This project will generate early evidence about the impact of midwifery integration in the nation’s largest public health system on maternal health care, outcomes, and equity and create a strategic plan for achieving even fuller integration. The research team will: 1) conduct interviews, focus groups, site visits, and surveys to provide an overview of the strengths and challenges of maternity care services throughout NYC Health + Hospitals’ facilities and to describe the potential impact of fuller midwifery integration; 2) explore adapting the Midwifery Integration Scoring System (MISS), which determines how midwifery integration at the state level can impact population-level outcomes, for health systems in New York and beyond; and 3) assess evidence-based practices of respectful birthing care and principles of midwifery care by piloting the Undisturbed Labor and Birth (U-LaB) Index at six sites in the city. The team will then create a strategic action plan for fully integrating midwifery care within NYC Health + Hospitals and disseminate lessons nationally. Throughout the project, a nine-person steering council will provide guidance and ensure accountability.