St George's Maternity Unit in Tooting, SW London, must implement significant cost-saving measures due to a financial deficit. There has been recent discussion about the Birth Centre being closed as a result. We, the staff and families who have worked, given birth or plan to birth there, declare that the Carmen Birth Centre offers a valuable, cost-effective service which cannot be replicated by the Delivery Suite or by being sent to another unit many miles away. The petitioners agree with the compiled evidence which follows and request that the decision to close the Birth centre is not approved by the GESH Trust Board. We welcome the plethora of staff suggestions to enable this birthing place and workforce to be used in more flexible ways to support the wider maternity services.

Evidence:

The NICE Intrapartum Care guideline NG235 (2023) emphasises the importance of informing all women of their right to choose any birth setting, including home, midwifery units, or obstetric units. It further recommends supporting women in their preferred choice of birth setting.

1. Evidence-Based Benefits of a Birth Centre:

A substantial body of evidence highlights that for low-risk women, planning to give birth in a midwife-led setting is associated with significantly better clinical and emotional outcomes. The Birthplace in England Study (2011) demonstrated that healthy women, particularly those having their first baby, experience fewer medical interventions such as epidurals, instrumental births, and episiotomy (cut) when giving birth in midwifery-led units compared to obstetric units, without any increase in adverse outcomes for their babies. For women who are birthing again, the benefits were even more pronounced, with lower intervention rates and a higher rate of vaginal birth thus reducing birth trauma.

The lifelong psychological impact of childbirth was recognised by the All-Party Parliamentary Group on Birth Trauma report in 2024. Traumatic birth experience is strongly linked to unnecessary intervention, lack of choice, de-personalised care and can have long-lasting mental health consequences. Post-traumatic stress disorder following childbirth affects 3-5% of women in UK, with higher rates among those who undergo emergency caesareans, instrumental deliveries, or experience disrespectful care. Additionally, postnatal depression, anxiety, and difficulties bonding with their baby, are more prevalent among women who felt a lack of control over their birth experience.

Midwifery-led care offers a safer alternative for many women, helping to build trust and reduce fear. The calm and empowering environment of a birth centre has been shown to lower cortisol levels, increasing the labour hormone oxytocin to support physiological (natural) labour.

The Birthplace Study and subsequent research have also shown that babies born via elective or emergency caesarean are more likely to experience respiratory complications, whilst instrumental births increase the risk of birth injuries. By promoting physiological birth and minimising unnecessary interventions, midwifery-led care not only protects maternal wellbeing but also enhances neonatal safety.

2. Cost Effectiveness

Operating a Birth Centre is significantly more cost-effective for low-risk births, driven by both immediate and long-term savings across the maternity care pathway.

One of the primary factors contributing to this cost-effectiveness is the reduced use of high-cost medical interventions. Midwifery-led care models consistently result in fewer inductions, caesarean sections, and operative deliveries, all of which require greater use of resources including the operating theatre, anaesthetic teams, recovery beds, medications and extended hospital stays. Additionally, there are fewer admissions to neonatal intensive care, further decreasing the financial burden. A cost analysis by Schroeder et al. (2011) found that births in midwifery units were less expensive per case than those in obstetric units for low-risk pregnancies, even when taking transfers into account.

Cost savings also extend into the postnatal period and beyond. Women who experience uncomplicated vaginal births typically recover more quickly, requiring fewer postnatal visits or interventions from GPs and community services. These women are also more likely to successfully initiate and continue breastfeeding, which is linked to lower rates of infant illness and consequently reduced healthcare costs in the first year of life (Renfrew et al, 2012).

Moreover, supporting physiological birth and reducing the incidence of traumatic birth experiences has substantial implications for mental health services. Avoiding psychological harm reduces demand on perinatal mental health pathways and decreases the likelihood of women opting for elective caesarean births in subsequent pregnancies, which carry further risks, higher costs and resources. Birth Centre midwives can work in any intrapartum area. They are highly skilled and adaptable midwives. At St George's they have proved this since the pandemic as they covered staff sickness across the service. The Birth Centre has a very low sickness rate and has no staff off on long-term sick, unlike other areas. The job satisfaction is second to none in the birth centre. 

Midwifery-led birth centres offer a cost-effective model of care by minimising expensive interventions, supporting faster recovery, promoting infant health, and reducing the long-term burden on both physical and mental health services. The staff are better retained due to high levels of job satisfaction. 

3. Carmen Birth Centre workload

Between 2020 and 2024, there has been a 15.7% decrease in total deliveries in our births. This trend reflects broader national patterns but has been compounded by local factors. Notably, in May 2023, the CQC published a report rating our maternity service as Inadequate. We lost many women late in their pregnancy to other units. At the end of 2023, two continuity of care teams previously supporting the Carmen Birth Centre were disbanded, with associated midwifery staff redeployed to other areas of service. The impact contributed to a continued decline in the proportion of births taking place at the Carmen Birth Centre, falling from 13.0% in 2020 to just 6.1% in 2024, compounded by 2 years of the pandemic when the Birth centre was frequently closed to divert the staff elsewhere, with a further decline to 5.0% observed in the early months of 2025. Therefore to use solely birth rate to inform an impact report does not reflect the workload of the birth centre midwives. 

The total number of recorded deliveries does not fully capture the overall activity within the Birth Centre, such as the hundreds of women every quarter who receive many hours of labour care before being transferred to the Delivery Suite, nor does it account for those triaged in the Birth Centre for spontaneous rupture of membranes, outpatient inductions, or membrane sweeps. While the total number of recorded births in the Birth Centre for 2024 was 236, this figure does not fully reflect the scope of activity carried out by the Birth Centre team. Between July and December 2024, the midwives provided care to 290 women. This highlights that the Birth Centre supports significantly more women than birth numbers alone suggest, including those who may have required hours of labour support, assessments, or interventions before transfer to Delivery Suite if needed.

4. Alternatives to Closure of Carmen Birth Centre

. Review of Day Assessment Unit (DAU) Weekend Operations: 
Activities on DAU during weekends, adjusting the operating hours/days. Cost saving in staff pay by closing on Sundays and bank holidays. 

. Maternity Helpline Operating Hours:
Currently under review - the Maternity Helpline at St George’s Hospital operates from 08:00 to 20:00. Proposal in discussion - to reduce the hours to 09:00 to 17:00. However, analysis of triage activity indicates that the period from 17:00 to 19:00 is typically the busiest, and a reduction in helpline hours could significantly impact the service’s ability to respond effectively. Could the Birth Centre staff assist during this time or the helpline be based in the Birth Centre? 
Could St George’s join the Surrey Heartlands Pregnancy Advice Line - a 24/7 maternity advice service serving Epsom & St Helier in collaboration with Royal Surrey County Hospital and Ashford & St Peter’s Hospital. 

. Flexibility of Birth Centre Midwives with their physiological skill set:
To optimise staffing, Birth Centre midwives could be included in the home birth on-call rota as the second midwife. Provide continuity of care for women planning to birth in the Carmen Birth Centre, beginning antenatal continuity from 36 weeks gestation for those choosing the low risk environment. This model would enhance personalised care and ensure efficient use of valuable skilled midwifery resources.

. Outpatient Clinic Space:
Maternity currently uses rooms at Nelson Health Centre and other Trust sites.  Evaluate whether these clinic spaces are used effectively. 

These proposals present cost-saving and service-enhancing alternatives that should be thoroughly evaluated prior to any final decision regarding the potential closure of the Carmen Birth Centre. A strategic reallocation of resources, improved continuity of care, and collaboration with existing regional services may collectively support a more sustainable model of maternity care.

In line with the most recent evidence-based guidelines, we have recently expanded the criteria for admission to the Carmen Birth Centre to broaden access and enhance choice regarding place of birth for more women. Additionally, we have invested in essential facility upgrades, including the installation of a new birthing pool in 2024 and the implementation of central fetal monitoring. These improvements enable midwives to conduct spontaneous rupture of membranes assessments and support outpatient induction of labour safely and effectively. Furthermore, we are in the process of introducing a continuity of care model for women opting to birth at the Birth Centre, commencing from 36 weeks gestation, which is known to improve both clinical and experiential outcomes. We predict that this expansion of workload could double the birth centre births by the end of 2025 with significant cost-savings in staff retention. 

It is also critical to acknowledge that some women choose the Birth Centre outside of medical recommendations. Removing this option risks pushing these women towards home birth without adequate clinical oversight, thereby increasing the potential for adverse outcomes at home.

In summary, maintaining the Birth Centre will be cost effective if we continue service development which will increase the birth rate overall, thus upholding our clinical standards and ensuring our commitment to person-centred care and choice. The closure of the Birth Centre would represent further regression of our maternity services, with negative implications for clinical outcomes, patient experience, staff morale and the future of the maternity service. As a Trust committed to delivering excellence, it is imperative that we safeguard the Birth Centre to secure the birthing experiences of thousands of families in years to come. 

References available on request.