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The Care Quality Commission has written to the chief executive of East Kent Hospitals raising concerns over the pressures placed on midwives treating high risk women.
In a feedback report following an unannounced inspection by the watchdog last month, concerns are raised about midwives having to make decisions which should have been made by doctors at the QEQM in Margate.
Chief executive Susan Acott is also told that junior nursing staff at the William Harvey have been rostered for women in day care without sufficient senior support and that risk monitoring of women was not robust.
The CQC says it wants to develop a further understanding of how the trust makes sure it addresses the out-of-hours provision.
Ms Acott, in response, outlines a number of measures including the introduction of a flow chart and a red-amber-green risk rating system, put in place following the CQC visit.
She says full clinical assessments are carried out determining if a registrar or consultant is needed.
The inspection, of which the findings are yet to be published, took place after it emerged there had been a number of preventable baby deaths at the trust, including Harry Richford.
On Thursday, East Kent Hospital's board said it could be as many as 15 in seven years.
The figure, from 2012 to 2019, was previously thought to be at least seven but has remained unclear until now.
East Kent Hospitals says necessary steps are being taken to provide safe care and concerns about the safety of the service are being treated with the utmost seriousness and urgency.
A spokesman said: "This includes making use of support from leading maternity experts, who have already identified further improvements that we will make.
"We recognise that the change needed in our maternity service has not taken place quickly enough, and we are doing everything we can to improve our culture so that we become an organisation which is constantly learning and improving.
"As part of this we continue to work with our regulators in an open and transparent way."
But county councillor Karen Constantine, who sits on the health overview committee, says Ms Acott should consider her position.
"It is crass and grossly insensitive to say there were ‘six or seven’ avoidable deaths," she said.
"The CEO doesn’t have a tight enough grasp of the facts of the situation and her continued tenure as CEO adds insult to injury to a dramatically failing system.
"How can we trust in any way the word of a CEO whose track record of cover up is evident?
"Why didn't the CQC find these huge deficiencies earlier when it inspected?
"What measures are being put in place to independently monitor actions to rectify the situation.
"The public need action and I believe a full public enquiry is required."
An expert team of medics from across the country, including midwives and obstetricians, have also been brought in to work in the maternity units at the QEQM in Margate and William Harvey in Ashford.
A spokesman for East Kent Hospitals said improvements are being made at the trust.
"We are taking all necessary steps to provide safe care and we are treating the recently raised concerns about the safety of our service with the utmost seriousness and urgency.
"This includes making use of support from leading maternity experts, who have already identified further improvements that we will make.
"We recognise that the change needed in our maternity service has not taken place quickly enough, and we are doing everything we can to improve our culture so that we become an organisation which is constantly learning and improving."
