Abstract: Background: Rural and remote birthing services have been closing for several decades. The rationale behind these closures are often concerns about safety, economic resources, and professional indemnity. Many developed nations have experienced similar trends in closure of rural birthing services. These closures have considerable implications for patients, communities, clinical workforce and health services in rural areas. Many non-metropolitan community members continue to lobby for the reinstatement of local birthing care as they seek safe, equitable service access and high quality care. After many years of closures, the state of Queensland in Australia has seen increased interest and success in restarting remote birthing services. There are significant challenges to be overcome for any birthing service to recommence, including: ensuring appropriately skilled workforce, consideration of community expectations, equipment availability, navigating health system requirements and the politics of the time. Those wishing to reopen a rural birthing service would benefit from understanding the essential tasks and processes required to restart services and the enablers and barriers to achieving this. Analysing and collating this data from a number of services into a ‘toolkit’ may assist the direction of other remote health services seeking to reopen birthing care after a period of closure. Aim: This paper outlines results from the first case study of a reopened birthing service in a remote northern Queensland health service. Methods: A qualitative, case study approach was employed to investigate key enablers, barriers, tasks and processes associated with reopening a remote birthing service. Purposive sampling was used to identify key stakeholders and actors throughout the system including clinical and support staff, local service managers, community advocates and relevant district managers. These actors were invited to participate in individual semi-structured, in-depth interviews during which they discussed the experience of reopening the birthing service from their perspective; highlighting enablers, challenges, and important influences. Interviews were transcribed and analysed using an iterative, thematic technique. Results: Qualitative analysis of the results found key enablers, barriers, tasks and processes can be categorised into thematic groups; the largest of which were associated with workforce, funding and safety. These will be discussed in light of the timeline for reopening: from initial groundwork required to start the process, service reopening and then ongoing concerns after the service recommences. The contextual factors surrounding the service recommencing are presented from community, staff and political perspectives.