Fears have been raised that expectant mothers who want to deliver their babies at home could be pushed towards hospital instead after NHS Lothian's home births service was "dismantled".
For the past four years, the health board ran a dedicated home births team headed by a Band 7 midwife who was supported by seven midwives who had applied to work in the service because they had an specific interest in home births.
However, a reorganisation saw the team leader removed from the role in April and redeployed to another midwifery post within the region.
NHS Lothian has argued that the changes, made without any prior consultation, were necessary to save money.
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Since then, all but one of the remaining midwives have quit the home births team for new jobs outwith NHS Lothian, or to retire. Some are understood to have left midwifery completely.
The sole remaining midwife from the home births service has now been incorporated into the wider community midwifery team.
Home births in the Lothian area will now be provided by community midwives on an on-call basis, leading to fears that women could find themselves pressured to go into hospital instead if they end up with a midwife with little experience of delivering babies at home.
Daisy Dinwoodie, a doula who has run a home births support network in Edinburgh for the past 17 years and has helped to deliver hundreds of infants, described the current situation as shambolic.
She said: "The service remains, but it's a bare bones now and everyone in the Lothians is struggling to figure out what on earth is going on.
"Changes have been brought in without any consultation or warning, and women are being left with appointments unattended by a midwife.
"For the past four years we had a dedicated home birth team which means that midwives who are specifically interested in, skilled in, and passionate about home births applied for a specific job in that team.
"It was all going very well, but now it's been pretty much dismantled.
"They cite reasons of finance but it doesn't make any sense. The team lead was a Band 7 midwife - very experienced - but she's still a Band 7 midwife, they haven't saved on her salary.
"Since then, change after change after change has meant that the midwives in that team not only don't feel supported, but all but one have recently left. It's a complete shambles."
Ms Dinwoodie added that women often choose a home birth because of previous bad experiences.
She said: "Many of the people who plan home births are people who have previously been traumatised in hospital.
"I've supported hundreds of births with and without a midwife present, and the midwives who are more inclined to being frightened of being in someone's home and the potential for something to go wrong, or the potential for them to do something wrong and get in trouble, [are the ones] who don't have the skills and experience in home births.
"They're just inclined to transfer women into hospital to get it off their hands.
"So many women will have been transferred for no good reason, and that's really tragic - especially when we had a team of midwives who were utterly dedicated to providing exactly that type of care."
Home births have been increasing in Scotland, accounting for more than one in 100 deliveries in 2021 compared to one in every 150 in 2017.
The Scottish Government has never set a target for home births but its 'Best Start' maternity agenda says women "should be encouraged to consider home birth as an option" if they have had previous vaginal births without complications.
Jaki Lambert, director for the Royal College of Midwives (RCM) Scotland, said: “Earlier this year we were made aware of changes that had been made to the Lothian Home Birth service, which we understand were introduced without any consultation with midwives or, to our knowledge, the women who were accessing the service.
"Unfortunately, this has had a direct impact on some of our members and they have subsequently moved on from their roles within the Home Birth team.
“The RCM will continue to work in partnership to find a solution to providing adequate and appropriate support for home birth in the area that works for both the midwives and the women and families in their care.”
Mercedes Perez-Botella, director of midwifery, gynaecology and neonates at NHS Lothian, said: “Like many NHS services, our dedicated Homebirth Team has experienced recent workforce challenges.
"We do, however, have very experienced and skilled staff within our Community Midwifery Teams who provide expert care and support to women who choose to have a home birth.
“NHS Lothian remains committed to ensuring that homebirth is an option for women across Lothian and are working hard to address these workforce challenges.”
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