BACKGROUND:
Despite global recognition of evidence-based midwifery practices, implementation gaps undermine care quality during labour and birth. In Uganda, key practices such as using varied birth positions (dynamic birth positions), continuous intrapartum support, and perineal protection, are underused which negatively affects maternal and newborn health.

OBJECTIVES:
To assess how a co-created, midwife-led quality improvement (QI) intervention increased and sustained the use of evidence-based midwifery practices and improved birth outcomes in a public hospital in Kampala, Uganda.

METHODS:
The Midwize intervention was co-created with midwives, other hospital staff, policy-makers, educators, the midwife association, women, and birth companions. Seven trained midwives (“Midwize Ambassadors”) led implementation over seven months, supported by mentorship and peer learning through structured QI cycles. Data were collected from 703 women before, during, and at 3 and 6 months (2023), and again at 2 years (2025) post-intervention using structured observations and questionnaires.

RESULTS:
The midwife-led quality improvement intervention significantly increased use of key practices—dynamic birth positions (0% to 79%), intrapartum support (0% to 62%), and perineal protection (62% to 92%)—with gains sustained at six months and two years. Maternal perineal injuries decreased, and newborn Apgar scores improved. Success stemmed from co-creation, a train-the-trainer model, midwife role models leading change, peer mentoring, engaging women and birth companions, regular staff and policy updates, all within a structured QI approach promoting continuous learning.

CONCLUSIONS:
Midwife-led, co-created quality improvement interventions can effectively embed evidence-based practices into maternity care, resulting in better outcomes for women and newborns. This approach strengthens core midwifery competencies and supports more responsive and respectful health services.

KEY MESSAGE:
Midwife-led quality improvement interventions are a scalable strategy to strengthen evidence-based care, enhance professional leadership, and improve maternal and newborn health across diverse settings. Physiological - midwife interventions (Including three-minute presentation competition)