Doubt over West Cumberland Hospital maternity care
Further doubt has been cast over the future of specialist-led maternity care at a Cumbrian hospital.
A number of options are being considered to improve care in the north of the county, including removing consultant-led services from Whitehaven's West Cumberland Hospital.
The boss of North Cumbria University Hospitals NHS Trust said it does not look like Whitehaven has the "infrastructure" to maintain services.
Midwives have raised safety concerns.
They have warned mothers and babies "may die" if consultant-led maternity services are removed from Whitehaven and concentrated at Carlisle Cumberland Infirmary.
Trust chief executive Stephen Eames told BBC Cumbria: "The options we are looking at are likely to mean there will be changes in maternity services and they're likely to mean we'll need to concentrate our expertise in our consultant staff in one place.
"Everybody involved would prefer a consultant-led service in both, but I think the reality is it isn't just about maternity, it's about the other clinical services that support it.
"So while we've made some improvements in children's services recruitment it doesn't look like we can recruit the infrastructure to support two independent consultant-led services."
Midwives at Whitehaven are concerned mothers facing unexpected problems would need a potentially risky 40-mile (64km) transfer across the county.
Earlier this month, Bernadette Bowness said: "We're going to become a third world area because of our inaccessibility to a consultant-led unit.
"If ladies have to be transferred, mothers may die, babies may die.
"If babies have foetal distress, what with the transfer time they may end up brain damaged."
A public consultation exercise will be launched next month to gauge opinion on the future direction of services provided by the trust.
The organisation has been in special measures since 2014 after Care Quality Commission inspectors judged it to be failing to provide a sufficiently high level of care in a number of areas.