By Graeme Esson BBC News Online Scotland

The Southern General Hospital in Glasgow is part of a review

Health chiefs in Argyll and Clyde met on Tuesday to decide the future of the area's maternity services. At the same time, hospital managers across Scotland are facing difficult choices over the way ahead in their areas.

Argyll and Clyde NHS Board agreed to centralise its consultant-led services at the Royal Alexandra Hospital in Paisley.

Services at Inverclyde Royal Hospital in Greenock and Vale of Leven Hospital in Alexandria will be handled by midwife-led units.

However, the Scottish director of the Royal College of Midwives said it was not the only area to be considering the future of its services.

Patricia Purton told BBC News Online Scotland that the status quo was "not an option".

Greater Glasgow NHS Board is currently looking to reduce the number of maternity hospitals in its area from three to two.

We don't want to throw the baby out with the bath water Patricia Purton Royal College of Midwives

A review will produce proposals later this year, with either the Southern General or the Queen Mother's facing closure.

Mrs Purton said services were also being examined in Tayside and in the Highlands, where there are fears that Wick will lose its consultant-led service.

The reviews come against a backdrop of a falling birth rate, which has reached its lowest level since records began.

Women in Scotland are having fewer children and having them later in life.

The implementation of the European Working Time Directive, which limits the amount of hours worked by junior doctors, has also caused problems with staffing.

Cost-effective practice

Last year, the Scottish Executive published a report by the Expert Group on Acute Maternity Services (Egams).

It said the current set-up was "no longer sustainable" in Scotland.

This was due to demographic changes, pressures on training and the workforce and the need to ensure "clinically safe and cost-effective practice".

The group recommended that care should be provided as close to women's homes as possible.

The birth rate is falling in Scotland

Women with low-risk pregnancies should be able to give birth in community maternity units staffed by skilled midwives.

However, there should also be specialist care available for those women at risk of complications, the report went on.

Ministers said they would invest �2m in developing the framework recomended by Egams.

Mrs Purton said midwives had long been keen to reclaim some of the work which they did before births became "very medical".

But she added: "We don't want to throw the baby out with the bath water.

"In terms of safety and skills and technlogy the world has moved on. We are not talking about moving backwards, but it is about looking sensibly at what we have got and what we can offer as a professional group."

Social patterns

She said there was an issue over the running of maternity services - and the NHS as a whole.

"The status quo is not an option any more because of changes in the way in which women conduct their lives and our social patterns, as well as the number of doctors coming through who want to be obstetricians.

"That is reducing, and the number of doctors keen to do paediatrics is reducing," she said.

Mrs Purton said the RCM had few problems with the favoured option in Argyll and Clyde - as long as the employers and the Scottish Executive could support midwives through the "monumental change" in service provision.

An expert group examined maternity services

She said education programmes were already in place for mothers-to-be to support the change.

Mrs Purton acknowledged that it was "not the smoothest of paths" which was being considered.

But she said the experience of similar moves in England had been positive.

Women enjoyed having the choice, while also having specialist care available for those where a risk has been identified.

Liz Goudie, the Scottish representative for the National Childbirth Trust, said her organisation supported the principles of the Egams recommendations.

The NCT was "right behind" efforts to provide services as close to mothers as possible.

Ambulance service

However, she said there was a need to ensure a proper provision for women and their families if they had to travel to a consultant-led unit which is further away from their home.

"Sometimes it is not about money, it is about being sensible and human - for example, having somewhere that a father can stay over after the birth," she said.

The new strategy will also impact on the ambulance service, as some mothers will be spending longer in its vehicles.

Staff are now being sent on the same courses as midwives, and there will also be changes to ambulances themselves.

Restraint straps cannot be used by pregnant women are being swapped for harnesses.