Up to 20 maternity units across England may need to close or change their roles amid growing concerns over staffing shortages and increasing caesarean section rates, NHS representatives have warned. Matthew Hopkins, director for acute care at the NHS Alliance, described the centralisation of childbirth services into fewer hospitals as “inevitable” and necessary to maintain safe care for mothers and babies.
Hopkins emphasized that many smaller maternity units, particularly those delivering between 1,500 and 2,000 babies annually, are becoming unsustainable due to a widespread lack of consultant obstetricians and a sharp rise in both planned and emergency C-sections in recent years. These changes are most pressing in rural and coastal areas, where staffing difficulties are often more acute. He urged government ministers and MPs to show “courage” in supporting major service reconfigurations, which would require some expectant mothers to travel farther to access care.
“The current configuration is not fit for purpose,” Hopkins stated, warning that hospital units with insufficient staffing cannot provide the 24/7 coverage necessary to ensure patient safety. He also expressed concern that an upcoming government maternity taskforce report, expected before Christmas, might fail to address the fundamental, strategic issues, particularly the need for increased resources to manage the rising demand for operating theatres and skilled staff associated with higher C-section rates.
However, the proposal sparked immediate opposition from professionals within the maternity care field. Hannah Leonard, chief policy officer at the Royal College of Midwives, stressed the importance of maintaining local access, saying, “Women and families rely on local maternity units to be there when they need them.” Similarly, Dr. Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, argued that alternative solutions exist to address workforce challenges without resorting to closures.
The debate comes amid ongoing uncertainty at several hospital trusts. For example, the Royal Devon University Healthcare NHS Foundation Trust was expected to decide whether the maternity unit at North Devon District Hospital in Barnstaple, which temporarily closed in August due to staffing shortages, can safely reopen. The closure required mothers from north Devon to travel approximately 43 miles to Exeter to give birth, a situation that prompted criticism from politicians. Helen Morgan, the Liberal Democrat health spokesperson, described the prospect of closing rural units as “unsafe” and “unacceptable,” emphasizing the risk to local communities.
Experts outside the NHS Alliance have also called for reconsideration of service configurations. Professor Marian Knight, an Oxford University maternal health specialist, has highlighted the increasing C-section rate—from 33% in 2020 to 45% in 2025—and the associated pressures on maternity services. She suggested consolidating care into fewer, larger units may be necessary to manage demand safely.
Recent reports, including the MBRRACE-UK maternal mortality review, noted deaths related to delayed or postponed C-sections due to lack of staff or operating theatres, underscoring concerns about service capacity. Lady Amos, who conducted a government-commissioned maternity care review earlier this year, identified poor infrastructure and insufficient political support for difficult changes as key barriers.
As discussions continue, government health officials have yet to provide a formal response to calls for restructuring maternity services, which many view as a critical step to safeguarding care quality amid evolving challenges.