Lakes District Health Board says it remains strongly committed to providing a primary birthing and postnatal service at Taupō.
But such a service being available 24/7 has lately become difficult to achieve, with midwife and registered nurse shortages meaning the DHB had to restrict the opening hours of the birthing unit at Taupō Hospital last week. Further overnight closures of the unit are possible.
Midwives can practise either in the community as self-employed lead maternity carers or in birth facilities (hospital or primary facilities) on shifts, as DHB-employed midwives. Both hospital and community midwives are in short supply.
The DHB had trained registered nurses to work at the birthing unit alongside midwives but recent resignations had also removed that option.
There were no staff available for night shifts at the birthing unit last week which meant that no women and babies were able to stay overnight after birth between Monday and Friday.
Lead maternity carer midwives were able to use the unit for their clients to birth in but the women needed to then be discharged home or undertake the hour's travel to Rotorua Hospital's maternity unit for postnatal care.
The Taupō birthing unit reopened last Saturday, however there are upcoming gaps on the roster which the DHB is trying to fill.
The unit's clinical midwifery manager resigned last September and other resignations mean the Taupō unit has less than half the required staffing.
Taupō mother Tina Gillies, whose second child, son Rory, was born in Taupō in a rapid birth says the unit is "an amazing unit" with great support. After birthing Rory mid-afternoon on November 17, Tina stayed the night and had hoped to spend a second night there.
"I wasn't feeling 100 per cent and I wanted to try to get as much support as I could with my second to try and do better with breastfeeding," Tina says.
However, she was told the unit had to close for lack of staff and care at Rotorua was not offered as an option.
"There was no alternative [to Taupō] offered, there was no 'are you going to be okay?' It was just 'you have to go home, you have to go home today'."
After arriving home, Tina felt scared and unwell and says she was probably in delayed shock after such a speedy birth. She says if Rory had been her first baby she would not have been confident or comfortable to go home so soon and fears that other new mothers will have to be discharged before they are ready.
She wrote to Lakes DHB chief executive Nick Saville-Wood praising the Taupō unit but expressing her concerns about the early discharge.
Mr Saville-Wood replied saying any woman who needed clinical care (who was not safe to be discharged home) could be transferred to Rotorua Hospital, but most women who were clinically safe to go home were discharged home, albeit earlier than anyone would have liked.
"We are sorry that this happened in your case but please be reassured that this only happened when all other staffing options had been explored," the letter said. "We continue to seek to recruit and would employ midwives in the unit 24/7 if they were available."
Lakes DHB chief operating officer Alan Wilson said in a statement that everything possible was being done, with the DHB actively recruiting. However a national shortage of midwives has been compounded with the borders to Australia reopening, with a number of midwives heading to Australia.
Mr Wilson says the safety of both birthing women and their babies and staff is paramount.
There have been occasional closures of the Taupō unit over the past year, where staffing shortages have meant the unit is unable to offer or support continuing postnatal care due to gaps in the roster.
No Taupō community midwives were willing to comment but New Zealand College of Midwives midwifery adviser Claire MacDonald said retaining midwives was a national issue.
Ms MacDonald said while it was good news that women could still birth in Taupō, ideally they would be able to stay after the birth if they need to. However, if women had to go home their community midwife would still visit them there to provide care.
Contracts and pay equity for midwives was an issue but the job was also becoming harder and harder. Midwives lacked administrative and support structures and the community's expectations kept going up, she said.
"Pay for self-employed midwives has improved but the conditions have continued to get more difficult."
Part of that was because health outcomes were related to social inequities like poverty. Where women needed extra care or more input such as home visits or help to access obstetric services, midwives would provide them, although they did not receive any more money than they would for a straightforward pregnancy.
"Midwives see those needs and really feel a professional responsibility to meet them but it's not being factored into our contract model and it's not being factored into the pay that midwives are receiving so they carry a lot for these women," Ms MacDonald said.
"There's also increasing medical complexity which is happening for a whole lot of reasons and midwives in hospitals are feeling really stretched."
However, Ms MacDonald said that despite some difficult conditions, midwifery was a satisfying job.
"Midwives really love what they do and it's a profession that's underpinned by a really deep sense of purpose and ultimately that's what keeps people in it. Every single time you're at a birth and a new baby is born and a new family is made, it fills your cup again."
Midwifery degree enrolments jumped post-Covid but it is a four-year degree and the cost at WinTec in Hamilton is $29,888 for the degree. Online learning with on-site block courses are available for students in areas such as Taupō but the impact on a family can be huge.
Ms MacDonald said while the government was providing incentives for people to train in male-dominated areas like trades, it needed to apply the same thinking to female-dominated professions like midwifery and nursing where there was also an urgent need for staff.