NHS leaders in England say maternity care is "not fit for purpose" and warn up to 20 smaller consultant-led units may need to close to ensure safer services.
The NHS Alliance, which represents health managers, told the BBC that consolidating maternity services is necessary because staffing problems and rising caesarean rates have made smaller units potentially unsafe. It estimates that up to 20 of England's 155 consultant-led maternity units could face closure, particularly those delivering 1,500 to 2,000 babies annually in rural and coastal areas.
Matthew Hopkins, director of the NHS Alliance's acute and ambulance network, said: "Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care." He stressed that any local plans must involve NHS leaders, clinical staff, patients and communities, and that politicians "must have the courage to make the case for patient safety".
The NHS Alliance identified staffing shortages as a critical issue. Smaller units struggle to maintain safe 24-hour coverage of midwives and consultants such as obstetricians. The organisation also flagged that emergency caesarean rates have risen (BBC analysis shows one in four births in England is now emergency caesarean), straining operating theatres and beds in outdated buildings. The taskforce into neonatal and maternity care must address these gaps, the alliance said, alongside disparities in care. A June review by Baroness Valerie Amos found racism and discrimination "embedded throughout the system", with worse outcomes in deprived communities and raised maternity mortality rates for Black and Asian women.
The Department of Health and Social Care responded that "every woman deserves safe maternity care" and the taskforce "will deliver the reforms needed to ensure services meet the needs of women and families now and in the future".
The Royal College of Obstetricians and Gynaecologists called for "other solutions" to prevent closures. Dr Alison Wright, the college's president, urged the government to commit to "expanding the maternity workforce to ensure safe staffing levels, along with investment in training and retention of dedicated staff". She stressed that smaller units in rural and coastal areas "must be recognised and supported".
A real-world example emerged in August when Devon's Barnstaple Hospital suspended standard birthing services due to staffing issues, forcing pregnant mothers to travel 53 miles to Exeter. The North Devon maternity facility remains suspended. Catherine Mchomvu, chief executive of the Devon Antenatal Family Centre, warned that closures would undermine continuity of care, as women would not see the same healthcare team across antenatal and postnatal experiences.