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, the release of the CMQCC Community Birth Transfer Toolkit, together with recent resources from the Alliance for Innovation on Maternal Health and the American College of Obstetricians and Gynecologists, marks a broader shift toward intentional integration of midwifery and hospital-based care across all levels and locations of care.
What Is the CMQCC Community Birth Transfer Toolkit?
The CMQCC Community Birth Transfer Toolkit provides practical, structured guidance for improving safety, communication, and collaboration during transfers from community birth settings (home birth and freestanding birth centers) to hospitals.
The toolkit focuses on:
- Building relationships between hospitals and community midwives
- Standardizing communication and handoffs during transfer
- Developing shared protocols and expectations
- Strengthening coordination with EMS
- Supporting respectful, patient-centered care
For many hospitals and communities, this type of guidance is foundational. It helps teams that may not yet have strong integration in place begin to align around shared goals, language, and processes for community birth transfer.
From Framework to Practice: The Importance of Simulation
While the CMQCC Community Birth Transfer Toolkit provides essential guidance, one theme stood out during the recent CMQCC launch webinar: teams learn the most when they practice together.
Emergency transfers are complex, time-sensitive events involving multiple teams across different settings. Even well-designed protocols can break down if teams have never tested them in real time.
That’s why interdisciplinary simulation and transfer drills are such a critical next step.
How Step Up Together Supports Implementation
As part of developing and implementing the Community Birth Transfer Toolkit, CMQCC partnered with Step Up Together to convene an Action Collaborative with participating hospitals and community birth teams in several pilot communities across California.
Step Up Together faculty worked directly with these teams, including on-site facilitation, to plan and conduct interdisciplinary simulation drills using structured Drill Kits.
These drills tested the full community birth transfer process in real time:
- Recognizing the need for transfer
- Activating EMS
- Communicating across teams
- Receiving and continuing care in the hospital
This was the first time their teams had practiced and debriefed a transfer together across settings.
During the recent CMQCC toolkit launch webinar, leaders shared that these simulation experiences were consistently described as the most impactful part of the initiative—a powerful validation that practicing together is essential to improving real-world performance.
A Turning Point for Midwifery Integration
The release of the CMQCC Community Birth Transfer Toolkit reflects a broader shift in maternity care: a growing recognition that safety depends on how well the system functions across settings and dynamic teams.
As community birth continues to expand, the focus is increasingly on how teams work together when care needs to escalate, a lesson that is also highly relevant to other types of perinatal transfer, especially in rural settings. Reliable, respectful transfer is a core part of the overall system of care, and a key marker of true integration.
California’s approach brings several critical elements together: shared guidance, stronger relationships between community and hospital teams, and opportunities to practice through interdisciplinary simulation. Taken together, these efforts offer a practical model that other states can adapt and build on.
Moving Forward
For hospitals and communities early in their integration work, the CMQCC Community Birth Transfer Toolkit provides a clear and accessible foundation.
For teams that are ready to operationalize that work, simulation creates the opportunity to test processes, surface challenges, and strengthen collaboration in a way that written guidance alone can’t achieve.
What’s emerging in California is a more coordinated, team-based approach to maternity care, one that recognizes the importance of connection, preparation, and shared accountability across all levels and locations of care. We were so proud to be part of it!
