A midwife-led maternity unit at Hawke's Bay Hospital has district health board approval.
The eight-bed midwife-led birthing unit and a day assessment unit will be built beside the hospital's Ata Rangi maternity unit. The work is due for completion in 2017. Additional outpatient rooms will be in nearby Renal House.
The Bay's high number of caesarean-section births, the low use of midwives and unpopular birthing services in Napier and Wairoa are some of the reasons for the changes, outlined in a report presented to the board.
Napier's unpopular birthing unit will be closed but new maternity resource centres will be established in Napier and Central Hawke's Bay, with greater support given to women giving birth in Wairoa.
The board approved an estimate of $2.62 million for the new building and $107,418 for an operating budget.
The report said the Bay had New Zealand's third-lowest rate of standard births. Since 2005, there has been a 32 per cent increase in caesarean sections - almost 28 per cent of all births in 2012. It cited a UK study that found low-risk mothers giving birth in an obstetric facility had more interventions compared with those in a midwife-led setting.
Fewer than 40 per cent of Wairoa women deliver at the Wairoa primary birthing facility and fewer than 9 per cent of Napier women deliver at the Napier unit, with the close proximity of specialists the reason for hospital births being favoured by mothers.
Meanwhile, the high number of teenage Maori mothers was raised by the board's deputy chairman, Ngahiwi Tomoana.
A report showed that in 2011 5.1 per cent of Maori women delivering were under the age of 18 compared with 1.8 per cent of Pacific women and 0.7 per cent of others.
Board member Denise Eaglesome said the status quo was unacceptable.
"We'll look at that because we want our young girls to enjoy being teenagers, and not mums, so they can reach their potential," she said. "They just need to realise a bit more about the consequences - it's not cool to have a baby at 15."
Another board member, David Davidson, said that in the past new grandmothers were sometimes "quite pleased with the idea".
"You can't get through to the teenagers if you can't get through to their mothers."
Mr Tomoana said many mothers did not have the best circumstances to return to after giving birth at Hawke's Bay Hospital's Ata Rangi.
Dr Davidson said: "Going back in history, the late Doris Gordon went up and down this country promoting the idea that women had the right to stay in maternity hospital for two weeks, so they could get an education. Now we have moved, in the process of efficiency, to early discharges. A lot of those opportunities for education have just gone up in smoke. The world has changed and not always for the best."
Ms Eaglesome said she delivered a contract for the Ministry of Social Development at Wairoa College, working with teenage mothers: "There is no financial support for them when they are under 16 - their families have to support them. They are slowly realising that's actually a move by the Government."
At age 16 they were eligible for a benefit "with a raft of obligations".
"The case manager is constantly working with them but it is still not a good idea to be a mum at 16."
Board member Dr David Barry said studies had shown sex education needed to be earlier rather than later.
Chairman Kevin Atkinson emphasised the board's condom programme was only for sexually active teens.
Its chief executive, Kevin Snee, said if teenage births decreased it would "have the biggest long-term impact" on health outcomes.
Maori children made up 45 per cent of all births in the last 10 years in the Bay.
The child-bearing population is projected to drop 7 per cent in the next 10 years but Maori women of child-bearing age will increase by 4 per cent, Pacific women 17.4 per cent and Asians 22.8 per cent.