Blog

We’ve Participated Before. Should We Join Another Action Collaborative?

then updated June 23, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

One question we hear from past Step Up Together participants is: “We already did an Action Collaborative. Is there any reason to do another one?” In most cases, the answer is yes. The goal of Step Up Together has never been to conduct a single drill and call it done. Like any aspect of emergency

What’s In It for Hospitals? Why Join a Step Up Together Action Collaborative

then updated June 2, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

When hospitals are invited to participate in a Step Up Together Action Collaborative, the first question is often practical: what’s in it for us? Hospitals are managing workforce shortages, high acuity, financial pressure, and competing quality priorities. Community birth transfer improvement may seem like one more thing to add to the list. But this work

Get Inspired to Run Your Drill. Share Your Learning with Others From Across the Country.

then updated May 18, 2026.

By Alexa Dougherty, MSN, PHN, CNM

Join us on Monday, June 1st at 12 PM EST for our next free Step Up Together Quarterly Community Drill Debrief, focused on our Retained Placenta with Doula Present postpartum transfer drill.  Midwives, nurses, doulas, paramedics, quality improvement specialists and students from 29 States across the country have already registered to attend and are running

New CMQCC Community Birth Transfer Toolkit Signals a Turning Point for Midwifery Integration

then updated March 20, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

The California Maternal Quality Care Collaborative (CMQCC) has released a major new resource: the CMQCC Community Birth Transfer Toolkit, designed to improve how hospitals, community midwives, and EMS teams work together when a transfer to a higher level of care is needed. Because California has long been a national leader in maternity care quality improvement,

What We Learned from Our First Open Community Debrief: Practicing Intrapartum Transfer for Fetal Bradycardia

then updated March 12, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

On March 2, Step Up Together launched our new Quarterly Community Debriefs with a discussion focused on First Stage Fetal Bradycardia and intrapartum transfer from community settings. Community Debriefs are 60-minute sessions that bring together professionals across the maternity care system—community midwives, hospital teams, EMS personnel, educators, and quality improvement leaders—to reflect on what happens

No More Silos: A Unified Response to Maternal Emergencies

then updated February 25, 2026.

By Emily Bronson

Perinatal emergencies are the classic “low-frequency, high-acuity” challenge for EMS: they’re uncommon enough that confidence and muscle memory can fade, but when they happen, the stakes are large: two patients, rapidly changing physiology, and a system that has to coordinate fast from dispatch to the receiving hospital. Step Up Together® bridges the gap between silos.

Rural Health Transformation Must Include Maternal and Newborn Health

then updated January 28, 2026.

By Emily Bronson

When care is far away, the risks don’t wait. Complications in pregnancy, labor, postpartum, or the newborn period still happen, sometimes in homes, in birth centers, in clinics, or en route to the nearest hospital. Rural communities are strongly associated with long travel times to seek care, fewer prenatal visits, more preterm births, and higher

ACOG Takes an Important Step to Strengthen Transfer Systems for Community Birth

then updated January 7, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

In a significant move that aligns with their increasing focus on community-based and collaborative care models, the American College of Obstetricians and Gynecologists (ACOG) has released a new position statement: Transfer Protocols for Out-of-Hospital Birth (2025). This guidance explicitly affirms that safe maternity care across levels and locations of care depends on clear, respectful, and

Preparing the Drill Patient for Optimal Drill Fidelity

then updated December 16, 2025.

By Jennifer Johnson, CNM

On the day of your Step Up Together Drill, whether you’ve planned a Partial Transfer or Full Transfer Drill, the fidelity of the clinical scenario rests largely on the acting of the patient. This role should be held by someone who is very familiar with community birth, such as a midwife or student midwife, nurse

Disaster-Ready Maternity Care: Perinatal Transfer Drills Belong in Emergency Preparedness

then updated December 15, 2025.

By Emily Bronson

Pregnancy, labor, postpartum complications, and newborn needs don’t stop during emergencies. Yet many disaster preparedness plans still treat maternity as a downstream clinical issue rather than a time-sensitive mobility, communication, and coordination problem that starts at home, in a birth center, on the road, or in an overwhelmed emergency department (ED). The Step Up Together®

🚑❄️ A Snowstorm, a Hemorrhage, and an Incredibly Coordinated Team: Full Transfer Drill in Minneapolis

then updated May 28, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

Last week, teams from Twin Cities Midwifery, Hennepin County EMS, and University of Minnesota Medicine Fairview Riverside came together for a Step Up Together Full Transfer Drill simulating a postpartum hemorrhage that began in the community, moved through EMS transport, and concluded with hospital-based emergency care. And we did it in a snowstorm! Under the

Step Up Together for PQCs: From Drills to Sustainable System Change

then updated December 3, 2025.

By Emily Bronson

Perinatal Quality Collaboratives (PQCs) exist to turn evidence into action so maternal and infant health care gets safer and more equitable. The National Network of PQCs (NNPQC) and the CDC describe PQCs as state or multi-state networks that rapidly improve care through data-guided implementation. After more than a decade of focus on hospital-based preparedness, there

AABC Birth Institute Roundup

then updated November 10, 2025.

By Jennifer Johnson, CNM

The American Association of Birth Centers (AABC) has stood by their mission to promote and support freestanding birth centers and alongside midwifery units in all communities to achieve a high-value model of evidence-based care that is equitable, safe, and respectful for over 40 years. I have been fortunate in my career to have worked in

Transforming Maternal Health with Step Up Together

then updated October 27, 2025.

By Emily Bronson

Have you heard of the new CMS model designed to improve maternal health care?  As of January 2025, 14 states and D.C. are participating in the Transforming Maternal Health (TMaH) Model. TMaH is a 10-year care delivery and payment model that funds state Medicaid programs to focus on three pillars: 1) Access, Infrastructure & workforce

What It Really Means to Join a Step Up Together Action Collaborative

then updated August 28, 2025.

By Amy Romano, MBA, MSN, CNM, FACNM

If you’re considering joining a Step Up Together Action Collaborative—or encouraging your hospital or community partner to do so—you might be wondering: what does participation actually look like? The short answer: it’s a structured, time-limited commitment with real benefits for your team and your patients. The longer answer is that there’s a rhythm to the

Right-Sizing Your Drill: Finding the Fit for Your Team

then updated January 22, 2026.

By Amy Romano, MBA, MSN, CNM, FACNM

There’s nothing quite like the power of a large, truly interdisciplinary Full Transfer Drill. One Massachusetts participant recently reflected: That drill brought together area home birth midwives, EMS providers, hospital team members from multiple departments, hospital administrators, and Department of Public Health officials—an extraordinary example of what it looks like when a whole system shows

Tools for Massachusetts Hospitals Integrating Community Perinatal Services

then updated August 14, 2025.

By Amy Romano, MBA, MSN, CNM, FACNM

In the wake of historic maternal health legislation providing greater access to community midwifery and doulas, the Massachusetts Department of Public Health embarked on and funded a collaborative process to implement system-wide change to fully integrate these care models into the healthcare system. A major part of this effort has involved making community-specific plans for

The 3 Delays: Strengthening Your Transfer Process Before It’s Urgent

then updated August 11, 2025.

By Amy Romano, MBA, MSN, CNM, FACNM

When an emergency happens in a community birth setting, every minute counts. In Step Up Together, we use the 3 Delays Framework to help teams identify and address the most common barriers to safe, timely, and respectful transfers from home or birth center to hospital care. The 3 Delays model has been used worldwide to

From Drill to Real-World Change: The Most Common QI Projects Sparked by Full Transfer Drills

then updated September 9, 2025.

By Amy Romano, MBA, MSN, CNM, FACNM

Full Transfer Drills are one of the most powerful tools for strengthening community-to-hospital transfer processes. They don’t just test logistics, they spark lasting quality improvement (QI) projects that make care safer and more seamless. Through the Step Up Together® Action Collaborative, we’ve seen clear patterns in the kinds of QI projects that emerge. These projects often map directly onto the Three Delays framework, a proven lens for understanding barriers to safe and timely care.

Which Hospital Are You? 3 Stages of Readiness for Community Birth Integration

then updated July 24, 2025.

By Amy Romano, MBA, MSN, CNM, FACNM

Hospitals across the country are grappling with how to engage more meaningfully with community-based care models. Whether you’re navigating growing demand for out-of-hospital options, responding to calls for equity and respectful care, or just trying to ensure smoother transfers from home or birth center births, one thing is clear: integration doesn’t happen overnight. But that

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