Childbirth has leapt from the outer reaches of the NHS, where I and many other mothers have laboured in what I can only describe as the Dark Ages, on to centre stage. Ten ministers have broken ranks to campaign against the closure of maternity units in their constituencies. Patient groups are lining up to highlight the risks of longer travel times to fewer regional centres. The Tories are calling the moves “a desperate bid to save money” — although it used to be Tory policy that thrift was a good thing. It is, frankly, confusing.

Are these threatened maternity units as god-awful as the ones that I and my friends have suffered in? In which case, should we rue their demise? Will they be replaced by the warm, cosy corners evoked on Tuesday by the Government’s maternity czar (I kid you not), who offered a rosy vision of home births and small, midwife-led centres nestling alongside larger, regional centres with consultants 24/7? It is hard to say, since her report was almost entirely data-free. She also refused to say what distance between home and hospital was considered safe. Ivan Lewis, the minister responsible, did not even turn up to the launch of Sheila Shribman’s report. He, of course, has also been campaigning to save maternity units in his constituency.

If the minister is not convinced, should we be? The consensus that all closures are bad is almost certainly wrong. But government really has to do better in selling them to us. Announcing closures soon after trusts went into debt was bound to convince campaigners that the first was a consequence of the second, although it was not.

The plans for larger units are being driven partly by neonatal paediatricians who want to increase the survival rates of sick babies. In Manchester, they hope to save up to 30 lives a year by reducing the number of units in the city. In Nottingham, consultants want to merge two units that are only five miles apart, because they feel that they cannot provide adequate neonatal care if they are spread across two sites.

There is a logic to this. Consultant time is fixed. Junior-doctor time has been severely limited by the Working Time Directive. Consultants want trainees to be trainees, not amateur stand-ins. You can make better use of doctor time at delivery if you make patients travel farther. Several doctors have assured me that a longer journey rarely affects the outcome, because few deliveries are that quick. But it would be nice to know what the consensus is about how far is too far. We could have one unit treating all 722,000 births a year. But we don’t. So where do you stop?

Other doctors say that we have already gone too far: Britain already has the largest and most centralised maternity units in Europe. The largest French unit handles about 4,000 births a year, and the largest in Germany 3,000. Each of the units that would be merged in Leeds and Nottingham are already considerably larger. A report by the think-tank Reform in 2005 found no evidence that larger units were safer. Reform also pointed out that maternity care now generates more than half of all negligence claims against the NHS. Most are allegations that brain damage or birth defects were caused by mistakes at delivery. The bill is potentially enormous, up to £4 billion. That is eight times the size of last year’s deficit.

It seems to me that there is a simpler argument in favour of larger centres. This is the need to bring more women closer to doctors who are actually available. Only about 60 per cent of women now achieve a normal birth. About a quarter end up having a Caesarean and the rest need forceps or ventouse deliveries. All of these require a doctor. It is impossible to predict which births are going to be tricky. As new mothers get older, it is frankly meaningless to offer them a “choice” of home births and midwife-led centres. The reality is that fewer and fewer clinicians will let them make that choice.

Dr Shribman’s vision of 24-hour consultant care is a myth. Even the biggest units have consultants on site for less than half the time. But maximising access to a doctor during delivery — the time when most women are at greater risk than at any other time in their lives — is surely a sane objective. My first child was born at a weekend when the doctor arrived only after the midwives had had me pushing for an hour and a half. He said it was too early and was putting the baby at risk. Only three days ago one friend was told that she was not in true labour and did not need a bed, when in fact she was fully dilated. The stories are endless. Many of us who expected a normal delivery ended up relieved to see the operating table, because it was the first time we felt we were in the hands of a professional.

Midwives are the weak link that no one wants to talk about. When there are 10,000 midwife vacancies, when 60 per cent of those who do work are part-time, some cannot even spot a woman in labour, let alone provide the one-to-one support that controlled trials have shown can significantly reduce adverse outcomes. And when so many are patronising or panicked, the effect can be disastrous. One reason that the number of Caesareans is so high is because so many women become terrified by the feeling that no one is in charge. It stalls their labour.

Ministers are talking about efficiency. Mothers are talking about feeling safe. Right now, we do not. We need far more good midwives. We need to know how far is too far to travel, so that we can distinguish between what is inconvenient and what is life-threatening. We need a minister making the arguments, not a community paediatrician masquerading as a “maternity czar”.

If we had that, then frankly the proposed closure of 14 out of 282 maternity units might not have become such a controversial issue.

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