Dozens of maternity units are being closed and more will be axed unless the Government steps in to protect the smaller services which give pregnant women greater chance of a normal delivery or a home birth.

A report from the National Childbirth Trust, which was sent to the House of Lords last week as it took evidence on maternity services, says the midwives' shortage is forcing staff out of small towns and villages and into larger specialist hospitals.

They say there is no clear rationale behind the piecemeal closure and reconfiguration of dozens of units and services across England and Wales, which reduces a woman's chances of having access to care close to home.

A survey carried out by the NCT questioned 105 of their representatives around the country to find out how services had changed between 1998 and 2001. They found that 43 areas had seen a withdrawal of some local services, and in 21 of those it was the result of a unit closing.

This backs up evidence from a report by the Royal College of Obstetricians and Gynaecologists who carried out a survey in 1999 and found that, out of the country's 250 maternity units, 31 were likely to close within the next five years, largely because of reorganisation and staff shortages.

Midwifery vacancy rates are at a record level, and the Government is not sure it will meet its pledge to recruit 2,000 extra midwives by 2004, and a total of 10,000 over the next seven years. For many hospitals, it is becoming a vicious circle. As staff leave, extra pressure is put on the rest, many of whom then consider quitting because their workload becomes too great.

Mary Newburn, head of policy research at the NCT, is worried that some pioneering schemes, which had resulted in more women getting to know their midwife well and having non-surgical deliveries, are being closed to shore up the hospital services.

She feels this might exacerbate, not help, the staffing shortage. 'Many midwives want to work in schemes where they build up relationships with their patients, and where women have control over their birth. They want to give them one-to-one support during labour.

'But very often services are cut without any local people being involved in discussions. All the good schemes which have been set up to encourage normal birth and breastfeeding seem to have taken a hard knock.'