Matthew Hopkins, the NHS Alliance's director for acute care, said centralising childbirth services into fewer hospitals was "inevitable" and "the right thing", but would trigger a political backlash. He told the Guardian that smaller units delivering 1,500 to 2,000 babies a year are becoming unsustainable because of a widespread shortage of obstetricians and a sharp rise in caesarean sections.
Up to 20 of England's 155 consultant-led maternity units could shut or change role, he said, urging ministers and MPs to show "courage" in backing changes even though mothers in affected areas would have to travel further to give birth. Many of the units most at risk are in rural or coastal areas, where staffing is particularly challenging.
"We are calling for a thorough appraisal of maternity services and where they need to be located because the current configuration is not fit for purpose," Hopkins said. Consolidation at fewer sites represented "doing the right thing ... the safe thing for patients". He added that hospital bosses fear the government's maternity taskforce, due to report before Christmas, will be "tokenistic" unless it addresses the rise in caesarean sections, which require more staff and operating theatres.
His comments drew immediate criticism. Hannah Leonard, chief policy officer of the Royal College of Midwives, said: "Women and families rely on local maternity units to be there when they need them, and we must ensure there are high-quality services close to home." Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, said: "There are other solutions to our workforce challenges that are far safer than closing maternity units, and these should be explored."
Liberal Democrat health spokesperson Helen Morgan said: "Forcing women in labour to travel an hour or more to the nearest hospital is unsafe, unacceptable, and leaves local communities abandoned."
The warning comes as caesarean rates rose from 33% of births in England in 2020 to 45% last year. The most recent MBRRACE-UK report found some women who died during childbirth between 2022 and 2024 did so because their caesarean was delayed or postponed because an obstetric surgeon or operating theatre was not available.
Hopkins is not the first senior figure to argue for reconfiguration. Professor Marian Knight of the University of Oxford has suggested the NHS consider "consolidation into fewer, bigger [maternity] units" to manage the surge in C-sections. A government-commissioned review by Valerie Amos in June found key challenges included "poor infrastructure" and "too little (political) backing for difficult reconfiguration decisions".
The comments also come as the Royal Devon university healthcare NHS foundation trust was expected to decide this week whether the maternity unit at North Devon district hospital in Barnstaple, shut since August due to understaffing, can safely reopen. An estimated 194 women have had their child in Exeter, 43 miles from Barnstaple, because of the closure. The Yeovil unit reopened earlier this year after being shut for almost 12 months, and the unit at Daisy Hill hospital in Newry was earmarked for closure last month.
The Department of Health and Social Care said: "Every woman deserves safe maternity care, and the Secretary of State has made this issue a personal priority. Through the national maternity and neonatal taskforce, that she is chairing, this government will deliver the reforms needed to ensure services meet the needs of women and families now and in the future."