''This is putting a lot of pressure on midwives,'' she said.
''There is a perception in the public that we get paid extra for petrol, but we don't. Midwives are dipping into their own money to cover costs. That means they are using their families' income.''
DHB funding came as reimbursement so midwives still had pay the upfront costs. Plus, Northland midwives do not get funding despite other region's services being funded for petrol via vouchers.
That had been a concern in Northland, particularly during midwifery pay-equity negotiations, now dating back to 2015. There is no contingency plan, nor means of including one, in the funding model co-designed by the College of Midwives and the Ministry of Health, Pihema said.
She had travelled 2000km in the past week alone. The wear and tear on vehicles caused by rough Northland roads was also high, especially tyres, she said.
Northland midwives could drive for over an hour to see clients, some of whom were unable to travel themselves. Others met clients halfway where possible.
But a visit and return journey could mean a chunk of three or more hours of a midwife's day.
In such cases, they often shared workloads but it was hard to ask a colleague to run up costs they might not be reimbursed for, Pihema said.
There was also concern pregnant women unable to afford petrol to get to a midwife would not have pre-natal checks or birth plans in place, at a risk to themselves and their baby.
''The big message is that women must keep communicating with their midwives. If for some reason they can't see each other, the woman must engage with her midwife.
''Midwives do work together. We are lucky we are very collegial in our approach here in Northland, and that includes the district health board.''
Certain areas are not fully covered by community midwives and rely on the Northland District Health Board to provide services. Pouto, 75km south of Dargaville, is one such area.
As rural midwives face turning down clients who live further out, their services are also more in demand.
''We have noticed an influx of urban people moving into the area, and often to outlying areas,'' Pihema said.
''These could be women returning home to have their children or people moving here from Auckland.''
That influx has impacted on what is already a busy time of year — the birth ''season'' after summer conceptions, she said.
Meanwhile, this week the Government and the oil companies have fallen barely short of blaming each other for the petrol price increases.
Prime Minister Jacinda Ardern said the fuel kings were "fleecing" motorists at the pump.
The big companies - Z, BP and Mobil - have blamed the high prices on the rise in the product's cost and the weakening New Zealand dollar.
Ardern said she did not find that answer acceptable, nor understand why the companies could not supply a more adequate explanation.
The Prime Minister said the fast-tracked Commerce Commission Bill would "force the hand" of the fuel industry which had refused to co-operate with previous efforts to understand pricing.
The fuel companies have welcomed the bill and the transparency it will bring.
