A new birthing centre in Māngere is at less than half capacity and can't get taxpayer funding, despite Middlemore Hospital struggling with demand.
Nga Hau Māngere opened in May, and is free for women registered with a midwife with an access agreement, and whose pregnancy is low-risk.
Women can stay for three nights after giving birth and have their own room with ensuite. Fathers can stay for the first night.
There have been 25 births there so far, but only seven of 20 birthing suites are used. The purpose-built centre is funded by the Wright Family Foundation charitable trust, and wants taxpayer funding to help with costs.
Talks with Counties Manukau DHB have been unsuccessful, despite serious issues with maternity services at Middlemore Hospital.
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A damning internal review last September linked problems like a lack of staff and bed space to the death or stillbirth of three babies. Thousands of women were also sent home too soon after giving birth, despite some having issues like difficulty breastfeeding.
Tish Taihia worked at the DHB for 22 years, including as charge midwife manager of the high-risk antenatal and postnatal ward at Middlemore.
She left in April to become the clinical midwife manager at Nga Hau Māngere, and told the Herald of the "unrelenting" pressures in the public system.
"They are so under resourced... we are really feeling for the staff at Counties, and the women using those services. Because I know firsthand what it was like to work within that environment.
"The facility here is excellent, it's long overdue for this community. And it's not being funded. We're not asking for a contract that covers everything, we're asking for a small piece of the birthing fee."
As well as Middlemore, there are DHB-run primary birthing units in Botany Downs, Papakura and Pukekohe.
Births within the district have dropped to about 18 a day, but cases are increasingly complex, partly because of poverty and increasing obesity rates. From 2014-2017 women turning up in labour "unbooked" and with no antenatal care rose from 88 to 118 a year, for example, and 245 more women had caesareans.
Since the internal review last September, the DHB has made changes including a new maternity assessment clinic and more midwife, nursing and support staff roles. Some women with babies in the neonatal unit will move in phases to another ward, freeing up 22 beds on the maternity floor.
Asked why Nga Hau Māngere wasn't supported, a DHB spokeswoman said it was important to note that many residents needed hospital births.
"Of the approximately 7300 births in the Counties Manukau area each year, 800 choose to birth in primary birthing units. Health conditions including diabetes and obesity mean many women must birth at Middlemore Hospital because they require specialist care for pregnancy complications and medical interventions such as induction of labour and caesarean section."
The DHB is working on a primary birthing strategy, the spokeswoman said,
and if that suggests a big change in demand then "additional capacity" could be funded.
This would be a tender process because "there are many potential providers".
Chloe Wright, chief executive of Birthing Centre, which runs Nga Hau Māngere and other centres in Tauranga, Palmerston North and Lower Hutt, said she sympathised with DHBs over funding.
"I think the answer lies with the government to redirect funding to follow mothers and their choice [where to give birth]. DHBs have got a horrible problem with having to make decisions of where to put their funding. I wouldn't want to be in their shoes, quite frankly."
Wright said if the centre continued to be paid for only by the foundation, then its other charitable work would be put on the backburner.