NHS trusts could be risking the safety of mothers and babies by using maternity support workers to do the work of trained midwives, a report says today.
The independent study for the Department of Health found a number of trusts across England were converting midwife positions into posts for lesser-qualified maternity support workers (MSWs).
The health secretary, Patricia Hewitt, has always insisted MSWs would not be used as substitutes for professionally qualified midwives. But the report found they were doing tasks deemed within the role of midwives and requiring specialist midwifery knowledge and training.
The report said a lack of consistency in the training and role of MSWs had the potential to leave midwives and hospital managers uncertain about their competence, and placed patients at risk from a low standard of care.
King's College London, which surveyed trust managers across England, noted there was no statutory requirement for MSWs to undergo training, or any regulation to ensure public protection.
Midwives have legal responsibility for the work of MSWs, but systems to enable them to fulfil this task were variable, the report said.
It recommends a national framework to set training and standards for MSWs, and said the skills and tasks that could be delegated to them needed to be urgently identified.
The survey found MSWs made a "key contribution" to maternity care, and managers were "enthusiastic" about their role, reporting that they freed up midwives to spend more time with women and babies.
Their role included breastfeeding advice and support, running antenatal and postnatal groups, assisting midwives at home births and in birth centres and working in operating theatres.
Last month Ms Hewitt pledged MSWs would not act as a substitute for the care provided by qualified midwives, as she outlined plans to guarantee expectant mothers a "full range of birthing choices" by 2009. She described reports to the contrary as "completely untrue".
Jane Sandall, who led the research, said: "There is a danger that support workers could cease to become 'another pair of hands', freeing the midwife and other members of the maternity team from administrative and routine duties in order to look after women.
"Instead, they may be called upon to substitute care provided by midwives, without sufficient investment in their training or development."
A Department of Health spokeswoman said: "This study shows that in only a tiny proportion of trusts were inappropriate tasks such as minor examinations being undertaken by maternity support workers.
"It is completely unacceptable if a hospital is using a maternity support worker as a substitute for a midwife and the chief nursing officer has written out to all trusts to clarify this ... Every baby must be delivered by a registered midwife or a doctor."