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 emergency transfers of midwifery-led births into the hospital for needed obstetric or neonatal care. Planning and rigorously testing processes through interdisciplinary, inter-agency Full Transfer Drills can lead to sustained collaboration and improve preparedness for a range of perinatal complications. The Massachusetts DPH partnered with Primary Maternity Care (PMC) to support this planning process and provide technical assistance and Step Up Together programming to hospitals, community midwives, and EMS personnel ready to engage in drills.
After initiating efforts less than a year ago, Massachusetts now leads the nation in the number of hospitals completing Full Transfer Drills with community birth partners, setting a new standard for readiness and integration— 5 hospitals have now completed such drills using Step Up Together Drill Kits.
To sustain these efforts and replicate them across the remaining birthing hospitals in the state, PMC has compiled the resources below to capture the tools, guidance, and examples from this statewide initiative that leveraged our team’s technical assistance and the Step Up Together emergency preparedness program.
Background / Pre-Drill Materials
Many hospitals are not yet ready for a Full Transfer Drill. Often there is groundwork, information-gathering, and trust-building required. PMC offers several open source materials for hospitals and other stakeholders. While these materials highlight birth centers, the concepts apply to home birth practice as well, and many of the tools are easily adaptable.
These resources are great for hospitals that are at different stages of readiness for Full Transfer Drills and joint quality improvement.
- Hospital Guide to Integrating the Freestanding Birth Center Model — Step-by-step frameworks and implementation tools for assessing readiness, building partnerships, and sustaining quality across hospital and birth center care models.
- Community Birth Integration Stakeholder Map – A tool to systematically assess different community birth center stakeholders and identify approaches to address their concerns and/or interests.
- Transfer Planning Template — A tool for hospitals to document and communicate their standard process for incoming adult and neonatal transfers from community birth settings, helping ensure clarity, efficiency, and respectful care in every case.
In addition to these PMC/Step Up Together resources, we recommend the resources, program steps, and data tools developed by Smooth Transitions in Washington and adapted for other state-based initiatives.
Open-Access Drill Kits
The entire Step Up Together Drill Kit Library is available open access to professionals in Massachusetts and beyond. To support Massachusetts hospitals integrating doula-friendly policies along with community birth integration, two Drill Kits were added to the library that include an explicit role for doulas (as well as for clinical participants).
CNE / CME Sessions on Planning and Conducting Drills Using Step Up Together Drill Kits
Our Spring Focused Action Cycle was launched to support Massachusetts teams and others around the country to use one of the new Drill Kits to complete a drill in their own communities. These sessions were recorded and are available through December 2025 for participants who want to earn up to 4.5 CME or CNE credits.
Step Up Together Focused Action Cycle Kickoff
Drill Planning Session: Community Preparedness:
Drill Planning Session: EMS Preparedness:
Drill Planning Session: Hospital Preparedness:
To claim CNE or CME credits:
- Visit the Weitzman Education Platform and create a CME account. If you already have an account, please go directly to Step 2.
- Navigate to Step Up Together Focused Action Cycle Summer 2025 and click on the Register tab for the activity and then scroll down to then click on the Register button. We suggest you bookmark this activity. Once you register, you will be automatically enrolled in all the sessions and will see a list of the available sessions. Some sessions will not appear in the list until the session date is determined. This does not assume you have attended or will attend all sessions.
- To complete the post-session evaluation and claim your credits, log into your Weitzman Education Platform account by accessing the Step Up Together Focused Action Cycle Summer 2025 activity and under the Continue tab, select the appropriate session from the list of sessions. Select the Continue button below the tabs to complete the post-session evaluation, claim credits, and download your session certificate.
Highlight Videos on Drill Planning and Emergency Preparedness
As part of these CME/CNE sessions, participants drilled down on how they worked to prevent the “3 Delays” and designed their drills to stress-test these prevention strategies. They also heard from participants in recent Full Transfer Drills in California. These highlight videos capture the key take home messages from the sessions.
First Delay: Community Preparedness for Emergency Transfers
Second Delay: EMS Preparedness for Emergency Transfers
Third Delay: Hospital Preparedness for Emergency Transfers
Articles on Implementation Topics and Best Practices
The Step Up Together Blog posts articles on implementation and best practices that have emerged from the Step Up Together network. These articles can assist hospitals and other stakeholders working on community birth integration or planning Full Transfer Drills.
The 3 Delays: Strengthening Your Transfer Process Before It’s Urgent
Which Hospital Are You? 3 Stages of Readiness for Community Birth Integration
Practice Makes Prepared: Choosing Between Partial and Full Transfer Drills—and Why Both Matter
From Drill to Real-World Change: The Most Common QI Projects Sparked by Full Transfer Drills
Integrating Doulas into Community Birth Transfer Drills
New National Guidelines Strengthen Intermittent Auscultation in Community Birth Settings
Photos and Videos of Drill Activities
Photos from Full Transfer Drill from Seven Sisters Midwifery and Community Birth Center and Cooley-Dickinson Hospital
These photo compilations of Massachusetts Full Transfer Drills show different methods of conducting drills depending on resources and participants available. Mount Auburn Hospital invited local home birth midwives and a doula to participate in a drill which was set up in the hospital conference room and transferred to Labor and Delivery. Seven Sisters Midwifery and Community Birth Center and Cooley Dickinson engaged their local EMS service and conducted a Full Transfer Drill that began in the birth center and moved by ambulance to the hospital.
