A health board has been urged to approve a midwife-led maternity unit at Caithness General Hospital following the death of a newborn baby last year.

An internal review carried out by NHS Highland's director of public health recommended last week that the current maternity services, led by three consultant obstetricians, be replaced with a midwife-led unit.

The review followed the "potentially avoidable" death of a newborn baby at the hospital in September 2015.

Dr Roderick Harvey, NHS Highland's medical director, said changing to a midwife-led Community Maternity Unit (CMU) would reduce the risk of a baby dying in similar circumstances.

He will present a number of recommendations to the health board at a meeting next week.

If approved, the new CMU unit will be in place by December 1 and round-the-clock obstetric cover will be phased out during a four-month transition period.

When complications do arise, women would be transferred to a "strengthened" unit at Raigmore Hospital in Inverness to give birth.

On Tuesday, dozens of protesters held a demonstration outside the hospital in Wick over the proposed changes to the maternity services.

They are worried about the distance some patients may be forced to travel for emergency care, in some cases around 100 miles.

Dr Harvey said: "The circumstances that precipitated the review are tragic. Everyone has worked tirelessly to examine the facts objectively and to see how we can reasonably reduce the risks of something similar happening again.

"I am satisfied that I am now in a position to advise the board and, in doing so, can reassure all concerned that the changes being proposed will overall provide a safer level of care for both mothers and their babies.

"Understandably some concerns have been expressed about 'what-if' scenarios especially around emergencies and transport.

"However, it is really important to recognise that the proposed changes to the configuration of the unit will undoubtedly reduce the risk in the future of the type of adverse events that we have actually observed and that the sorts of scenarios people are raising as concerns are, in reality, extremely rare.

"Such events do not present a problem in our other Community Maternity Units."

He added: "While the majority of care and services including antenatal clinics and gynaecological procedures will continue to be provided locally, for a number of mothers and babies where there is a risk of complications then the safest place to deliver is in Raigmore Hospital.

"The Community Model Unit model works well elsewhere in Highland and has proven to be safe."

"Going forward, NHS Highland estimates around two babies per week being delivered in the Caithness General Hospital, with only the need for support by midwives.

"A little over every two weeks we would also expect one mother who had planned to deliver in Caithness to require transfer in labour to Inverness as a result of unanticipated problems."

The report on the review published last week suggested most births at the hospital, around three per week, do not require an obstetrician to be present.

The low number of births, the report said, also meant it was not safe or effective to provide those services locally as obstetricians were unable to maintain their skills.

It also highlighted that Caithness General had never had facilities for on-site specialist neonatal paediatric support and carrying out procedures that require specialist care would result in more avoidable perinatal deaths.