Members of the union representing midwives in Scotland have rejected the latest NHS pay offer.
The Royal College of Midwives (RCM) said 65% of members voted against it. The union will now consider next steps including possible industrial action.
The result of a ballot by the Royal College of Nursing is expected in the next few hours.
The NHS pay offer is worth about 7.5%. It was accepted by Unison and Unite members but rejected by the GMB.
Jaki Lambert, RCM director for Scotland, said: “Our members have spoken loud and clear – the latest pay offer by the Scottish government is simply not good enough. It goes nowhere near addressing the rising cost of living and would see many midwives actually worse off in real terms.
“Our members have been consistent throughout this process – they want a decent deal, and they are prepared to take industrial action to get one. No midwife wants to do this and it is for the Scottish government to make sure that they do not feel that they are left with no other option.
“While we acknowledge that the Scottish government has listened to some of the concerns regarding career opportunities and development, it has failed to meet our members’ needs on pay.”
Last month, Holyrood ministers tabled an improved deal averaging 7.5% to health workers threatening industrial action.
Annual pay rises under the latest deal would range from a flat rate payment of £2,205 for staff in Bands 1 to 4 and up to £2,660 for staff in Bands 5 to 7, backdated to April.
This represents an increase of 11.3% for the lowest paid workers and delivers an average uplift of 7.5%.
The Scottish government said previously that the pay offer was unprecedented for front-line employees at a “time of extraordinary financial challenges”.
The RCM is part of the Scottish Terms and Conditions Committee (STAC), which negotiates pay deals with the Scottish government. STAC staff will meet with ministers on Thursday to share the outcomes of their respective consultations, the RCM said.