PURPOSE:
Hospitals specializing in high-risk pregnancy care often default to an overly medicalized model, even for those with low-risk pregnancies. This abstract describes how one hospital used a quality improvement (QI) framework to implement midwifery-aligned, evidence-based practices that support physiologic birth for all birthing people—regardless of medical complexity.

DISCUSSION:
Evidence from the midwifery model of care demonstrates improved outcomes when physiologic processes are supported in labor and birth. However, translating these practices into high-acuity hospital environments requires cultural and structural change. This initiative focused on shifting birth culture through practical, low-cost strategies rooted in existing resources and clinical evidence. The hospital leveraged support from its state perinatal quality collaborative and initiated a QI project grounded in stakeholder engagement and interdisciplinary collaboration. Key steps included: Securing leadership and provider buy-in across obstetrics, midwifery, nursing, and pediatricsIdentifying practice gaps and aligning goals with existing perinatal initiativesImplementing practice changes that support physiologic birth, including: Immediate skin-to-skin contact following vaginal birthFamily-centered cesarean birth practicesPhysiologic (delayed) cord clampingIntermittent auscultation for low-risk laborsExpanded use of non-pharmacologic comfort and coping tools

EVIDENCE WHERE RELEVANT:
Early implementation demonstrated increased interdisciplinary collaboration, stronger alignment with evidence-based care, and greater support for physiologic birth practices among staff. These changes required minimal new resources and were sustained through shared ownership and regular QI cycle reviews.

KEY MESSAGE:
Physiologic birth practices are feasible and impactful in high-risk hospital settings. With intentional QI strategies, interdisciplinary teamwork, and alignment with midwifery care principles, hospitals can transform labor and delivery unit culture to better support all birthing people across the risk spectrum. French - SRHR (including three-minute presentation competition)