One in three maternity units in the south-east have too few midwives, and almost one in four in London are also affected by shortages that can damage the care mothers receive, the NHS watchdog warned on Thursday.
Overall, one in seven of the 141 hospital trusts that provide maternity and midwifery services in England do not have the recommended one midwife for every 28 births, the Care Quality Commisison (CQC) said.
Maternity care is "emerging as a problem area for a number of NHS Trusts, due to midwife numbers not increasing in line with demand and an increase in complex births, owing to risk factors such as maternal age, weight and co-morbidity", said a spokesman for the NHS regulator for England.
Shortages of midwives have been so acute that they have forced Castle Hill hospital in East Yorkshire to close and to send patients to Hull Royal Infirmary to ensure they were looked after properly. The same problem meant that there was sometimes only one midwife on duty overnight, and at least one woman received intravenous antibiotics later than planned, at Pinderfields general hospital in Wakefield, West Yorkshire. Maternity staff at Queen's Hospital in Essex, where staffing has been increased, told inspectors things had still not improved, and that some women were put into its discharge lounge "too soon" due to a lack of beds.
The Royal College of Midwives (RCM) said it was "deeply concerned" at the CQC's findings and demanded urgent government to increase the number of midwives in the NHS. "A failure to have adequate numbers of midwives leads to mistakes and lower quality care," warned RCM deputy general secretary Louise Silverton.
The CQC also used its first "market report" into the quality of health and social care to voice concern that almost one in 20 (4.8%) of midwifery posts are vacant. The RCM said most regions of England had too few midwives and also that antenatal and postnatal care were both also "failing" as a result.
The CQC report is based on its review of around 17,000 unannounced inspections of 581 NHS healthcare organisations, 856 independent healthcare providers of services such as cosmetic surgery, 11,808 social care organisations and 796 dentists surgeries in the ten months from June 2011 to March 2012.
Overall, about one in four services were not providing the right standard of quality or safety of care. Dr Peter Carter, general secretary of the Royal College of Nursing, said that figure was "shocking" and "a long overdue wake-up call for the government". He welcomed its recognition that inadequate staffing levels and large numbers of empty posts – which his union has been warning about – can affect patient care.
Simon Burns, the NHS minister, said: "There is no excuse for anything but the best care. By exposing poor practice and shining a light on best practice we are determined to drive up standards for everyone."
A Department of Health spokeswoman said that the government was "committed to improving choice of place of birth, continuity of care and women's experience of care through a wave of investment, including a record 5,000 midwifery students, 4,200 extra health visitors, increased access to psychological therapies and reform of NHS services over the next few years."
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