SDHB attempts to fix our maternity Russian Roulette

by Kim Bowden - Jun 30, 2020

An options paper detailing where Central Otago and Wanaka mums might birth their babies in years to come is expected to be delivered to managers at the district health board by today.

That’s the guarantee from the Southern District Health Board's (SDHB) general manager of Primary Care and Population Health Mary Cleary Lyons after Covid-related delays in community consultation.

The options paper is a hangover from the SDHB’s 2018 regionwide review of maternity services, which deferred a decision on how to best cater for population growth in Wanaka and Central.

Cromwell midwife Nadine Pauley: 'I have no idea where it’s heading.'

Despite it being more than two years in the making, Cromwell midwife Nadine Pauley, of New Beginning Midwifery, isn’t eagerly awaiting the contents of the options paper.

She’s too busy being a rural midwife.

She says she has engaged in her fair share of consultations and meetings with the health board, and she’s learnt not to get her hopes up too much about any particular outcome.

“It’s that slightly defeated feeling of being a rural midwife.

“I have no idea where it’s heading.”

Her local midwife colleagues are a passionate bunch, and there are midwives working really hard behind the scenes to try and secure the best outcomes for mums and bubs across the catchment, she says.

But, there seems to be constant roadblocks to progress somewhere in the chain of command at the health board, she says.

“It’s frustrating because we do see movement, but it gets to a point and then it stops.”

As deadlines for consultation and decisions are made and pushed-out, Ms Pauley and her colleagues work hard and work together to keep clients safe.

The SDHB's Mary Cleary Lyons.

“It’s just Russian Roulette.

“We’re just keeping things together with terrible glue.

“It’s broken, but it’s not shattered yet.

“It hasn’t crumbled, but we’re not solidly put together.”

Alongside midwives, Central Otago and Wanaka whanau have made huge sacrifices to allow the district’s maternity services to stretch without breaking, Ms Pauley says.

Just more than a year ago, Kristi James gave birth to son Makai on the floor of her midwife’s office in Wanaka.

Not the planned arrival, but kind of apt for a mum who’s part of Save Our Wanaka Midwives, a group campaigning for better birthing facilities for their town and others like it.

Despite feeling heavily invested in the outcome of the SDHB’s review, Ms James is despondent.

“Sometimes I do wonder if it (the latest consultation) is just a bunch of smoke and mirrors and nothing is going to be taken into account and nothing is going to happen again for another year.”

In between juggling the tumultuous and time-consuming demands of new motherhood the members of the grass-roots lobby group have elbowed their way into conversations held by district health board officials and politicians on where local maternity services are wanting.

“After battling for two years, we’ve not really seen any massive changes.

“We’re all sacrificing our time with our families…At some stage we have to kind of leave it up to the politicians and the district health board to sort it out amongst themselves.

“But it feels like a total ‘squeaky wheel gets the oil’ situation. As soon as we stop barking in their ears, they just don’t do anything. It just shouldn’t be like that.”

Wanaka midwife Deb Harvey: 'This has been an ongoing conversation that we’ve been having for several years now.'

Wanaka midwife Deb Harvey says the options paper is long overdue.

However, she’s hopeful the effort made by the health board to engage widely with local communities means the long process will result in well-thought out options for consideration.

“This has been an ongoing conversation that we’ve been having for several years now.

“So, hopefully, with the proper feedback and information the district health board will have from providers and people that engage with the services, they’ll be able to commit to something that’s suitable going forward.”

In the meantime, she’s helping bring babies into the world from an interim midwife clinic at the Wanaka Lakes Health Centre, which the SDHB foots the bill for.

“Three or four midwives use that space, so it’s sometimes oversubscribed.

“There are always going to be occasions where two people need to use one space, and that’s not ideal, so we have to adapt quite quickly and run around and beg or borrow another space (also paid for by the SDHB).”

Yet, in June last year, the health board announced it had signed a lease and taken possession of a ground floor space at 21E Gordon Rd to site its much-anticipated Wanaka maternal and child hub.

The hub, one of several promoted for the district by the health board and something of an experiment nationally, was to be a custom-created space that would provide care for new and expectant Wanaka mums and be ready for business earlier this year.

So, why are Ms Harvey and her colleagues operating out of the Wanaka Lakes Health Centre when the board is sitting on a building?

Waitaki MP Jacqui Dean says she can only guess how many babies have been born since the maternity hub was announced.

“I’ve certainly lost faith in the SDHB’s work around maternity services. It’s dragged on.

“This is a very long-running issue for Wanaka mums and babies and it’s certainly getting to the point where who knows what to believe frankly.”

Wanaka midwives (Deb Harvey among them) queried the health board’s decision to run with the Gordon Rd site, Ms Dean says.

The new hub site at Gordon Road - the SDHB has been 'sitting' on the building for more than a year, and now the site may be off the agenda.

It was cramped, with not enough room for equipment and to triage women, and with no helipad close by.

“So, if the midwives had given feedback on Gordon Road, why on earth did they sign the lease?

“And how much have they signed up to, what is the term of the lease, what is the break fee for the lease?”

A silver lining: Perhaps Wanaka midwives may get a facility better fit for purpose, like they were asking for all along, Ms Dean says.

“But it just means more delays.”

Waitaki MP Jacqui Dean: 'If it's just another report, well that's another waste of our time.'

As for the paper due today outlining options for the location of maternity services across Wanaka and Central Otago, Ms Dean says she’s open to what the health board has to say.

“But I will put a rider on that by saying they haven’t covered themselves in glory so far, so I do have a slight degree of scepticism, but I do welcome any progress as long as it’s not just a report.

“If it’s just another report, well that’s another waste of our time.”

The SDHB’s Ms Cleary Lyons says she can’t provide Crux with details of the lease arrangement or any costs related to the Gordon Rd site, including the costs of engineering and design work already undertaken, as it’s all “commercially sensitive”.

While the health board still holds a lease on the property, other “more fit-for-purpose” spaces have become available in the town as a result of Covid-19, and the board is now shopping around, she says.

“It is true that this property (Gordon Rd) was not perfect for a hub, but we were constrained at the time by the lack of alternative sites.

“We want to make sure we thoroughly explore every option to achieve the best solution for the community.”

Despite Covid-19 fall-out disrupting timelines for consultation on where-to for birthing units in Central Otago and Wanaka, a written options paper will be delivered to health board managers by today, Ms Cleary Lyons says.

From there, consultation with stakeholders will be complete by August 15, and a paper outlining the options discussed, and identifying a preferred option, will be submitted to the health board in September.

According to its roadmap from its 2018 shake-up of maternity services, the board remains “on track”.

When the number of babies being born in Wanaka and Central Otago is considered, a report on where the SDHB should provide or fund birthing units is well past its due date.

It gave itself three years to implement changes, despite acknowledging the burgeoning populations in this neck of the woods means it's "entirely probable" it's not meeting legal requirements to provide or fund certain facilities for a certain number of births.

But, Ms Cleary Lyons points out some important features of the strategy have long been implemented, such as additional financial support for midwives and ensuring interim maternal and child hub facilities in Wanaka.

“We believe most people in the community understand the recent delay due to Covid-19.”

But for now, for midwives Nadine Pauley and Deb Harvey and expectant mothers across Central Otago and Wanaka, it remains a case of wait-and-see: Will the health board’s arrangement with Alexandra’s Charlotte Jean be mantained or will a new facility be built in Cromwell or Clyde, both options suggested in the 2018 strategy? Will the Gordon Rd site be abandoned in favour of somewhere better suited, but at what cost, and when will it be up and running?

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