Planning for pregnancy and birth is one of the most transformational times in a family’s life. Every birthing individual deserves to feel supported, informed, and in control of their care journey. Continuous labor support provided by doulas is proven to decrease cesarean births, lower medical intervention rates, shorten labor duration, and improve emotional well-being.

With Colorado’s Health First Colorado (Medicaid) doula benefit now active and updated clinical guidance from the American College of Obstetricians and Gynecologists (ACOG), healthcare systems have a timely opportunity to formalize collaborative partnerships with doulas.

To guide healthcare leaders and care teams through this transition, the Colorado Perinatal Care Quality Collaborative (CPCQC) has released Integrating Doulas into Clinical Care Settings: A Hospital-Focused Framework.

What’s Inside the Framework?

Developed by Lead Author Sydney Comstock, MPH, with contributions from statewide perinatal leaders, interviewees, and community doulas, this guide provides practical approaches to hospital integration:

Supporting Clinical Teams and Birthing Families

Doulas do not replace clinical care providers—they complement midwives, nurses, and physicians by offering continuous physical, emotional, and informational support. When clinical teams and doulas work together with clear roles and open communication, patient satisfaction increases, communication improves, and clinical safety is reinforced.

“When we center birthing people and their babies in every interaction and every system of care, we create the conditions for better experiences and healthier outcomes for families across Colorado.”

— Annette Dayley, MPS, RN, Reproductive Health Implementation Specialist

How to Get Started

Hospitals and care providers can download the full guide to assess unit readiness, review sample hospital policies, and engage L&D staff in interdisciplinary collaboration.

 Download the Full Integration Guide (PDF)

We all have a role

Partnering Together to Prevent Perinatal Suicide

Emerging collaborative initiatives designed to address maternal mental health complications across Colorado

Last September, CPCQC gathered with more than 60 national leaders in perinatal mental health to begin developing a PCORI-funded, patient-centered, perinatal suicide prevention research agenda. Suicide remains a leading—and largely preventable—cause of maternal death, yet it continues to be poorly researched, understood, and addressed. 

The convening centered the experiences of more than 20 patients and family members affected by postpartum psychosis and suicidal ideation, alongside researchers, clinicians, and other national experts. It sought to balance the need to advance the research agenda with a clear focus on action and impact—ensuring that the priorities identified through the convening would translate into meaningful benefits for patients and families, rather than remaining confined to academic or research settings. 

Since the convening, attendees have continued to further national efforts to prevent perinatal suicide. This work feels exceptionally important now, as national rates of maternal death due to perinatal mental health conditions continue to rise and the complexities of postpartum psychosis flood newsfeeds with the Lindsay Clancy mistrial. 

Together with our partners, CPCQC remains committed to advancing meaningful improvements to Colorado’s perinatal behavioral health landscape to ensure that all perinatal women and families receive timely, quality, and accessible care. 

CPCQC’s new “We All Have a Role” training is one contribution to this work—helping equip a variety of clinical and community-based providers with improved skills to recognize and respond to perinatal behavioral health complications—including perinatal suicidal ideation and psychosis. 

From Research to Action: We All Have a Role

We All Have a Role isn’t just a name – it’s also a call to action. Suicide risk is highest in the late postpartum period, which means as obstetric care is ending, risk is peaking. Without a framework for who owns perinatal mental healthcare after the six-week follow-up visit, it’s easy for new mothers to slip through the cracks. 

This message compels us to recognize that mental health in the postpartum period doesn’t sit on one provider’s shoulders. It’s a shared responsibility that extends across communities and systems – from clinicians and community-based providers to researchers, educators, advocates, and, importantly, patients and families themselves. Each one of us has a different role to play in reducing preventable deaths related to perinatal mental health. 

CPCQC’s partnership with the University of Colorado Department of Psychiatry Prenatal, Reproductive, and Early Childhood Mental Health (PRE) Section on the development of the We All Have a Role course is evidence of what this shared responsibility looks like in action. The CU PRE team has walked alongside CPCQC throughout the development and launch of this new curriculum. They served as conveners for the PCORI gathering, conducted needs assessments across Colorado’s perinatal health landscape, and thoughtfully co-developed the We All Have a Role curriculum for IMPACT BH partners, integrating hands-on coaching and role-play to help providers connect didactic content to real-life situations. 

I hope people hear [“We All Have a Role”] as an invitation to act. You do not have to be a mental health specialist to listen without judgment, take a concern seriously, and help someone take the next step toward support. Our specific responsibilities differ, but each of us can help make it easier for someone to speak honestly and receive a compassionate response. That first conversation can help someone believe that help is possible and that they will not have to find it alone. – Dr. Sarah Nagle-Yang, Prenatal, Reproductive, and Early Childhood Mental Health (PRE), Co-Section Head

CPCQC is also partnering with the Community Language Cooperative (CLC) to launch We All Have a Role training in Spanish, increasing accessibility of the curriculum for providers and communities across Colorado. Their translation services are an important part of this work, helping ensure that when we address perinatal mental health, we address it for all patients. 

Language should never be a barrier to recognizing warning signs or finding support and resources. By translating materials and providing language access at every point of interaction with healthcare and community resources, we can ensure that community members have access to potentially lifesaving information in the languages of their hearts. – Rosa Guzman-Snyder, Community Language Cooperative, Co-Founder & Principal Consultant

CPCQC and PRE launched a bilingual pilot of the new training this month for our current IMPACT BH cohort across Chaffee, Custer, Grand, Jackson, San Miguel, and Ouray counties, as well as the San Luis Valley. CPCQC aims to expand access to former IMPACT BH counties and additional communities in the near future. 

A Growing Education Suite for Perinatal Suicide Prevention

We All Have a Role is just one step in the broader effort to address preventable maternal mortality related to mental health in Colorado. That effort requires coordination and support across systems, as well as champions committed to advancing perinatal suicide prevention over the long term. The Behavioral Health Administration is one such champion, committed to doing their part “to reduce preventable maternal mortality, including investing in programs that work to recognize and effectively respond to the leading causes of maternal mortality, such as suicide and unintentional overdose.”

“The development and recent release of the ‘We All Have a Role’ training is an important and meaningful step forward in ensuring that care teams working with Colorado’s perinatal population are equipped with the knowledge, skillset and resources to effectively support pregnant and newly parenting individuals who may be at risk for suicide.” — Kallen Thornton, Behavioral Health Administration

It also requires continued investment in expanding responsive resources for clinicians. Along with We All Have a Role, CPCQC is partnering with Colorado PROSPER to develop Mental Health is Maternal Health, a clinician-facing, point-of-care decision-support website for perinatal behavioral health. It is designed to help obstetric, primary care, and other frontline clinicians move from screening to further assessment, clinical formulation, treatment considerations, safety planning, consultation, and referral. PROSPER and CPCQC are currently finalizing and piloting the tool, and aim to publicly launch Mental Health is Maternal Health by early 2027. 

PROSPER has also launched a new asynchronous course on suicide screening and assessment, Recognizing and Responding to Suicide Risk in Pregnancy and Postpartum. This training equips providers with the tools to conduct suicide risk assessments, develop personalized perinatal safety plans, and identify and address compounding risk factors such as sleep deprivation, isolation, and overwhelm. 

The Mental Health is Maternal Health resource and Suicide Risk course join PROSPER’s suite of trainings, tools, and resources for providers, alongside their provider-to-provider warmline for perinatal behavioral health consultation. Together, these tools are intended to help providers assess for suicide risk, and close the persistent gap between identifying a concern through screening and taking meaningful clinical action.

“We are encouraged by the growth of care that meets pregnant and postpartum people where they already are. Integrating mental health services into obstetric, pediatric, and other familiar healthcare settings makes it easier to get support from a team they know and trust. Perinatal psychiatry access programs, including Colorado PROSPER, extend that reach by giving clinicians consultation, education, and help connecting patients with resources. Together, these approaches are building the capacity to address mental health as a routine part of pregnancy and postpartum care.” – Dr. Sarah Nagle-Yang,  Prenatal, Reproductive, and Early Childhood Mental Health (PRE), Co-Section Head

Perinatal Mental Health at the Intersections

The recent national focus on postpartum psychosis has exposed how much remains misunderstood about the condition, and perinatal mental health more broadly. It is important that the conversation does not end with the Lindsay Clancy mistrial. Instead, this is an opportunity to better understand what is needed to recognize warning signs earlier, build stronger systems for families, and address perinatal mental health complications before they become a crisis. 

Greater awareness of perinatal mental health has helped more people speak openly and seek support. That conversation must also make room for severe illness and suicidal thoughts. – Dr. Sarah NY

These moments do not happen in a vacuum. There are often overlapping risk factors, with experiences such as trauma, health-related social needs, and isolation significantly increasing someone’s vulnerability during the postpartum period. This means that perinatal suicide prevention does not start and end with mental health screenings—there are opportunities across and beyond our systems of care to understand and address factors that increase this risk. 

Intimate Partner Violence (IPV) is one place where these risk factors may intersect – in 15% of maternal suicide cases, IPV played a role. Many healthcare providers are unsure how to start a conversation or respond when someone discloses abuse—and missing the opportunity to support a patient could also mean missing the opportunity to prevent a crisis before it happens. 

This year, CPCQC partnered with Safehouse Progressive Alliance for Nonviolence (SPAN) to develop a clinical perinatal IPV training. The new course, Building Safety, equips providers with the tools they need to recognize and safely respond to intimate partner violence, helping them build confidence to provide trauma-informed care and identify themselves as a safe place for their patients to seek help. 

“When we talk about preventing suicide in the postpartum period, we have to look at what is happening in a person’s whole life—not only their mental health. Intimate partner violence can intersect with depression, anxiety, [and] substance use because of isolation, financial dependence, and fear for the safety of both the parent and their baby. These experiences do not happen in separate boxes, and neither can our response…through initiatives such as Building Safety, we are working to help perinatal providers understand how IPV, mental health, suicide risk, and safety can intersect, recognize when someone needs urgent intervention; and offer support” – Kari Ricard, CPCQC, Clinical Quality Improvement Program Manager (SPARK) 

And when firearms in the home contribute to high-risk situations involving suicidal ideation and intimate partner violence, suicide prevention also extends beyond the clinical walls to anyone who plays a role in firearm safety.

This is what We All Have a Role looks like in action. Suicide prevention is not about one singular moment, one clinical encounter, one individual provider. It takes all of us: from the leaders at the PCORI gathering, to the researchers at the University of Colorado, from the translators at the Community Language Cooperative to the advocates at SPAN. Perinatal mental health is complex, and will require us to work together across systems to better understand how to prevent crises before they happen. As we look back on Suicide Prevention Month, We All Have a Role is an invitation to consider what your own role is in this work. There is still a lot of progress to be made, but if each of us is committed to showing up, learning from one another, and educating others, we can make a meaningful difference in the lives of perinatal women and families in Colorado. 

CPCQC is excited to introduce CORE: Colorado Obstetric Readiness in Emergency Care, a new statewide initiative designed to strengthen obstetric emergency readiness in rural and low-volume emergency departments across Colorado.

CORE will bring hands-on, simulation-based education directly to participating hospitals, giving emergency teams an opportunity to practice the recognition, stabilization, and response to obstetric emergencies within the environments where they actually provide care. The program is being developed specifically around the realities of rural emergency departments, including low patient volume, limited onsite obstetric resources, small care teams, and the need to stabilize and coordinate transfer when a higher level of care is required.

Why This Work Matters

Access to obstetric care is changing across Colorado, particularly in rural and frontier communities. Today, 37.5% of Colorado counties are classified as Maternal Care Deserts, meaning they have no labor and delivery or obstetric facilities or services. For patients living in these communities, accessing obstetric care may require traveling significant distances, and when an unexpected complication occurs, the local emergency department may become the first and sometimes only immediate point of care.

At the same time, rural hospitals continue to face significant workforce, financial, and operational challenges that can make sustaining labor and delivery services increasingly difficult. CPCQC’s recent examination of five rural Colorado hospitals found that facilities were balancing low delivery volumes with the ongoing need to maintain staffing, clinical skills, equipment, and systems necessary to respond safely when an obstetric emergency occurs. Even when a hospital no longer operates a labor and delivery unit, the need for obstetric readiness does not disappear. CPCQC’s rural hospital case study found that emergency deliveries continued to occur after L&D services were reduced or discontinued, prompting hospitals to strengthen transfer relationships, coordinate with EMS, and invest in staff training and simulation.

Low clinical volume creates another challenge. Obstetric emergencies may occur infrequently in rural emergency departments, but when they do occur, teams must be prepared to act quickly in situations that can rapidly become life-threatening. Limited exposure to these events can make it difficult to maintain procedural confidence, clinical skills, and coordinated team response over time. CPCQC’s rural hospital work identified these concerns specifically in relation to low-frequency, high-risk obstetric events, reinforcing the value of opportunities for teams to practice together before an emergency occurs.

The need for readiness has also taken on new urgency with updated CMS Conditions of Participation for obstetrical emergency services. Acute care hospitals and critical access hospitals that provide emergency services must maintain protocols addressing obstetric emergencies, complications, and immediate post-delivery needs, and applicable staff must receive annual training on those protocols. These requirements apply to hospitals providing emergency services regardless of whether they routinely provide obstetric care, underscoring the importance of ensuring that emergency teams have the knowledge, systems, and practice necessary to respond when an obstetric emergency arrives at their door.

That is the need CORE was built to address.

Bringing Obstetric Emergency Training to Rural Teams

CORE will bring hands-on, simulation-based training directly to participating hospitals, with education designed around the realities of rural emergency care. CORE trainings will be facilitated onsite by CPCQC clinical simulation faculty, including a RNC-MNN specialty certified Registered Nurse and an OB/GYN physician, bringing multiple perspectives to team-based obstetric emergency response. Training will focus on rapid recognition and stabilization, interdisciplinary communication and role clarity, obstetric emergency response, neonatal support, escalation of care, and transfer coordination.

Participants will work through realistic simulations and facilitated discussions addressing emergencies such as unplanned delivery, shoulder dystocia, postpartum hemorrhage, hypertensive emergencies in pregnancy, and maternal cardiac arrest. The goal is not only to strengthen clinical knowledge, but to give teams an opportunity to practice how they respond together — including communication, role assignment, use of available equipment and medications, escalation pathways, and transfer processes.

The curriculum is also intentionally aligned with relevant CMS Conditions of Participation priorities, including emergency preparedness, staff competency, patient safety, communication, stabilization, and quality improvement, helping hospitals strengthen both clinical readiness and their approach to meeting federal expectations.

What’s Next for CORE?

CORE’s first onsite training is planned for January 2027, with CPCQC aiming to deliver training at a minimum of five rural emergency departments during 2027. These initial site visits will allow CPCQC to learn alongside participating hospitals, evaluate the training model, and continue refining CORE as the program develops and expands.

CPCQC also plans to convene a CORE Steering Committee to help inform implementation, evaluation, and continued program development. The committee will bring together individuals whose professional expertise or lived experience is directly relevant to rural obstetric emergency care and who can contribute to the continued development of the program.

Those interested in being considered for the CORE Steering Committee may contact Dani Courtney, Clinical Simulation Program Manager, at dcourtney@cpcqc.org to be added to a list for future communications regarding committee eligibility and the application process. Questions about CORE, future training opportunities, or the program more broadly may also be directed to Dani at the same address.

Since launching in 2022, IMPACT BH has grown alongside the rural Colorado communities at the heart of the initiative. What began as a responsive effort to strengthen perinatal behavioral health care has evolved into a comprehensive model that combines grant funding, clinical and quality improvement support, data technical assistance, and peer learning.

This evolution reflects both the continued need for access to perinatal mental health, substance use, intimate partner violence, and social supports—and the tremendous strengths of rural communities themselves. Rural communities are creative, resilient, and committed to supporting one another. IMPACT BH is designed to build on those strengths, bringing resources and training alongside local knowledge and relationships to help strengthen their local perinatal behavioral health systems. 

Led by the Colorado Perinatal Care Quality Collaborative (CPCQC) in partnership with the Colorado Behavioral Health Administration, IMPACT BH has supported eight rural Colorado counties since its launch. We’re proud of what communities have accomplished together and are excited to welcome 12 additional counties across five communities to the 2026–2027 cohort.Each community is anchored by two lead partners: an outpatient clinic and a community-based organization. These lead partners participate directly in the IMPACT BH learning collaborative, receive clinical and quality improvement coaching, and collect and submit data on screening and referral improvements for perinatal behavioral health. 

But the work of IMPACT BH extends well beyond these lead organizations. Each lead partner is surrounded by a broader network of local partners—including local family resource centers, midwifery practices, behavioral health providers, peer support services, community-based organizations, public health departments, people with lived experience, and more—who come together through a  local Perinatal Continuum of Care (PCOC) working group. 

Our 2026–2027 communities and lead partners include:

• Chaffee County: Chaffee County Public Health and Salida Health Center
• Custer County: Custer County Kids Council, Custer County Public Health, and Custer County Health Center
• Grand & Jackson Counties: Grand Beginnings and Middle Park Health
• San Miguel & Ouray Counties: Bright Futures for Early Childhood and Families and Telluride Regional Medical Center
• San Luis Valley: San Luis Valley Area Health Education Center, San Luis Valley Behavioral Health Group, and San Luis Valley Health

New Implementation Partners Bring Additional Expertise

As IMPACT BH enters its next phase, CPCQC is excited to welcome two new core implementation partners to the program: 

James Bell Associates (JBA) is a nationally recognized research and evaluation firm with decades of experience strengthening health and human services programs. JBA brings expertise in designing and implementing learning collaboratives, building quality improvement capacity, and strengthening behavioral and maternal-child health systems. Its team of quality improvement advisors partners with clinics and community-based organizations to identify and test tailored solutions that work within each site’s unique, local context. Through IMPACT BH, JBA provides continuous quality improvement (CQI) coaching and data technical assistance; facilitating collaborative learning sessions, supporting data collection and use, and helping each partnership implement and sustain meaningful change. 

The CU Section for Perinatal, Reproductive, and Early Childhood Mental Health (CU PRE) serves as IMPACT BH’s lead clinical training and technical assistance partner. CU PRE brings specialized expertise in perinatal behavioral health, including screening and brief intervention, referral to treatment, intimate partner violence (IPV), suicidal ideation, and health-related social needs. CU PRE works with IMPACT BH communities to deliver practical clinical training and technical assistance grounded in evidence-based practices and the realities of rural care.

A New IMPACT BH Model—Built with Rural Communities

Over the past year, CPCQC partnered with CU PRE and JBA to listen, learn, and shift IMPACT BH’s approach to supporting rural perinatal behavioral health systems. 

We engaged current, former, and prospective IMPACT BH partners—including rural providers, community-based organizations, public health departments, peer support providers, and people with lived perinatal experience—alongside statewide partners. Their insights helped shape an updated IMPACT BH model designed with and for rural communities. 

The updated model brings together three complementary components:

1. Quality Improvement Learning Collaborative: The new IMPACT BH learning collaborative combines clinical education, quality improvement, peer learning, and coaching to help communities improve perinatal behavioral health identification and response. The learning collaborative is designed to complement statewide implementation of AIM patient safety bundles by strengthening the outpatient and community-based systems of care surrounding hospitals.
2. Implementation Grants: IMPACT BH provides direct funding to help communities strengthen and sustain local perinatal navigation services, as well as participate in the learning collaborative. 
3. Perinatal Continuum of Care Working Groups: IMPACT BH communities will continue to launch local Perinatal Continuum of Care Work Groups (PCOCs). PCOC partners will have access to IMPACT BH clinical training and quality improvement support, extending the reach of the learning collaborative and helping ensure shared knowledge of best practices across local systems of care. 

What’s Coming Next

We All Have a Role Training

Over the past year, CPCQC and CU PRE connected with IMPACT BH partners to identify paths to improving perinatal behavioral health identification and response across a variety of rural clinical and community partners. Partners emphasized the desire to dive deeper into clinical best practices, develop improved screening workflows, and improve local connections to statewide resources. 

In response, CPCQC, PRE, and IMPACT partners developed a forthcoming asynchronous training entitled “We All Have a Role: Recognize, Respond, and Connect in Perinatal Behavioral Health.” The training will provide practical skills for recognizing behavioral health concerns, responding with confidence, and connecting people to support. Available in English and Spanish, it will launch initially with current and former IMPACT BH communities.

A New Sustainability Model

CPCQC is partnering with former IMPACT BH communities to develop and eventually pilot a sustainability model that will extend access to clinical coaching, statewide connections, and peer learning beyond the core 12-month IMPACT BH program. This work will also strengthen a statewide network of former IMPACT BH communities, creating new opportunities to learn from and support one another.

Looking Ahead to 2027

Recruitment for the next IMPACT BH cohort is expected to begin in early 2027. Stay tuned for more information or reach out to info@cpcqc.org to learn more.

CPCQC IMPACT BH team members, Lauren Smith and Kylie Hibshman, at the FY27 cohort kickoff

This spring, CPCQC’s Annual Forum, Better Together: From Shared Purpose to Statewide Progress, brought together more than 200 clinicians, hospital leaders, public health professionals, and community partners from across Colorado for a day of learning, collaboration, and inspiration. After many years of smaller convenings, seeing the perinatal quality improvement community together under one roof at the History Colorado Center proved that we aren’t just an aligned network – we are a movement! 

We were energized to have such deep statewide representation —including participants from rural, frontier, mountain communities—that came together for a unique opportunity to connect across maternal and infant health disciplines, regions, and sectors. Through 13 sessions featuring national and local experts, attendees explored practical solutions to some of the most pressing challenges facing Colorado families, including rural maternity care, perinatal substance use, safe sleep, suicide screening, and patient-centered quality improvement.

More than a conference, the CPCQC Annual Forum served as a statewide gathering point for people committed to improving outcomes for mothers, babies, and families. This year’s event elevated patient voices, sparked new partnerships, and equipped participants with tools and strategies they can take back to their communities. 

Thanks to significant sponsor support, travel stipends helped ensure that teams from resource-limited and rural areas could participate, allowed for excellent presenters to join us, and created an inviting day to strengthen impact across the state. The result is seen in the exchange of ideas and experiences that continues to fuel collaboration, innovation, and progress in perinatal health long after the event concludes and our planning starts for a 2027 Forum.  We will see you there in Spring 2027! 

Of course, the work doesn’t stop after a Forum; it is the beginning of the next chapter.  CPCQC is looking forward to the start of our fiscal year 2027 programming, beginning  in July with continued energy and targets for deepening collaborations and driving to sustained, measurable systems change.  In the months ahead, we will be sharing more data resulting from implementing the full scope of the 2024 Improving Perinatal Health Outcomes Act, our updated organizational strategic plan, and even more opportunities to engage and affect change with our rural partners.  

“If our ultimate goal is to improve patient outcomes and to really impact lives, then when lived experience isn’t at the table, we are missing an entire perspective of the people we are trying to support with our work.” — Sydney Comstock, Program Manager, CPCQC

There is a concept embedded in quality improvement work that is easy to say and harder to put into practice: that the people most affected by a problem are also the most essential to solving it. In perinatal health, this means that the birthing person is not just a recipient of care, they are at the center of it.

At CPCQC, this belief is shaping the focus of our work. Data alone cannot tell us what it feels like to be in a hospital bed making decisions about your own body, or to be a new parent whose mental health needs go unrecognized by the clinical team in the room. These perspectives belong in the room where decisions are made.

Introducing FIRST: Family Integration to Restore Trust

FIRST was established in 2021 on the premise that people with lived experience with the perinatal health system are not just beneficiaries of quality improvement work, but qualified, essential partners in it. The vision behind FIRST is to create a structured, supportive pathway for people with lived experience to engage meaningfully in CPCQC’s work as ongoing collaborators who help shape the direction of our programs.

FIRST participants take the Patient Family Partner training offered by MoMMA’s Voices, a close partner with CPCQC since FIRST’s inception. The training is designed to help PQCs and the people we serve work more effectively together by equipping participants with skills in quality improvement, storytelling, and community involvement. By building a shared foundation between patients and providers, we can work towards a foundation of more collaborative, patient-partnered care. “[MoMMA’s Voices] basically teach you how to go from… I had these experiences… to being collaborative,” said one participant. “It’s really good therapy for yourself, but then good to learn how to talk to professionals.” Once FIRST participants take the MoMMA’s Voices training, they are matched with one of CPCQC’s programs (SPARK, SOAR, Turning the Tide, NEST, IMPACT BH) that align with their interests and lived experience. FIRST participants inform programs by serving on steering committees, reviewing patient-facing materials and provider scripts, sharing their stories in monthly cohort meetings or at educational trainings, and so much more.

The FIRST community is made up of people who have moved through the perinatal health system and carry insights that no literature review, clinical training, or data dashboard can replicate. Participants come with different backgrounds, stories, and reasons for wanting to partner with CPCQC in efforts to improve infant and maternal outcomes in Colorado. “My husband was like, we just had a traumatic event, don’t stress your body out” one participant shared, “but that was making it worse for me because [advocacy] is something I wanted to do.” What FIRST participants share is a commitment to making the system better for those who go through the process after them. 

FIRST in Action: A Conversation with Sydney Comstock

Sydney Comstock has been a program manager at CPCQC since 2023, and has worked directly with FIRST participants from the start. Her program, SOAR (Supporting Vaginal Delivery for Low-Risk Mothers), focuses on helping hospitals lower their first-time, low risk cesarean section rates through evidence-based care. Inherently, this has become a very clinical program. And that, she will tell you, is exactly why lived experience is so essential to it.

“For someone running a very clinically-focused program,” she shared, “I rely on people with lived experience to make sure the importance of patient perspective is getting across to nurses, providers, and people who are interacting with patients everyday.” Sydney admiringly notes that one FIRST participant she has worked with on SOAR’s steering committee has reviewed every resource the team has produced. Sydney appreciates what this partnership has kept at the center of her mind. “Having people with lived experience there,” she said, “is a reminder that it [is] the first time for everybody at this birth. I think that is my favorite thing to be reminded of constantly.” 

Sydney’s statement highlights a profound duality. For a provider or a quality improvement professional, a birth might be the hundredth they are attending or reviewing. For the birthing person, this may be their first birth, first time in a labor room, or first time in a surgical suite. Whether or not that is the case, giving birth is a transformative experience. This transformation can best be described as matrescence, a term coined by Dr. Dana Raphael, a medical anthropologist, to describe “the process of becoming a mother – a developmental passage where a woman transitions, through pre-conception, pregnancy and birth, surrogacy, or adoption to the postnatal period and beyond.” This asymmetry in giving birth—what may be routine for one person is once-in-a-lifetime for another—is something that only a person with lived experience can consistently and credibly bring back into the room.

Sydney is clear-eyed about what is missing when that voice is absent. “When we think about the birthing team, it is really supposed to be the patient or client running the show. I think if lived experience isn’t there, we don’t have that captain of the ship.” 

What We Are Learning, and Where We Are Headed

There isn’t a clear-cut template to integrating lived experience in perinatal health. Listening to our FIRST participants and to our own staff has given us a chance to improve lived experience integration within CPCQC. Some parts of this are logistical, such as streamlining onboarding and creating channels for ongoing communication. But an equally important part of this is follow-through. Sydney put it plainly: “You never want to include somebody just for a panel and then never talk to them again. There has to be a moment to circle back and share with them the importance of the work they have done. I could still be better at this, [and] it is still on my mind.” This kind of closing of the loop is something we are building more intentionally into every engagement. 

These reflections are not unique to CPCQC. Earlier this year, the National Network of Perinatal Quality Collaboratives (NNPQC) hosted a patient and family engagement webinar, providing the opportunity for PQCs to connect with each other to discuss lived experience integration in our organizations. We used words such as striving, building, trial and error to describe these efforts, and these conversations made it clear that there is always more we can be doing to engage and integrate lived experience perspectives in perinatal health. And we are beginning to create systems to measure this integration. The field is collectively asking: how do we move from bolting lived experience onto existing work, to baking it in from the beginning? How do we shift from QI programs that consult people with lived experience to programs that are co-created with them? 

For CPCQC, the next chapter of FIRST is about deepening that integration. Sydney described her own excitement about the year ahead: “I’m really really excited to see how the integration works between our quality improvement programming and FIRST. I’m really excited for it to become intertwined, that it won’t even be a question or conversation, that we will just be bringing in lived experience from here on out in everything that we do.” This vision is the one we are collectively building toward at CPCQC. 

Making It Possible: A Grateful Word About Early Milestones

None of this work happens without investment. We are deeply grateful to Early Milestones Colorado for enabling CPCQC to continue investing in FIRST. 

Early Milestones Colorado’s Impact on Equity Initiative enabled CPCQC to continue co-developing the FIRST program in partnership with participants and community-based organizations across Colorado. Together, we developed updated training and onboarding materials, expanded the program’s capacity, learned about best practices, and developed a new evaluation plan to ensure continued program improvement. 

When a funder invests in centering lived experience, it signals to the broader perinatal health community that the perspectives of those most affected by our health system are worth investing in. Thank you to Early Milestones for believing in this vision alongside us.

Rising Together: A New Chapter in Colorado Perinatal Health

Recently, one of our nurses, a QI advisor, shared a story about a patient she cared for in the hospital: a new mother recovering from an unplanned Cesarean birth who needed connection to substance use recovery support. As she prepared to leave the hospital, the team focused on something just as important as her physical recovery: making sure she had real connections to postpartum support in her community.

It was a reminder that the work to improve perinatal care in Colorado shows up in families’ lives every day.

That’s what this moment in Colorado is about. With the implementation of Colorado SB24-175, our state has made a meaningful investment in maternal and infant health. Through this work, CPCQC is now partnering with all 49 birthing hospitals in the state, creating a shared effort to strengthen care for families across Colorado.

As a practicing nurse-midwife in Colorado, I see every day how much coordinated, system-level work matters. When hospital teams, clinicians, and community partners are aligned, families experience the difference, now and into the future.

Over the past few months, CPCQC has released several new statewide data reports to help illuminate the current landscape of maternal and infant care in Colorado. We’ve also published practical tools for hospital teams, including a Field Guide and Sustainability Toolkit for Perinatal Substance Use, the Maternal Quality and Safety Toolkit for Rural and Frontier Hospitals, and an Implementation Guide for Colorado’s Quick Care Card.

We’re strengthening the bridge between maternal and infant care with the launch of our first infant-focused quality initiative, NEST Safe Sleep, addressing a leading cause of preventable infant death.

This momentum will come together on April 28 at our statewide forum, where clinical expertise, public health perspective, and the experiences of Colorado families will help guide what comes next.

Colorado is showing what’s possible when hospitals, clinicians, and communities work side by side. We’re rising together to give every family the best start.

IMPACT BH Expands to Support Improved Maternal and Infant Behavioral Health Outcomes Across Colorado

In 2022, CPCQC and the Colorado Behavioral Health Administration launched the IMprove Perinatal Access, Coordination, and Treatment for Behavioral Health (IMPACT BH) program to help Colorado communities strengthen and integrate local perinatal behavioral health systems. The program addresses longstanding gaps in identification, referral, and access to care for pregnant and postpartum women—particularly in rural Colorado.

From the outset, IMPACT BH was grounded in a clear understanding: investing in perinatal behavioral health is foundational to healthy families, strong communities, and improved maternal outcomes. When perinatal women receive timely, appropriate behavioral health support, the benefits extend beyond the mother—strengthening the mother–infant dyad, supporting infant development, and creating positive ripple effects across families and communities.

Since its launch, IMPACT BH has supported perinatal system-building efforts in eight counties across Colorado’s Western Slope and I-70 corridor. These early investments have strengthened local partnerships, expanded navigation services, and built more coordinated pathways to care for perinatal women and families.

Why This Work Remains Critical

New and emerging data continue to underscore the urgency of this work:

• Approximately one in three births in Colorado involves a mother with a diagnosed mental health condition—most commonly depression or anxiety.
• Nearly two-thirds of perinatal women in Colorado with a mental health diagnosis do not receive services during or after pregnancy.
• Suicide and unintentional overdose were the leading causes of maternal mortality in Colorado between 2016 and 2020
• Rural, Black, and Native perinatal women in Colorado face increased risk for severe maternal morbidity (SMM)

Partnering to Expand IMPACT BH to New Communities 

CPCQC is proud to announce the continued expansion of IMPACT BH in partnership with the Colorado Behavioral Health Administration. Beginning July 1, 2026, the program aims to support three to five additional communities through the 12-month collective impact program.

IMPACT BH will continue offering grant funding to expand local perinatal navigation services, helping ensure pregnant and postpartum women—and their infants— access vital supports. Funding may support peer support providers, community health workers, doulas, home visitors, and other trusted community-based roles that help families successfully connect to care.

Beginning in FY27, learning collaboratives will serve as a core strategy of IMPACT BH. These collaboratives will convene local clinical providers, community-based organizations, public health agencies, and other partners to strengthen local perinatal behavioral health systems. Participating communities will focus on improving identification, referral, and care for perinatal mental health and substance use needs, supported by targeted quality improvement coaching.

Apply Now to Join the IMPACT BH Community 

CPCQC will accept Expressions of Interest (EOI) from interested communities from Monday, February 2nd through Friday, March 6th. Interested communities must submit a single collective EOI to be considered for the next program cycle, beginning on July 1, 2026. 

To learn more and apply, please review the IMPACT BH Expression of Interest below:

Press Release

FOR IMMEDIATE RELEASE

Date: Monday, May 21, 2025

Contact: Aly Boral, CPCQC Integrated Care Program Manager, aboral@cpcqc.org 

IMproving Perinatal Access, Coordination, and Treatment Behavioral Health (IMPACT BH) Program to Enhance Perinatal Behavioral Health Services in New Counties

The Colorado Perinatal Care Quality Collaborative (CPCQC) is proud to announce the launch of the IMPACT BH program in new counties beginning July 1, 2025. 

Behavioral health plays a central role in perinatal health. Unintentional overdose and suicide accounted for 39% of pregnancy-associated deaths in Colorado from 2016 to 2020, according to the Colorado Maternal Mortality Review Committee (MMRC). In response, CPCQC launched the IMprove Perinatal Access, Coordination, and Treatment for Behavioral Health (IMPACT BH) program in partnership with the Colorado Behavioral Health Administration to serve the 1 in 5 people who are affected by perinatal mental health conditions (PMHCs). 

IMprove Perinatal Access, Coordination, and Treatment: Behavioral Health (IMPACT BH) helps communities strengthen and integrate their local perinatal behavioral health services. The program: enhances a diversity of local perinatal navigation and peer support services; provides perinatal mental health and substance use training to local healthcare providers; and helps integrate local perinatal behavioral health services through improved coordination, communication, and trust. Collectively, IMPACT BH counties work to ensure that no local mother, infant, or family falls through the cracks. 

“CPCQC is excited to introduce the IMPACT BH program to new counties” says Kylie Hibshman, Director of Integrated Behavioral Health at CPCQC. ”Together with our partners, we’re working to ensure that perinatal people access safe, effective, and respectful care from conception through one year postpartum.”