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By midwife Katherine Mabey


Midwife Katherine Mabey

What is Birth Outside the Box?

Derby Birth Outside the Box team is an informal forum at Royal Derby Hospital which aims to bring midwives, doctors and other team members together, with the common goal of increasing rates of physiological birth and improving women’s experience for all births regardless of mode of birth or where they occur. Following several successful projects such as changing the way beds are used and implementing an aromatherapy training package, the group was looking for a project which would appeal beyond the midwifery team.

Members of staff are encouraged to lie on the theatre table

Inspired by the work of #MatExp on social media, especially #LithotomyChallenge, we decided to focus on women who transfer to theatre with the question; ‘How could we make theatres less frightening for women, and a better birth environment for mothers and babies?’

The project developed to become #TheatreChallenge whereby staff members are encouraged to lie on the theatre table and reflect on how this makes them feel. Then they are encouraged to make a pledge regarding one aspect of their experience which they would change to improve for women using the service.

An integral feature of #TheatreChallenge is the use of social media to allow staff to explore and share ideas both within the security of a private facebook forum and also via twitter to encourage debate in other units and introduce new ideas to our maternity unit.

The project was publicised using this 2 minute film (below) showing the journey to theatre from the woman’s perspective.

This generated a huge number of suggestions for changes which could be grouped into 8 themes: Skin to skin in theatre, Optimal cord clamping, Dignity, Keeping families together, Babies that go to NICU, Theatre Birth Plans, Theatre Environment, & Teamwork.

These eight films were then used to focus discussion on specific areas and a display on labour ward encouraged staff to think of new ideas to change practice.

We quickly realised that to implement change relating to any of the 8 themes would rely on the WHOLE TEAM and this became a key feature of the project. Initial challenges of gaining permission to use an active theatre space without causing disruption and the unpredictability of labour ward activity meant some careful negotiations took place but there was nothing which could not be resolved.

Maternity theatre team

Ripples have spread beyond our maternity service

The original plan was to run the project over one week, but we continued for much longer, as so many staff wish to participate. We have involved midwives, managers, doctors, anaesthetists, housekeepers & HCAs. We’ve even had hospital governors on the table! The simplicity of the project, with its powerful impact has really engaged people and #TheatreChallenge has proved extremely popular. I am presenting at audit meetings, and I recently presented with Gill Phillips and Florence Wilcocks at two Picker workshops. The ripples have spread far beyond our maternity service in Derby with other maternity units across the country discussing the challenge, many keen to implement something similar. Check out the Tweets below!

We’ve had lots of wonderful pledges and feedback from women. Staff are reporting that the atmosphere in theatres is changing and many of the ideas put forward are already being explored although we plan to attend labour ward forum with an action plan to try to formally integrate some of the ideas into routine practice.

#TheatreChallenge has been a project about building team relationships and reviewing working practices but has also been a tool to give staff a voice no matter what their background. Every contribution is considered valid. Everyone has a part to play in patient experience.

Katherine writes a related blog here:, and can also be found on Twitter @KatherineMabey 

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