Midwives are failing to offer proper care and reassurance during childbirth, with one in four women being abandoned during labour or soon after, a watchdog says today.

As proposals are being considered for the closure of specialist maternity wards, a shortage of staff and funding is putting mothers and babies at potential risk, experts say.

In the largest study of NHS maternity care, the Healthcare Commission found variations across England, with nearly half the women in some trusts reporting that they had been left alone during labour or soon afterwards.

The Government has proposed that all mothers-to-be should be supported by a named midwife throughout their pregnancies by 2009, while official guidelines state that a woman in established labour should not be left on her own, except for short periods or at her own request.

Yet in 18 out of the 148 trusts inspected more than one in five women said that they were left alone at a time that worried them while they were in labour. First-time mothers felt particularly unaided.

The Healthcare Commission surveyed 26,000 women who had a baby in January or February. An analysis of the results showed wide variations among trusts. The worst-performing was Milton Keynes General Hospital NHS Trust, where almost half (49 per cent) of women were left alone at a time that worried them. At Lewisham Hospital NHS Trust, 46 per cent were left alone. At Mid Staffordshire General Hospitals NHS Trust, 39 per cent were left alone. At East Cheshire NHS Trust, in contrast, 85 per cent of mothers were never left alone.

Many women surveyed also complained about postnatal care, and more than half said that the food on offer was only “fair” or “poor” and one in five said that the bathrooms were “not very clean” or “not at all clean”.

Today’s report comes before a wider investigation into maternity services that the Healthcare Commission is expected to publish next year.

Responses to the quality of care overall were largely positive, with nine out of ten women saying it was excellent, very good or good. But the Royal College of Midwives estimates that at least 5,000 midwives are needed on top of the 24,000 already in England. Louise Silverton, deputy general secretary of the college, said: “Without this, the Government’s targets will just be broken promises. We have got to aim for all women to be happy with their care but we will struggle to make this happen unless the worsening shortage of midwives is addressed.”

The medical royal colleges advised last month that every woman should receive one-to-one care from a dedicated midwife as she goes through labour. Only one in five women surveyed said that she had a midwife who looked after her during labour and birth, while more than two in five said that three or more staff had cared for them at different times.

Other divergences from best practice meant that 43 per cent of women were not given a choice of having their baby at home, and 36 per cent were not offered antenatal classes.

The Commission also found that 57 per cent of women gave birth either lying down or with their legs supported in stirrups, despite guidance from the National Institute of Health and Clinical Excellence suggesting that women be discouraged from having their baby in these positions.

Overall, two thirds of women said that they “definitely” had confidence and trust in the staff caring for them while a quarter said that they had only “to some extent”.

The Government has pledged that, by the end of 2009, women expecting a normal birth will be able to choose whether to have their baby at home, in a midwife-led unit or in hospital.

Norman Lamb, the Liberal Democrats’ health spokesman, said that the survey had exposed “a huge gap between Government promises and the reality in maternity units across the country”.

“As well as being denied the option of a home birth as the Government promised, some women also have the confusion of having to deal with a series of different midwives throughout their pregnancy,” he said. “There simply aren’t enough midwives to deliver on ministers’ promises of one-to-one maternity care.”

Gwyneth Lewis, national clinical lead for maternity services at the Department of Health, said: “It is encouraging that the vast majority of respondents reported their care as being excellent, very good or good.”

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