3,000 midwives needed to give all women choice of birth at home

Expectant mothers will be able to see a midwife directly instead of going through their GP and by 2009 will be able to opt for a home birth.

Experts warned that the changes would require a huge expansion in services and 3,000 extra midwives.

Health Secretary Patricia Hewitt promised that by 2009 all women will be able to choose to give birth at home, in a unit led by midwives or in a hospital department under the care of a consultant.

But financial problems in the NHS have left many midwifery units unable to recruit more staff and newly qualified midwives unable to get jobs.

The Evening Standard has found London hospitals were forced to turn away mothers in labour for a total of 300 hours in one year because they were full.

Mrs Hewitt acknowledged that maternity services will have to be given a higher priority but said some hospitals such as Guy's and St Thomas' were already offering many women a choice of where to give birth.

She warned that where women opted to give birth at home or in a midwife-led unit, where epidural pain relief is not available, ambulances must be available to transfer patients to hospital if anything goes wrong.

Currently, one in 50 births takes place at home.

Ministers want services to be planned better so that women have access to midwives earlier in their pregnancy, which is known to help prevent complications.

Mrs Hewitt said community midwife services should be advertised alongside pregnancy testing kits in chemists.

She said: "Our commitment is to deliver 'gold standard' maternity services for women.

"In practice, this will mean that care is designed around the needs of women and their partners from the very beginning of a pregnancy through to providing much better and more personal post-natal care."

The Royal College of Midwives has calculated that England will need the equivalent of 22,000 fulltime NHS midwives, 3,000 more than the current total.

Dame Karlene Davis, the college's general secretary, said: "Although the number of midwives-is up and spending is up too, it is also true that both the proportion of the NHS workforce represented by midwives and the share of the NHS budget being spent on maternity services have dropped since 1997."

More consultant obstetricians and gynaecologists will also be needed in hospitals.

Professor Allan Templeton, president of the Royal College of Obstetricians and Gynaecologists, said: "There is the pressing need for us to refocus our attention to ensure that safety at birth is never compromised but, where possible, normal childbirth is encouraged.

"If we are to provide mothers with more choice, then this can only happen when our places of birth are fully staffed. We will need more consultants and midwives if both women's expectations and standards of care are to continue to improve."

Shadow health secretaryAndrew Lansley said: "What fails to make sense is how Patricia Hewitt thinks she will deliver it.

"Last year, Labour cut the number of midwives and this year 43 maternity units are under threat of closure.

"Health minister Ivan Lewis and Labour Party chair Hazel Blears have been out campaigning locally to save maternity services while hypocritically defending the national policy resulting in closures elsewhere."