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Where should we locate primary maternity facilities in Central Otago/Wanaka?

Updated 2 November 2020

Thank you to everyone who has continued to support our work this year to determine the best configuration of primary maternity facilities for the Central Otago/ Wanaka areas.

The Southern District Health Board today approved a recommendation, developed by the DHB and the Central Lakes Locality Network following months of consultation, to establish one primary birthing unit at Dunstan Hospital, and a second unit in in Wanaka, if possible.

It was noted that establishing two units for the area will require developing an operating model in collaboration with local midwives, to ensure the units are sustainable with the number of projected births in the region.

However, the board agreed it was worth exploring this, given the distance women and families in Wanaka currently need to travel to the nearest birthing unit in the region, currently in Alexandra.

If such an operating model cannot be achieved, further work will be undertaken to enable the board to consider a single birthing unit for the Central Otago/ Wanaka area, which would be located at either Dunstan Hospital, or at a new undetermined site in Cromwell.

In making the recommendation, Southern DHB General Manager Primary and Population Health Mary Cleary Lyons acknowledged that the Central Otago/ Wanaka area is unique in New Zealand when it comes to the provision of maternity services given its distance from secondary services, in such a challenging geography.

“This has meant we have needed to explore creative solutions, as we find the right balance between providing more facilities, and ensuring those facilities are well utilised and sustainable,” Cleary Lyons says.

While the details of such an arrangement have not yet been agreed, an option could involve collaborating with a community trust or local health care provider, and LMC midwives collaboratively working as a team to deliver care.

Meanwhile, establishing a primary birthing unit at Dunstan Hospital is an opportunity to develop a purpose built, modern facility with immediate access helicopter transfer, says Southern DHB Director of Midwifery Heather La Dell.

“We appreciate the enormous contribution of the team at Charlotte Jean maternity over many years, and heard that many women appreciated the supportive environment there. We sincerely thank their team for their professionalism as we have worked through this consultation process with the community.

“We now have an opportunity to design services for the future. We believe that developing these two units in these locations better meets the needs for the community in relation to the priorities that have been identified.”

The recommendations come following months of consultation with families and health providers across the region, including two public meetings and receiving over 500 written submissions and survey responses.

In endorsing the options, Acting Southern DHB Chair Dr David Perez acknowledged the significant input from across the community since the consultation began in February.

“This has been a challenging issue that our community is understandably passionate about. Through the tremendous engagement with community members, midwives and other health care providers, we can feel confident that all the dimensions of the issue have been raised and considered and appropriately weighed.

“By working collaboratively and thinking creatively, a very compelling recommendation has been presented to us. We look forward to continued progress in confirming that a two-model solution, including a long-awaited birthing unit in Wanaka, can be brought to reality.”

“We are especially appreciative of the LMC midwives who have been open to exploring alternative models in the interests of the women they serve, and the willingness to think creatively about approaches that could work.”

The full board paper can be found here.

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Where should we locate primary birthing facilities in Central Otago/ Wanaka? - Public meeting
If you have missed the meeting on 9 September, you can view the presentation slides and recording below.

The recording of the public meeting on the location of primary birthing facilities in Central Otago and Wanaka on Thursday 23 July is attached below. The presentation slides can be viewed here.

 


 


 

FAQs

Why are we exploring this question?

The population in the Central Otago/Wanaka area has been growing rapidly, and the numbers of women who are pregnant and having families in the area has been increasing. The current configuration of primary maternity facilities has evolved through historical circumstances. The need to look at the maternity facilities of the whole Southern health district led to Southern DHB creating the Integrated Primary Maternity System of Care. 

This recognised the configuration of facilities in the Central Otago/Wanaka area needed to be addressed, along with the shortage of LMC midwives practising the in the area.

We developed a strategy to allocate our resources in a more equitable way across the district. To better support LMC midwives across all our rural areas we paid them more (over and above the funding they receive from the Ministry of Health) and supported paid time off.

We also established maternal and child hubs in Wanaka, Te Anau and Lumsden.

With the growing population in Central Otago/Wanaka, we knew we needed to do more. The Central Lakes Locality Network was established to help advise on health needs for this part of the district. One of their first priorities is to advise on the best configuration of primary maternity facilities.
 

Who are the Central Lakes Locality Network?

The creation of Locality Networks was outlined in the Primary and Community Care Strategy and Action Plan, with the purpose of ensuring models of care align with population health needs and service requirements in different areas of the district. The network plays a vital role in prioritising and planning health services so they meet the needs of local communities and are well-integrated with the broader health system. Central Lakes Locality Network (CLLN) is the first of these networks to be established. Helen Telford, Queenstown resident and expert health consultant and programme manager is the Chair of the Network. Other members include local residents including patients and healthcare consumers, general practitioners and rural hospital clinicians, a general practice nurse and a health promotion advisor. Further information about the network and its members can be found https://www.southernhealth.nz/publications/central-lakes-locality-network-members-appointed.


What are primary maternity facilities?

Primary maternity facilities are locations that support maternity care that is provided outside of a secondary hospital. In the Southern district, these include:
 

PRIMARY BIRTHING UNITS

Care available:

  • Antenatal assessment
  • Labour and birth care to women having a normal pregnancy
  • Postnatal care for women and babies who have birthed at the primary unit, or who have birthed at home or hospital and then transfer to the primary unit for an inpatient stay

Care provided by:

  • The woman’s LMC midwife, supported by staff (usually a midwife or a nurse).

What are units not designed for?

  • Care that requires secondary or specialist support, such as epidurals, forceps delivery, blood transfusions or Caesarean sections.

 

MATERNAL AND CHILD HUBS

Care available:

  • Antenatal assessment
  • Telemedicine consult with obstetrician (available in Wanaka only currently)
  • Accessible to midwives 24/7 in case of rapid births

Care provided by:

  • The woman’s LMC midwife, supported by hub coordinator (a midwife or nurse)

What are hubs not designed for?

  • Planned place of birth or inpatient care; care that requires secondary or specialist support.

 

What primary maternity facilities are already in the Central Otago/Wanaka area?

Currently there is a primary birthing unit in Alexandra (Charlotte Jean), and at Lakes District Hospital in Queenstown. There are maternal and child hubs in Wanaka and Ranfurly.

lakes maternity

What are the principles for making a decision?

We have undertaken extensive consultation in recent years about the needs of a whole of district primary maternity system of care.  This led to creating the Integrated Primary Maternity System of Care.

During this process we established principles for a reformed configuration of services, and we will be continuing to apply these as we develop options for the Central Otago/Wanaka area. These are:

  • Critical mass – this means understanding our populations and birthing numbers across the district; meeting Ministry of Health birthing population standards; and ensuring there are sufficient numbers for a viable service and sustainable workforce, supported by a transfer/transport system
  • Equity for disadvantaged communities
  • Acceptable travel distances to a facility – in the context of improved support for home birthing and acknowledging the preference for travel towards secondary care locations.