Southern DHB to review implementation to date of primary maternity system of care, and recent ambulance birth

 Media statement from Chris Fleming, CEO, Southern DHB

There has been considerable interest in Southern DHB’s integrated primary maternity system of care, particularly following the birth of a baby in an ambulance enroute to Southland Hospital on Sunday morning.

Following the event, we undertook to review the incident, and I am now developing the details of how this will proceed.

My expectation is there will be two parts to this. Firstly, I have instructed my team to prepare a full report on the implementation of our integrated primary maternity system of care to date.

We are eight months into a two-year implementation timeframe, and we need to take stock of what has gone well, and where implementation has been more challenging, and what lessons we need to learn from this. 

Maternal and child hubs are a new concept. They were introduced following a review into our previous primary maternity system, that found shortcomings in the reach of services, and the sustainability of LMC midwifery across the district.  They supported the need to deliver care across an enormous district, to increase the reach of maternity services in places that previously had no formal maternity infrastructure, namely Te Anau and Wanaka, and to alleviate some of the costs for LMC midwives operating in these areas.

However, there has not been a blueprint to follow for this. We have acknowledged that aspects of the transition to a hub in Lumsden have not gone smoothly, and there may be range of reasons for this.  As we progress with the strategy, we need to understand this better so we can learn from this.

We need also to remember the hubs are only one part of the strategy, aimed at utilising our maternity resources in a more equitable and sustainable way. The more significant aspect of trying to strengthen the sustainability of the midwifery workforce in our rural areas has been the introduction of additional payments to LMC midwives, and providing rural midwifery support to ensure that the LMC are able to have adequate breaks.

The focus on the review will be the implementation of the strategy; we are not reviewing the strategy itself as this has already been thoroughly reviewed. The overall strategy may be evaluated in the future, once it has been fully implemented.

Secondly, however, we do also need to review the particulars of the birth that occurred on Sunday morning, given the circumstances and interest in this. I note the outcome for the woman and baby was positive, and that St John and her LMC midwife were in attendance, as we would expect when providing urgent care in such circumstances. 

However, I do want to understand more about the specifics of the case, the care she received, the decision making, and the overall network of support that was available to the woman, including the role if any that the changes to the primary maternity infrastructure may have played in this.

Given the many perspectives on this that have been expressed publicly, I would be looking to have independent midwifery input into this review.