PURPOSE:
Our multi-stakeholder team developed an accountability tool including indicators around environment, medical interventions, clinical standards, and conditions that affect experience of labour and birth care.

DISCUSSION:
The Undisturbed Labour and Birth Facility (ULab) index, uses a weighted scoring system that assesses degree of adherence to best practice within facilitiesThe majority of existing research in maternity care is focused on adverse outcomes. This use of pathogenic measures is appropriate for assessing standard medical treatments that are only used when people are unwell. However, pregnancy and birth are outcomes of a normal physiological processes, rather than an illness. The WHO Standards for Improving Quality of Care in Health Facilities have issued recommendations to reduce interventions and support physiologic labour and birth. However, they note a scarcity of evidence-based audit tools to evaluate facility adherence to best practices.

EVIDENCE WHERE RELEVANT:
We used a Global Delphi process to identify a set of measurable facility factors such as environment, equipment, human resources and policies that support movement, oral intake, intermittent auscultation, nonpharmacologic pain management, respectful care and cultural safety, as well as staff education on how to reduce disturbance, trauma, and mistreatment. We operationalized the items onto an online platform that can be completed in less than two hours by facility staff. We implemented ULaB in over 100 hospitals in urban and rural settings in the United States and Canada. Facility scores range from high performers to non-performers and scores reveal significant structural inequities across populations and communities.

KEY MESSAGE:
The ULaB Facility Index is well positioned as a quality improvement tool to assess facility readiness and accountability for supporting salutogenic birth for all, optimizing health systems costs, improving patient experience, and reducing overuse of interventions. It is a pragmatic metric for quality care, as defined by service users, and can be used to measure enabling environments for midwifery practice. Poster session 4 (Group B)