Clutha-Southland MP Hamish Walker today presented a petition to the Health Select Committee in a last-ditch effort to save the Lumsden Maternity Centre from being downgraded. His full verbal submission to the Select Committee follows.

I stand before you as the Member of Parliament for Clutha-Southland, on behalf of the people of Clutha-Southland in our last effort to save the Lumsden Maternity Centre.

In August last year, the community received the news the Lumsden Maternity Centre will be downgraded to a Maternal and Child Hub as at 15 April 2019. This means that there will no birthing and no in-patient postnatal stays at Lumsden.

As you will have seen and heard time and time again there is huge support to save this well-utilised centre, with my petition to save the centre attracting more than 5000 signatures. To put that into context, the population of Lumsden is about 200.

This centre is a vital asset to not only Northern Southland but all of rural Southland and the decision to downgrade it puts rural mothers and babies at risk and jeopardises the rural midwifery workforce.

Downgrading the centre by no means meets the needs of the community, which currently services mothers some 80km away.

This decision will have severe consequences for the rural Southland community, with the increase in risk of complications for mothers and babies during birth – blood I would hope no one wants on their hands.

Lumsden has had a maternity centre for more than 50 years and the Northern Southland Health Company has operated it for more than 20 years. It has been no smooth ride for the Northern Southland Health Company which runs the centre.

They’ve faced closures, funding and staffing challenges, problems with contracts and more, but through community support, nothing has overcome the centre – until now.

Quite frankly, downgrading the centre doesn’t take away the fact women in rural Southland will need a place to give birth.

It means their health and safety is put at risk and the distance they have to travel is further.

I have three main areas of concern when it comes to this downgrade decision, which is why I believe the Health Select Committee needs to investigate the decision.

The biggest concern I hold in the downgrade of the Lumsden Maternity Centre, and the biggest concern of the community, is the health and safety of mothers and babies in the area who are serviced by the Lumsden Maternity Centre.

While the Southern District Health Board has attempted to address these, through providing “emergency birthing equipment” it will not be enough.

It is more than a case of being prepared for a birth and the following health and safety issues are also created in downgrading the centre:

Midwives or Lead Maternity Carers ability to adequately and safely care for women and babies will be jeopardised because they will no longer have the back up of a 24/7 midwife stationed at Lumsden.

Without this backup, midwives are left to provide care to women and babies in isolation over a vast geographic distance.

This care spans from pregnancy to labour and birth as well as the crucial early postnatal stage.

Midwives cannot be in two places at once and trying to manage the demands of their role without the support the Lumsden unit previously provided will become unsustainable.

If midwives withdraw their services then a bad situation will quickly become a crisis in the Northern Southland area.

The pressure on other primary birthing units will be escalated as the demand will increase with more expectant mothers having to rely on units like Winton and Gore.

On call midwives will struggle to attend births or emergency situations in the Northern Southland area from their bases in Invercargill, Gore and Winton. It is some 130km from Winton to Te Anau as the closest base if Lumsden is downgraded.

With travel time being increased by some 30 minutes to the nearest primary birthing unit, roadside births will be increased and therefore too the risks. Rural pregnant women will be more isolated than before and it poses a major risk to both mother and baby.

As well as the downgrade of the centre, postnatal stays in these child hubs have been removed.

This will have huge ramifications for new mothers establishing breastfeeding and bonding with their baby with the appropriate support around them.

The increase in postnatal stays at the limited primary birthing units will also put a strain on those facilities.

This may lead to women being discharged earlier than they would like increasing the risk of complications and having flow-on effects to their mental health.

Twenty four seven ambulance cover is not available in rural Northern Southland and with the struggles of first responders in all of Southland the risk is even higher now for expectant mothers than ever before.

In Northern Southland and surrounding areas it is at least a full 60-minute drive to the nearest hospital, so if there was a crisis postnatal or antenatal, downgrading the hub would mean there is no support network available.

Losing the valuable midwives and lead maternity carers in the area would be a major loss to the health sector, but given the health and safety risks, it is understandable they would no longer want to work in the field.

Losing these midwives and lead maternity carers will create further uncertainty for expectant mothers, who will be in some ways left on their own to handle their pregnancy.

Resources are already stretched in the maternity space in Southland and downgrading the Lumsden Maternity Centre will cause further pressure in this space. Mothers in the area will face massive barriers in accessing postnatal and antenatal care.

Lumsden is the heart of Northern Southland, the gateway to Queenstown and Te Anau and an increasing population.

For these reasons in itself, the Lumsden Maternity Centre should be retained as a primary birthing unit.

For years this centre has managed its isolation with the ability to provide top-level care to mothers and babies and is a vital health service for the community.

It is a case of how many emergencies where things go wrong before the importance of this centre is realised.

Downgrading the centre is a health and safety risk.

The other area of concern is the figures used to make this decision.

The writers of the report did not consult with the Northern Southland Health Company or visit the premises of the Lumsden Maternity Hospital prior to or during their report writing.

As highlighted above the major reason the Lumsden Maternity Centre needs to stay as a primary birthing unit is a safety factor for those in Northern Southland and surroundings areas.

However, there are also issues which have been continuously raised by the Southern District Health Board that there were not enough births in the area to justify the primary birthing unit.

However, this overlooks the number of women who birth elsewhere (usually in Invercargill) and have their postnatal care at Lumsden.

For the year ended 31 March 2018, there were 46 births at Lumsden and a further 48 women birthed elsewhere but transferred to Lumsden for postnatal care.

Essentially, close to 100 women used the service.

It is this which leads to my next point about the Service Coverage Schedule. This schedule is part of the Crown Funding agreement between the Ministry of Health and the District Health Boards and is a legally enforceable agreement.

Its purpose “is to allow the Minister of Health to explicitly agree to the level of service coverage that the Ministry and District Health Boards are held accountable to.”

The Service Coverage Schedule says the District Health Board must fund a primary birthing unit, like the Lumsden Maternity Centre, in rural communities where there are 100 pregnancies and where the unit is 60 minutes away from a secondary unit.

This Service Coverage Schedule refers to pregnancies, not births. The issue which seems to arise in the Southern District Health Board’s decision is the catchment which the Lumsden Maternity Centre Services is not defined.

If you refer to the Wikipedia definition of a catchment, in this case, catchment area, is “in human geography, a catchment area is an area from which a city, service or institution attracts a population that uses its services.”

The numbers the Southern District Health Board has referred to in its decision and recommendation to downgrade the centre are the birth numbers at the Lumsden Maternity Centre.

These do not include the postnatal stays or transfer, or the fact many other women had planned to birth at Lumsden but due to unforeseen circumstances were unable to do so.

This also does not meet the Service Coverage Schedule which refers to pregnancies, not births.

The Southern District Health Board had also been supplied with information from the Lead Maternity Carer at the Lumsden Maternity Centre, Sarah Stokes, who is not the only Lead Maternity Carer using the centre, there were more than 100 registrations from pregnant women last year.

Therefore the total number of pregnancies for the catchment would be clearly more than the 100 required.

The Southern District Health Board was also provided with details of antenatal (AN1) blood test results for the most populated areas of Northern Southland which clearly demonstrated that there were far more than 100 pregnancies.

This information was acknowledged by the DHB chair as the best source of data to determine pregnancies in a catchment, yet the DHB chose an alternative interpretation of the catchment which would support their decision to close Lumsden Maternity Centre.

None of this information is new, and you will have seen a large amount time and time again, but it is incredibly alarming to me that the decision makers, who have written the Maternity Centre’s future, have chosen to interpret the numbers in this way.

Along with Health and Safety and the figures that were used it is the impact on the rural community of Lumsden which raises further concern for me.

Facilities like the Lumsden Maternity Centre are vital to the success of rural areas and are vital to the rural community.

Without access to health care and services like this centre, young families, expectant mothers and many others are deterred from coming to our communities.

Towns surrounding Lumsden are continuing to grow, like Kingston, which uses the Lumsden Maternity Centre.

There is already a 1000 section subdivision in progress in Kingston which if the Lumsden Maternity Centre is downgraded, will put even more pressure on the Lakes District Facilities.

As already stated, emergency services in the area are already stretched and new expectant mothers deserve specialist care.

All in all, Southland needs the Lumsden Maternity Centre, rural New Zealand needs the Lumsden Maternity Centre, we all need the Lumsden Maternity Centre.

The proposed child hub will be a waste of the wonderful resources already available at the Lumsden Maternity Centre and provide little benefit to expectant mothers in the area.

While I believe there should be more investment in areas like Te Anau, to take away the resourcing from one to give to another makes no sense and is a very weak band-aid.

An investigation is needed into how this decision has been made.

From the information provided to me, the support of the community and the outcry, Lumsden Maternity Centre needs to stay funded as a primary birthing unit.

It will require little Government funding to save the centre – a mere $200,000, which is a tiny amount of funding to provide safety for rural mothers and babies.

I’m asking the Health Select Committee to make the decision to investigate the downgrade decision and for the committee members to see for themselves how vital this centre is.