As many as a third of NHS maternity units should close and be replaced with a smaller number of large facilities where consultants are available around the clock, a senior childbirth specialist has said.
Dr Tony Falconer, the president of the Royal College of Obstetricians and Gynaecologists, argued that centralising childbirth would improve levels of care for expectant mothers.
In an interview with the Observer, he said some urban areas such as London had too many obstetric units and called for a regime of rationalisation.
"One has to embrace the concept of fewer consultant-based units which provide greater intensity of care. There are quite a few small units and their viability, I guess, you have to question," Dr Falconer said.
The health leader admitted that closing units would be unpopular and mean that some pregnant women would have to travel further for care. But argued that a smaller number or consultant-based facilities would provide higher levels of care at all times.
Dr Falconer said the larger, more specialised units were needed because childbirth was becoming more complex due to rising maternal obesity and a growing numbers of older mothers. He added that under the existing maternity care structure, there are too few consultants to guarantee high quality care for everyone.
Under the rationalisation programme, a fewer number of units would handle 5,000 to 6,000 births a year, Dr Falconer said.
Around 94% of births currently take place at hospitals, but he said the number could be reduced through the expansion of home births and midwife-led birthing units based at or near hospitals. This would also lessen the need for so many obstetric units.
The senior childbirth specialist cited the example of Manchester, where four hospitals lost their obstetric units after a review in 2006.
Professor Cathy Warwick, general secretary of the Royal College of Midwives, backed the calls but said they could raise fears that larger units could become "baby factories". She said: "We do need to rationalise because in future smaller obstetric units won't be affordable."
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