A staffing crisis is threatening the viability of maternity services across England, with NHS trusts struggling to maintain adequate physician and midwife coverage at smaller hospitals. According to NHS Alliance leadership, approximately 20 of the country’s 155 maternity units could face closure, with two units in Barnstaple and Yeovil already having suspended services and another facility in Northern Ireland planning permanent closure.
The challenges facing these units stem from multiple interconnected factors. Rural and coastal hospitals prove particularly vulnerable due to their inability to shift maternity services to alternative nearby facilities. Population shifts have also contributed, with the Royal Free hospital in North London announcing a permanent closure after local demand dropped roughly 30% over seven years. However, staffing constraints remain the primary concern for many facilities, as obstetrician shortages make it impossible to maintain safe service levels.
A significant driver of these pressures is the dramatic increase in caesarean deliveries. The proportion of births by caesarean section rose from 31% in 2019 to 45% in 2024, making it the first year that such deliveries outnumbered vaginal births in England. This shift reflects changes in clinical practice aimed at improving safety outcomes and expanding patient choice, alongside demographic trends showing older average parental age. Some evidence suggests women may also be requesting caesarean delivery due to concerns about quality of care during vaginal births, prompted by negative media coverage of NHS maternity services and documented cases of substandard care.
Experts point to the need for systemic changes to address the crisis. Rather than building larger obstetric facilities designed for higher caesarean rates, advocates argue the NHS should invest in community-based and continuous midwifery care alongside specialized obstetric services for complicated cases. Training challenges also loom, as trainee midwives struggle to gain adequate experience with complex vaginal births, potentially reinforcing the cycle of increasing caesarean rates.
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