BACKGROUND:
Unplanned intrapartum transfers from community settings to hospitals can disrupt physiological birth and continuity of care. A leading cause of these transfers is inadequate coping with labor pain. In rural St. Lawrence County, New York, the region’s only midwife-led birth center sought to address this issue through structured, evidence-based coping interventions.

OBJECTIVES:
To reduce transfers for pharmacologic pain relief by implementing a multi-modal labor coping pathway (LCP) that supports individualized, midwife-led care.

METHODS:
An LCP was developed through a systematic literature review and informed by the Biopsychosocial Model of Health. Birth center staff received targeted training. Clients engaged in shared decision-making during prenatal visits to create individualized birth plans. The LCP was implemented with all laboring clients over five months. Data on pathway use and transfer rates were collected and analyzed.

RESULTS:
Eighty-eight percent (n=64) of clients had a birth plan documented prior to admission. Staff applied the LCP when self-reported coping thresholds were reached. Transfers for pain relief decreased by 65% following implementation. Staff supported full integration of the LCP into practice, and post-birth surveys reflected high client satisfaction.

CONCLUSIONS:
A structured, midwife-led coping plan significantly reduced intrapartum transfers related to pain management and improved both client experience and continuity of care. This model illustrates how midwives can lead evidence-based, client-centered innovations—especially in rural and underserved areas.

KEY MESSAGE:
Meeting the global call for One Million More Midwives requires more than numbers—it demands models that empower midwives to lead transformative care. This labor coping pathway demonstrates how community-based midwifery can improve outcomes, enhance autonomy, and strengthen maternal health systems worldwide. Poster session 3 (Group B)