The closure of hospital services and a lack of midwives means pregnant women in Gloucestershire are facing fewer and fewer options for where they give birth.
The county has felt the reality of a nationwide shortage of midwives with Stroud's post-natal beds closed 10 months ago.
The birth unit in Cheltenham has also been temporarily closed to labour and births due to staffing issues.
Now a mother, who recently gave birth for the first time, has spoken about how she felt "anxious" after being told the unit where she was planning to give birth was closed.
Charlotte Chivers, whose baby was born eight weeks ago, wanted to give birth at Gloucester Birth Unit, where she could be cared for by midwifes but could also have doctors nearby if medical intervention was needed.
But after going into labour she was told the GBU was closed and to go to Stroud Maternity Unit where she was for eight to nine hours.
She then found herself moved to the Gloucester delivery suites at Gloucestershire Royal Hospital - this is where people go if they need medical assistance - due to the length of her labour.
Charlotte said: "You expect your birth plan to go down the pan, I didn't mind that, but I was quite shocked when the entire location had to change, it was a bit of a surprise.
"It means every single woman giving birth in Gloucestershire is having to go to same place really busy very stretched."
While in Stroud Charlotte said she felt "guilty" as women were phoning up asking to come to the unit, but due to midwife numbers, Charlotte was the only woman that could be supported through one-to-one care.
She said: "If they do have to keep closing units on and off there needs to be a way of communicating that out.
"If midwives could pre-warn you, in an ideal world these issues would get resolved but I think it's just important we're told."
Interim director of midwifery for the trust Lisa Stephens said: "Our overriding priority is to provide consistent, safe staffing levels and we must balance this alongside our aim to maintain as much choice as possible for women and birthing people.
"On occasion, this means relocating staff from our Gloucester Birth Unit (GBU) downstairs to the main delivery suite, where our Jasmine Room provides similar equipment and ambience to that found on the Gloucester Birth Unit.
"In terms of specific openings or closures of the GBU, this is very fluid and may not be for a full day, but rather based on hours, depending on the requirements of the individual women and birthing people who are using the service.
"Maternity staffing challenges are a well-reported national issue and our dedicated midwifery recruitment team has implemented several successful initiatives over the last year.
"However, while we have recruited several new midwives over the last few months this must be balanced against maternity leave, sickness absence and resignations."
Stroud Maternity Unit
Campaigners are now also calling for clarity on whether a "vital" service in Stroud which offers support for women, not only as they give birth but in the days afterwards, will reopen permanently.
The Stroud post-natal beds previously allowed mothers to stay for a few days and be looked after while learning how to look after their babies.
They would be taught how to wash, care for, and breastfeed their baby, while staff could pick up on any social issues or post-natal depression. Now women have to go home between 6 and 12 hours after giving birth.
Gloucestershire Hospitals NHS Trust admitted "patient choice has been reduced" due to a national midwife shortage. The midwife vacancy rate fluctuates from 6% to 15% in the county which has had a "significant impact" on services.
The Gloucestershire Hospitals NHS Trust says the closure of the beds has been extended until October 2023 "when a further review will be undertaken" and an update given.
'A treasured place'
A mother who moved to Stroud, partly for its maternity care, says the unit is a "treasured place".
Sarah Dixon has a nine-year-old daughter who was born in the town in 2013.
She told ITV News about her birthing experience: “It was great, I had the most amazing experience. I met a woman who had moved here to become a midwife on the day I was pregnant.
“It felt very personal, that’s the unique thing, they give continual care. It's good for happy mothers and happy babies."
Women now having to go home between 6 and 12 hours after giving birth can be "quite exposing" at what is "such a vulnerable time", Sarah says, especially when considering that suicide is one of the leading causes of death for new mothers, she highlights.
Sarah believes that an “extra few days can make all the difference to the lives of a family”.
While external agencies and local groups are stepping in to support families, Sarah believes that it all relies on a functioning core service from the NHS.
What is a midwife-lead birth?
Midwives are specialists in normal pregnancy and birth, and their role is to look after a pregnant woman and her baby throughout a phase of antenatal care. They can help to deliver a baby at home or in a birthing pool so families are in a relaxed environment.
Giving birth at a midwifery unit is as safe for most mums and babies as giving birth at an obstetric unit. You're more likely to have a birth at a midwifery unit with fewer interventions. If there are complications you can be transferred to an obstetric unit where doctors can help.
Now the post-natal beds are closed, care may be in the form of home visits, at a clinic in Stroud Maternity or a local community base such as Cirencester. This is following a conversation with the midwife in the first 24 hours following a birth.
Kate Buckingham is the chair of community group Stroud Maternity Matters, which acts as a liaison between the midwifery group and the community.
Kate believes the unit helps to give families the start together they need.
She said: "It’s not like going to hospital, it’s like going to somewhere you’re going to be nurtured.
"All my friends stayed on to two or three days after giving birth and say it made a massive difference to their confidence.
"Nearly everyone you meet in Stroud is passionate about the maternity unit as people can understand how to do early parenting, it's important to the identity of the town."
In November 2022, a march with more than 1,000 people took place protesting the closure of the beds, but Kate believes they haven't got far due to staffing models and a change in safety measures, which means there are not enough midwives to run it.
Kate says, as there has been the least amount of births in Stroud on record since the post-natal beds closed, she now fears for the future of the unit.
Stroud Maternity Matters also wants communications from trusts to be timely and updates on their websites to be prioritised, so people know what’s going on as delivery suites are not always available.
What's happening in Cheltenham?
The Aveta Birth Unit at Cheltenham has been temporarily closed to labour and births but remains open to other services including ante-natal care.
It is set to undergo a £2.7m refurbishment to transform the unit into a purpose-built midwifery-led facility, which the trust hopes will help to attract and retain staff, when it opens from spring next year.
Matt Holdaway, Chief Nurse at Gloucestershire Hospitals NHS Foundation Trust said: "We want to reiterate our commitment to the future of both the birthing unit at CGH and postnatal beds at SMU. There are no long-term plans to close services at Cheltenham or Stroud.
"While the measures that we have taken are far from ideal, they have enabled us to deliver a safe service. The safety of all babies, women and birthing people remains the guiding principle behind these difficult decisions."
Mr Holdaway added: “It’s really important to reiterate what these temporary changes actually mean because a lot of people believe that maternity services in Cheltenham and Stroud are completely closed when that’s not the case.
"We strive to retain as much choice as possible for women and families within the difficult circumstances we are currently operating in and apologise to everyone who continues to be affected by the decisions we have had to make."
Looking ahead to a longer-term solution, he said: "We acknowledge that the longer our staffing challenges continue, the more it appears that getting the right staffing model for the birth centres and community rather than just waiting to be fully recruited is likely to be the key to opening services as quickly as possible.
"This has been the focus of the senior midwifery team throughout this period. The team has made good progress in engaging colleagues in developing new models of care. However, we are not yet in a position to reinstate either of the suspended services."