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The permanent closure of birthing units at Newport’s Royal Gwent and Abergavenny’s Nevill Hall hospitals has been agreed by health chiefs.

The units were closed on a temporary basis in May 2022 as more and more women were choosing to give birth at the Grange in Cwmbran instead. Aneurin Bevan University Health Board (ABUHB) is concentrating on the new hospital to help NHS in Gwent deal with a shortage of midwives.

ABUHB had been some 20 full-time midwives below what it required but its director of nursing, Jennifer Winslade, told the board’s September meeting that has now reduced to around ten full-time equivalent roles.

The board has agreed to continue offering enhanced pay to attract midwives but Ms Winslade said that would require further work.

She said there is no “positive or negative financial impact” from the changes as four midwives will now work in community roles instead of at the closed units which she said means “we can provide better care for women and more choice and discharge more swiftly from the Grange”.

But Ms Winslade said the four roles would “not put us in a position where this service can be safely staffed. We have staffing gaps that are much bigger than four whole time equivalent (posts). The issue we have is there simply aren’t enough midwives in the UK, all the health boards (in England) are struggling with midwifery recruitment.”

Despite this the chief nurse said the board has had a “success” in recruiting from Bristol and surrounding areas and attracting students, but said: “We’ve had a bit of an influx but not in the numbers we’d hoped for.”

The board has also told the Royal College of Midwives Wales during the 18 months since the temporary closure it has seen “improved satisfaction for midwives in work, and improved continuity of care”.

The units in Newport and Abergavenny had been led by midwives, as is the unit at Ystrad Mynach’s Ysbyty Ystrad Fawr which moved from a 24 hour operation to only opening after 5pm as part of the arrangements introduced last year.

Women will also still be able to chose a home birth while the freestanding midwife unit Ysbyty Aneurin Bevan in Ebbw Vale remains open.

The health board has stressed evidence shows that midwife-led settings are safe, and Welsh policy aims for 45% of pregnant women to give birth in them.

The closures were described as “step one” of potential changes to maternity services which will continue to be reviewed as the board looks at how it should deliver services over the longer-term.

Its chief operating officer Leanne Watkins said midwives also need to offer support in the community due to issues such as an increase in digestible diabetes while cesarean births have increased from 26% before Covid to 40% since.

In response to ongoing challenges in recruiting midwives the board commissioned an independent review which suggested four options.

Those were going back to the system in place before May last year; a “hybrid” model that still closed the Newport and Abergavenny units but offered extended services at Ysbty Ystrad Fawr; a “more radical long-term” plan based around existing services at the Grange supported by community services and home birth options; or making the temporary arrangements permanent.

Going back to the previous model and the “hybrid” model were dismissed as the board said staffing and funding them on a “consistent basis would be challenging” and hard to justify due to the increasing trend for women to choose the Grange which has en-suite rooms. The “radical” plan to centre services on the Grange was also ruled out as it was considered “too restrictive in respect of future birthing options”.

The report to the board said using the Grange, supported by Ysbyt Ystrad Fawr, is “the best balance between local accessibility and service safety/sustainability, maintaining all birth options around Gwent and surrounding areas and minimising the incidence of additional travelling requirements.”

Figures show births at the Royal Gwent dropped from 85 in 2019 to 24 in 2021 – the last year its birthing unit was fully open – and at Nevill Hall they fell, over the same period, from 47 to 20 births. In 2021, the Grange’s first full year of operation, it saw 840 births and they increased to 931 last year.

Patient watchdog Llais endorsed the conclusions without further representation.

Board chair Ann Lloyd said a report evaluating the effectiveness of the changes should come back to it in six months.