Hospital bosses fear that pregnant women could be denied a home birth or water birth in the event of an exodus of midwives triggered by compulsory Covid vaccination for NHS staff.
There are concerns that mothers-to-be could also be unable to have their baby at their local hospital as already understaffed maternity units in England struggle to cope with the loss of up to 2,000 midwives.
Others may have their child delivered with the help of a doctor rather than a midwife, or be assisted during their birth by a midwife who is simultaneously looking after another labouring woman, they said.
Hospital chiefs have described preparing to scale back the care they offer to expectant mothers from 1 April, the deadline for frontline staff to be double-vaccinated or lose their jobs.
Hospitals in England are already 2,500 midwives short of the number they need to give every pregnant woman the right standard of care, the Commons health committee has estimated. Midwives and nurses are the two groups of frontline staff most likely to resist getting jabbed, NHS chiefs said.
Last week the Bishop of London, Sarah Mullally, a former chief nursing officer, told a House of Lords debate that as many as 12.5% of all midwives in London may lose their jobs because of their determination not to get vaccinated.
There has been speculation that the government is to delay introducing the policy, though it has insisted the date will not change. The medical royal colleges representing midwives, nurses and GPs have urged ministers to delay.
NHS insiders told the Guardian privately of their concern that women may not be able to exercise their rights under the NHS constitution to decide whether to give birth at home, in a midwife-led unit or in a hospital labour ward. Maternity guidelines say women should have the support of one midwife with them throughout their labour.
“The truth is that we won’t cope [if many midwives leave rather than get vaccinated]. It’ll be much harder to have a home birth and women may have to resort to [hiring] doulas,” said an executive at one hospital where many midwives remain unvaccinated 10 days before the 3 February cutoff set by NHS England for receiving a first dose.
Trainee midwives will also have to play a bigger role to help compensate for the loss of experienced, fully trained colleagues, the executive added.
The chief executive of another NHS trust said: “[The loss of midwives means] neighbouring units would have to do mutual aid when busy, so yes, more women will be asked to change their hospital of choice at the last minute.
“Hospitals will also have less capacity to do antenatal and postnatal appointments and midwife birthing units will be compromised because you would pull staff on to labour wards.”
Barking, Havering and Redbridge trust in London recently said its existing lack of midwives combined with a likely loss linked to mandatory jabs will pose a major challenge.
Matthew Trainer, its chief executive, told a board meeting that the birth centre at its Queen’s hospital in Romford, Essex, which is already closed because of the midwife shortage, would have to remain shut “if we lost another chunk of midwives” as a result of the new requirement.
Another senior NHS figure said: “From conversations I’ve had, I think that more than half of all maternity units will have difficulty maintaining their normal maternity services.”
Chris Hopson, the chief executive of hospital body NHS Providers, last month cited the case of an unnamed maternity unit that is facing the potential loss of as many as 40 midwives.
The Department of Health and Social Care defended the policy and gave no hint of a delay. A spokesperson said: “Health and social care workers look after the most vulnerable people in society, who could face serious health consequences if exposed to the virus.
“Ensuring staff are vaccinated is the right thing to do to protect patients and those in care. The vast majority of NHS staff have had the vaccine which is our best defence against Covid-19.”