the worst maternal mortality rate of all economically advanced countries. Additionally, a 2021 report released by the California Department of Public Health, using an enhanced surveillance methodology, showed that Black birthing and pregnant people have a pregnancy-related mortality risk that is four to six times greater than white people in California.

On top of this, California is dealing with a significant dilemma in maternity care access. In 2014, the American College of Obstetricians and Gynecologists (ACOG) observed that at least nine counties have no ob/gyn provider, and many more lack the necessary providers to meet the need. A 2023 investigation by CalMatters revealed that at least 46 California hospital maternity units have closed since 2012.

Safe, efficient transfer of care to the hospital, when needed, is an important component of healthcare quality.  National and international organizations, supported by research and a clarion call from community leaders, report that highly skilled and highly personalized midwifery care is an important strategy to improve maternal outcomes and access to care. Until recently, access to midwifery care was not credited as an essential approach to improving perinatal care in America. But times are changing. 

Midwives Are an Essential Part of Safe Maternal Care Systems

Robust studies in recent years show that excellent birth and infant outcomes result when midwives are a part of an integrated system of care committed to delivering whole-person safety. Who are midwives in California, and what are the differences between certified nurse midwives (CNMs) and licensed midwives (LMs)?

• CNMs and LMs attend about 12% of births in California, or about 50,000 births per year
• There are 1,600 midwives in California
• CNMs are licensed and regulated by the Board of Registered Nursing and LMs are licensed and regulated by the Medical Board of California
• CNMs complete a nurse-midwifery education program housed in a school of nursing or health sciences, and then take the certification exam administered by the American Midwifery Certification Board
• LMs complete an accredited three-year midwifery education program approved by the Medical Board of California and then take the certification exam administered by the North American Registry of Midwives
• CNMs and LMs can take care of patients determined by the Board of Registered Nursing and the Medical Board of California to be low-risk, and are obligated to transfer higher risk patients
• CNMs and LMs are Medi-Cal providers and in-network with commercial insurers

About Midwives & Community Birth

California has never attempted a statewide program to improve relationships between community midwives and hospital providers, nor has there been any large-scale effort to improve processes for transferring patients between community birth sites (the home or freestanding birth center) and the hospital. 

We want to change that. Every person deserves the safest and most respectful birth possible, regardless of where they intend to give birth. There is so much we can solve if we work together.

Where We Are Working 

Currently, we are focusing on two pilot groups/regions. We will take the learnings from this first pilot project to inform expanded work across the state. Hospitals from the greater Sacramento area and the Inland Empire (San Bernardino and Riverside Counties) will be working together with community midwives from their same areas.

Goals Of The Initiative 

• Improve relationships and dialogue between hospital and community birth providers;
• Enhance whole-person safety through the co-design of policies for hospital transfer by community birth midwives and hospital providers;
• Improve teamwork  and communication between community birth midwives, EMS, and the hospital team to ensure respectful, patient-centered, dignified transfer of care for every patient;
• Improve understanding of community birth and reduce stigma around home birth and birth in birth centers;
• Improve the patient experience of transfer; and
• Partner with community organizations to expand stakeholder understanding of community birth, find opportunities for joint initiatives that meet our collective goals around community birth, and engage patients in telling their stories about community birth.

Components of The Initiative 

• Virtual learning sessions and virtual small group sharing sessions between community midwives and hospital staff;
• Collaborative work sessions between community midwives and hospital staff to co-design policies for transfer;
• Virtual and in-person simulations of transfer to practice and improve processes; and
• Surveys of patient experiences of transfer in order to integrate patient-focused and community-specific change.

Resources for Community Birth Transfers

• Further Reading
  • "Are Perinatal Quality Collaboratives Collaborating Enough? How Including All Birth Settings Can Drive Needed Improvement in the United States Maternity Care System"
  • Quality Improvement in Community Birth: A Call to Action
• Transfer Tools and Guides
  • Best Practice Guidelines for Interprofessional Collaboration: Community Midwives and Specialist Providers (© 2020 by Birth Place Lab. Available at https://www.birthplacelab.org/best-practice-guidelines-for-transfer-and-collaboration/ and attributable to Home Birth Summit, Collaboration Task Force. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ or send a letter to Creative Commons, PO Box 1866 Mountain View, CA 94042, USA. This work has been reprinted in its entirety without any alterations. This work is provided "as-is" and CMQCC makes no representations or warranties with respect to the work.)
  • Community Birth Transfer Resoures from Across the U.S.
  • Transfer Guideline Example
  • AIM Community Birth Transfer Resource Kit
• Webinar: "The Role of Community Birth in Improving Outcomes: Insights, Strategies & Tools for an Integrated Care Continuum"

Want To Learn More?