By Adam Brimelow
BBC News, Health correspondent
The number of health visitors in England has fallen to its lowest level in 12 years, a trade union says.
Unions fear some cases of domestic abuse are being missed
Amicus said there had been a 40% cut in training places for those workers and warned many cases of domestic abuse and post-natal depression may be missed.
The government has said health visitors have a key role to play in its policy of bringing healthcare closer to home.
And it says the number of nurses in community care has risen by more than a third since 1997.
However, Amicus, which represents professionals working in the health, manufacturing, science and finance sectors, says some trusts are looking to replace health visitors with less well-qualified staff. It has been argued that the profession is in meltdown.
It says when you account for part-time working, numbers are at their lowest for 12 years.
It says a squeeze on health budgets means training places have been cut by 40%.
LACK OF HELP
Trudy Ward developed post natal depression after the birth of her son Georgie two years ago.
"Every day was spent crying, not eating, screaming at my children, going to the stage where I thought: 'Right I just want to throw myself under the nearest bus.'
"My little girl had mummy suddenly turn into an angry, snarly, crying woman who didn't want anything to do with her.
"My son probably didn't even know he had a mother. I didn't cuddle him. I just didn't want to be with them. I just felt there was no one who could help me. I just felt lost."
Trudy had a couple of cursory visits from health visitors - but she felt there just wasn't time to talk about her problems.
Fortunately, she feels a lot better now. But she is concerned about other women facing her problems in the future.
"Any new mother now looking for help from the health visitor is not going to get the support that they need. "
Claire Dent is a health visitor in Kent and speaks for the Community Practitioners and Health Visitors Association.
She said: "The government understand the importance of getting to parents early and their own documents speak about supporting parents early, but unfortunately they're not allowing us to do what they're asking us to do in all their public documents."
Ms Dent said increasingly health visitors were being told to focus on vulnerable families and child protection, rather than providing a universal service.
She is worried that problems like post natal depression are being missed.
"It may seem a minor thing initially but if we're not going to people and building relationships with them we can't ask them the important questions.
"We don't pick up that post natal depression until it's too late and they're going to the doctor and they're getting anti-depressants and it's much harder.
"And then when they've lost that attachment to their child because they've never realised how important it is, that child's affected for the whole of their life."
The concerns are by findings from from an online survey by the parents support network Netmums.
More than 4,500 people replied - a majority said services had got worse.
Health minister Ivan Lewis acknowledged that training for health visitors was at a low point.
But he said this was a temporary problem while Primary Care Trusts and Strategic Health Authorities work to meet the government's target of balancing their books by the end of this financial year.
Mr Lewis told BBC Radio 4's Today programme: "I don't dispute there is a reduction in training places this year and I also don't dispute the need to have a fundamental look at health visiting.
"That is why (Health Secretary) Patricia Hewitt announced several months ago we are having a fundamental review of health visitor services.
"But it has to be put in context - the number of nurses, including health visitors, working in the community has increased by 30,000 since 1997.
"Over the past four years there has been a 41% increase in undergraduate medical places and a 67% increase in training for non-medical staff and alongside that we have got to remember the massive increase - £17 billion investment - in early years provision through Sure Start, children's centres and nurseries."