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

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 doesn’t mean you have to figure it all out on your own.

At Step Up Together, we’ve worked with dozens of hospital teams and have found that most fall into one of three readiness “archetypes.” Each one has a natural next step — and a tool designed to move you forward.

🪁 The Budding Champion Hospital

“We’re not really doing anything with community birth right now, but I’m interested.”

In this scenario, integration hasn’t been a system-wide priority — yet. Maybe there’s one nurse, midwife, or physician who has seen a messy transfer or a missed opportunity and wants to do better. Maybe someone just learned about the evidence supporting midwifery-led birth centers or is seeing more home births in their region. Maybe one of your staff is going to local birth center for their own care.

Your next step:

Empower your budding champion to understand your landscape and build buy-in.

Your go-to tool:

👉 Stakeholder Planning Map
This tool helps you identify key allies, skeptics, and potential partners within your system. Use it to think through concerns, areas of aligned interest, and how to start conversations that shift culture and open doors.

🔧 The Systems Builder Hospital

“We know we need a better transfer process. Right now it’s inconsistent.”

This hospital is beyond the awareness phase. They’ve had enough transfers to know the process varies — maybe by shift, provider, or department — and they want to create standard operating procedures that work across teams. They’re not looking for perfection, but they are ready for structure.

Your next step: Map out and standardize your transfer process.

Your go-to tool:
👉 Transfer Planning Template
This tool walks your team through the steps of each kind of transfer (antepartum, intrapartum, postpartum, neonatal), identifies where delays or miscommunications occur, and builds shared understanding of the basic processes for incoming transfers from community birth settings.

📈 The Continuous Improver Hospital

“We’ve got a transfer process, but we want to test it and improve it.”

These are the hospitals that have laid a foundation. They might already receive regular transfers from a birth center or home birth practice and have meetings to discuss clinical issues. But they know that real preparedness comes from practice — and that systems only improve when you test them in realistic scenarios.

Your next step: Run a transfer drill and debrief the experience with your partners.

Your go-to tools:
👉 Step Up Together Drill Kits
Our drill kits walk you through how to simulate a transfer, from unfolding clinical scenarios to handoff checklists to structured debrief guides. When you download a Drill Kit, you’ll also learn about coaching programs that help your team learn from peers and expert faculty — and turn drill insights into system improvements.