One of Britain's most successful maternity hospitals is facing closure in a move that has set NHS officials who are trying to clear deficits against a community that passionately supports local services.
The Stroud Maternity Hospital, a nationally renowned midwife-led centre offering antenatal care and 'low-tech' childbirth for mothers in Gloucestershire, is due to close in September because the local health service has debts of more than £40m.
Campaigners, including a small army of mothers who have had children there, say it is a model for the kind of birth facility Britain needs more of, and that for women at low risk of complications it is a better alternative than going into a large hospital.
The fate of small community hospitals, including birth centres, will be discussed this week by the Health Secretary, Patricia Hewitt, who will announce that more than £500m will be available over the next five years to help local people set up and develop local health centres and community services.
She will issue new guidance to NHS trusts around the country, telling them they must consult local people properly before making decisions about services. But it remains unclear whether the extra money, to be taken from the health department's capital reserves, can be used to safeguard the future of hospitals that are under threat.
There are more than 800 community hospitals across the country, and some 15 midwife-led birth units, half of which face an uncertain future as the NHS deficits - and a new system of financial payments - begin to bite. Rural areas are most at risk of losing small local centres, including those run by GPs and offering care for the elderly or those with mental health needs.
More than 4,000 people turned out in the town last weekend, on a day of blistering heat, to demonstrate against plans to close the maternity hospital as well as eight other health centres around Gloucestershire.
The local health trusts have been told by the Department of Health that they have to clear the debt by the end of March 2007. Administrators plan to concentrate all maternity services within the Gloucester Royal Hospital, nine miles away, which will eventually serve most of the county as the birth centre in Cheltenham is also due to close in the next few years.
Stroud Maternity Hospital, which was set up to serve the town in the Fifties, is strongly supported by local people. It has only nine beds but delivered 364 babies last year, and thousands of women had their antenatal clinics there.
Tomorrow, the shadow health secretary, Andrew Lansley, will tour the unit, followed by Louise Silverton, deputy general secretary of the Royal College of Midwives, pushing the issues of choice in childbirth and community services higher up the agenda.
One of those who could now lose her job as a result of the changes is Caroline Saturley, a midwife who has worked in Stroud for six years. 'The great irony is that on the day that Patricia Hewitt spoke to the midwives' annual conference, advocating much more choice for women and midwife-led care, we were told that afternoon we were going to close,' said Saturley.
'The idea that we might close our doors seems absurd. We delivered five babies the other evening, and it's really busy because it's really popular. We give women the kind of care they desperately want, and no one is asked to leave after the birth until they are ready to go. There's a thorough assessment so that if there are any risks they are referred to Gloucester.'
Clare Watkins, whose daughter Lily was born at the unit five months ago, said: 'As soon as I went in I felt calm and relaxed. It was a long 13-hour labour but I got through it without any epidural.
'What made the difference for me was having a midwife constantly there, telling me what to expect, how to deal with the pain, and telling me that it was going to be fine. Afterwards, I was able to stay in for four days, which was fantastic because I initially had trouble breastfeeding and they managed to sort it out. The whole experience was very positive, and I just wish it was available to other women.
'The government goes on about giving patients more choice, and I don't see why we shouldn't have the choice of giving birth in a friendly, low-tech environment, if the risks are low and if that is what we choose to have.'
Asked about the future of the unit, a Department of Health spokesman said: 'We are not going to tell the local NHS bodies which facilities they should and should not keep open, but they do need to carry out appropriate consultations with local people.'
