Major changes are being made in the UK's maternity services for political, economic, and clinical reasons. Much has already happened. Antenatal care is provided mainly by midwives outside hospital, with general practitioners playing little or no part and obstetricians seeing only high risk cases. Maternity hospitals are being merged because of pressure to increase consultant presence in labour wards and reduce junior doctors' hours. Large units seem more efficient and can offer more back-up when complications occur. Closing small hospitals is unpopular, however, and a politically attractive alternative is to convert consultant units to free standing midwife led maternity units. The NHS, which has a near monopoly of childbirth, is promoting midwife units as a way of offering choice1 and is advising women that they are safe for low risk pregnancies. This advice is not based on evidence.