PLANS that could mean four out of five births taking place from 2010 at the new Pembury Hospital are essential, hospital chiefs claim.Changes in working time legislation and recruitment shortages, they say, are making it impossible to maintain a full range of maternity services at both Maidstone and Tunbridge Wells. But Dr Alan Pentecost, the consultant, who launched Maidstone Hospital’s first stand alone maternity unit 30 years ago, fears the solutions on the table will only make matters worse.

I started up the first autonomous Maidstone Obstetric Unit in 1974. It is very sad to see that the women of Maidstone are about to be, obstetrically speaking, disenfranchised.

Of course there were maternity services before 1974 but it was as part of the Chatham Unit and I felt we were very much second class citizens. I was very pleased to break the link even though I was single-handed until 1978. Both Chatham and Pembury have excellent maternity units but the decision to close down Maidstone is, I suspect, all and only about money.

The staff at Pembury have done sterling work over the years in a decrepit unit and the only way funding will be forthcoming for the new unit is to make it big and, in theory, absorb the Maidstone obstetric input. I say "in theory" because it won’t happen. Indeed it shouldn’t happen. Travelling 2O miles, partly along country lanes, in labour is not a good idea.

I predict that the deliveries in Pembury will go up from 2,300 per annum to 3,000 at the most. Other mothers-to-be will travel up the A229 to Chatham, a much easier ride and not so far to travel. As it happens Chatham is a different Unit Trust and the extra 2,000 deliveries will be somebody else’s problem. This would be a neat manoeuvre but hardly beneficial to the women of Maidstone. Moreover Chatham has the busiest unit in the South East and may or may not cope with the extra load.

Were I to be mischievious I might ask why the Obstetric Unit is going to the place with the smaller workload. The answer to that is partly the shape of the Maidstone and Pembury Unit Trust. It is a bipolar, dumbbell-shaped area and they exist elsewhere in the country, always on a financial and statistical footing.

They never work satisfactorily, are invariably the result of a shotgun marriage and the basis for a long-running feud. The outcome is due to working at a problem from the top down instead of from the bottom up. Instead of asking "what are the needs of the mothers of Maidstone", the question is "how can we find a new unit in Pembuiy?" Also bear in mind that medicine has its fashions and fads like everything else. One decade will advocate centralisation and the next will advocate peripheralisation. I was a consultant in Maidstone for 25 years and saw the tide flow past in different directions a few times.

The proposed birthing centres are not a good idea either. By all means have midwife led maternity units with a friendly, homely, atmosphere, but under the same roof as the high tech unit so that transfer can take place with minimal fuss. This worked very well in Maidstone where, incidentally, under the leadership of Di Garland, we have one of the leading units offering water births.

I always felt sorry for women transferred in labour, by ambulance, from the maternity unit in Fant Lane to the West Kent Hospital, before 1983. Two miles in such conditions were agony. Now it could be 20 miles! If there is a shortage of midwives, surely it is logical to staff two independent units and cut out extras such as birthing centres and home deliveries. (I am definitely not opposed to home deliveries in theory, but they make a disproportionate demand on midwife numbers.)

Then again there is the image projected of a spanking new high-tech unit with an extended range of facilities and a team of hand picked experts restlessly pawing the ground to be of service. That is 99 per cent trash. Most labours are intermediate tech and need only application and dedication. Nearly all high-tech stuff is pre natal or neonatal. There would be a place for transferring at risk babies in utero to a good neonatal unit, but we did that anyway.

Indeed I can foresee that consultant maternity cover may actually get worse. Consultants have to live within 10 miles of the hospital to which they are appointed. This could mean the consultant on call, if resident east of Maidstone, being over 20 miles away when on duty. Not much use then, unless the consultants are resident on duty which, under new EU ruling, would mean a week off after 48 hours weekend duty.

The whole thing seems to me to be intellectual sleight of hand, and the fact that consultants do not come forward to object is not necessarily significant. Firstly, subtle pressure can be put on whistleblowers, and secondly this is not about medical staff but about the women of Maidstone and their needs.