"Recently, I've had to not take a woman who lived quite a fair distance away, she had no transport so she couldn't even meet me halfway.
"That's an effort her family will have to try and make because we simply can't get there, its just too far."
Pihema said some midwives were dipping into their own pockets to pay for food for families and fuel for appointments. She said this was the dilemma facing most families.
"We are seeing the effects in their homes. It's the weigh up of, 'do I put petrol in my vehicle or do I feed my kids'."
She said midwives would need take on more women to afford the extra cost of fuel but this would simply raise costs even more.
"To be able to afford the additional costs, you'll either have to take on a larger case load but more women means more costs or you would have to draw back or let it go until you can actually afford that."
Pihema said DHB funding came as a reimbursement so midwives still had to deal with the upfront cost. She said North lad received no other funding despite other region's services received funding in the form of petrol vouchers.
She said it had a significant impact on the care midwives provided and women in outlying areas were the most in need.
"The women who are in those outlying areas are the ones that are particularly vulnerable and require that service."
It's not just about digging into the costs we have, you're actually in the red. It's money that you don't have."