Home » What is PPI? » Involvement in practice » PPI Case studies » Women’s and maternity » Active Birth Centre (ABC)

Robust clinical evidence supports the establishment of Alongside Midwife-Led Units, co-located to Obstetric-Led Units with a shared philosophy and understanding of normal birth.

This project aims to embed and sustain the Active Birth Centre (ABC) Alongside Midwife-Led Unit as an alternative and viable birthplace option for all women with low risk pregnancies birthing within BHSCT Maternity Service, therefore normalising birth and decreasing the likelihood of intervention.

Engagement with service users and families is essential to the success of this project and ensuring we connect our communities with the ABC birthplace option and raising the profile of midwife-led services within BHSCT.

At what level did the PPI take place?

  • One to one
  • Service development/delivery
  • Commissioning/policy

PPI helped the project to

  • Improve efficiency of a service
  • Improve quality
  • Improve safety
  • Inform commissioning


Women at low risk of complications should be given the choice to birth in any of the four different birth settings; home, freestanding midwife-led unit, alongside midwife-led unit or an obstetric unit.
The ABC was first opened in 2015 providing access to an Alongside Midwife-Led Unit for women birthing within BHSCT. However, activity levels for the ABC were consistently lower than the anticipated levels, there was an absence of standard operating procedures and pathways and not all women eligible for the unit were being offered, nor were they aware of, the opportunity to labour and birth in the unit.

It was recognised that care needed to be seamless and women centered and not systems led. Service users indicated a strong desire to see full utilisation of the unit thus providing additional choice for women within the current maternity service and also in preparation for the opening of a new maternity hospital in 2021.

The project commenced in October 2018 and acknowledged the importance of a fluid engagement process and shared ownership, led jointly by service users, families and staff to ensure the embedding and sustainability of the ABC as a ‘true’ Alongside Midwife-Led Unit.

The project is supported by the Maternity Service Liaison Committee (MSLC), project steering group and project operational group, each with service user representation and further engagement with service users is enabled by ongoing activity on social media platforms.

Aim of involvement

  • Creation of a positive birth environment to support the philosophy of natural childbirth including redesign and branding of the unit, signage, logo design and purchase of birthing aids.
  • Participation of service users, including antenatal inpatients in art workshops facilitated to explore ideas and create and design bespoke ‘felt’ artwork for the ABC birthing rooms.
  • Benchmarking with similar Alongside Midwife-Led Units.
  • Identification of measures and monitoring by means of continuous data collection, analysis, reporting and presentation of successful outcomes.
  • Connecting with our communities and co-design of promotional materials to raise the profile of the ABC including information leaflets, posters and ‘pop-up’ banners.
  • Partnership focus in the co-production of standard operating procedures and evidence based care pathways for the ABC, thus involving those who use our service in the design and delivery of their care.
  • Facilitated tours of ABC for women interested in birthing in our alongside midwife-led unit and providing opportunity for discussion and birth planning.
  • Utilising Appreciative Inquiry (AI) to connect, engage and inspire staff, women and families, linking the past, the present and the future to discover the positive core of the ABC birthplace option.
  • Seeking ‘real time’ feedback from mothers who have laboured and birthed in the ABC in relation to the environment and experience within the unit.
  • Opportunity for shared learning, locally, regionally and nationally.
  • Evolvement of a Model of Care embedded in current Maternity Service and transferrable into the new Maternity Build.

Method(s) of Involvement

  • Formalised involvement on strategic group
  • Steering groups
  • Workshop
  • Appreciative Inquiry
  • Focus groups
  • Questionnaires
  • Information documents


  • Adherence to GDPR in respect of communication processes with service users.
  • Ensuring those involved do not just focus narrowly on their own experiences but are representative of the broader group of women.
  • Providing opportunity for participation from different backgrounds and those more difficult to reach groups.
  • Making an effort to ensure that meetings remained accessible for all participants, which can be difficult.

Outcomes due to involvement

  • Provision of a viable and sustainable alongside midwife-led intrapartum service supported by the co-production of local standard operating procedures and pathways.
  • Increased percentage of mothers birthing in BHSCT midwife-led units (Alongside and Freestanding), thus normalising birth, decreasing medical intervention and improving birth outcomes for mothers and babies, which has economic, social and health benefits for the woman and her family. Utilisation of real time data linked to goals to learn and improve at every level.
  • Provision of a ‘home from home’ birth environment which supports women to mobilise and adopt comfortable positions with the use of appropriate birthing aids and inspires women to personalise their space whilst remaining within the same environment until postnatal transfer home as well as facilitating birth companions to stay throughout.
  • Attainment of a higher level of service user satisfaction and positive birth experience, resulting in reduced complaints and increased compliments.
  • Connecting our communities with the ABC birthplace option, robust communication links with all stakeholders, equity of access and raising the profile of midwife-led services within BHSCT through the co-design of promotional materials.
  • A sustainable midwife-led intrapartum service, transferrable into the new maternity build, providing scope for a future midwife-led antenatal, intrapartum and postnatal continuity model of care which is women centered and not systems led.



Further Information

Gillian Morrow, ABC Project Lead Midwife

Belfast Health and Social Care Trust, Maternity Service

Email: gillian.morrow@belfasttrust.hscni.net

Telephone: 07824313408