Newshub can reveal officials raised concerns about the closure of the Lumsden Maternity Centre over the distance pregnant mothers would be forced to travel to give birth.
Documents obtained under the Official Information Act (OIA) show red flags were raised throughout the process.
National is calling the whole process "a trail of destruction".
Ministry of Health advice to Health Minister David Clark and Associate Health Minister Julie Anne Genter in June 2018 raised concerns about the proposal to close the centre and centralise birthing care to a hub.
"The clinical risk faced by a small number of women in Te Anau who would be required to travel further to access a primary birthing facility (e.g. Winton or Invercargill) and access requirements as per the Service Coverage Schedule."
The advice said the schedule requires DHBs to fund primary maternity facilities in rural communities worked out by the number of births expected in a catchment and distance from a secondary service.
"In catchments where 200 pregnancies per year are estimated, the facility must be within 30 minutes from a secondary service. Where 100 or less are estimated, the facility must be within 60 minutes from a secondary service".
A further document detailed more concerns about the lack of dedicated maternity services in the area and the need for the hub to provide those services.
"Emergency birthing should be able to be facilitated in the proposed Lumsden Hub to mitigate the risk for women who do not have time in labour to drive to Winton or Gore, which is 1.5 hours from Te Anau," the email read.
"There are some areas where there is quite a distance between primary or secondary birthing units and these distances would for some women be outside the one-hour travel distance."
National's Clutha-Southland MP Hamish Walker told Newshub rural people have been put at risk.
"This is an absolute trainwreck, it has been all along. The Health Minister and the DHB need to give the community a pretty big apology."
"The Government has treated Southland people like second-class citizens
"The Government's can't even deliver basic maternity services across Southland, they owe the community a huge apology. It's quite disgraceful how they've treated them, this is complete incompetence," Walker said.
The documents go on to reveal even Labour was worried about the decision. Invercargill list MP Liz Craig wrote to the DHB in 2019 with concerns from residents regarding midwives' ability to access emergency maternity facilities at Lumsden and Te Anau.
An email extract said: "I have just heard… that despite the SDHB announcing that the Lumsden Child and Maternal Hub is operational, unfortunately it is not - firstly the locks have been changed and the midwives do not have access".
"Not much equipment here at Lumsden… Very basic drugs there in regards to controlling haemorrhage, no oxygen tanks etc. Currently the Lumsden hub consists of several unused empty cold rooms with one that has equipment in it to do antenatal checks," the email extract said.
Decision to downgrade
The DHB revealed its decision to downgrade the centre to a hub in August 2018, but in March the decision appeared to have already been made.
The documents say the centre isn't sustainable as it has approximately 38 births per year.
"Based on this, a decision has been made to transition Lumsden primary maternity unit to a Child Maternal Hub which means the bed (and birthing pool) would not continue.
"The closure will not take effect until the end of September 2018 when the current contract runs out."
The email went on to say the DHB had asked the Ministry for feedback on the decision document and was waiting to hear if the commissioner endorsed the idea.
"The DHB had not at that point communicated any of this to the Trust that runs Lumsden maternity centre, nor were there any dates set to discuss this decision with Lumsden."
The idea was agreed to by the commissioner, then communicated to the board before going out for public consultation.
A weekly report item to the Minister later in March discussed the consultation process and said "it is expected the final outcome will result in the closure of the Lumsden primary birthing unit later this year".
Walker says it was a predetermined decision all along.
"Mothers and babies in Southland have been put at risk. We had five mothers give birth without making it to a primary birthing unit."
Independent reviews
Two independent reviews were carried out, one into four rapid births at the Hub which included a woman giving birth in the car park.
The documents released to Newshub show frustration from Southern DHB's chief executive Chris Fleming at the draft terms of reference of the birthing review.
"I have read this again and am concerned that the review has gone down a pathway that is not in keeping with the intent of the review."
Fleming said it was "supposed to look at the emergency births that have occurred and ensure that each of these have been managed appropriately" but he was challenged for appearing to blame mothers and medical professionals for the emergency births.
"The first one being where the woman was loaded onto an ambulance and driven away from the Maternal and Child Hub and then ultimately delivered in the ambulance on the side of the road. Questions that should be asked would be, why was a known secondary birth still located in the remote area at the stage of the pregnancy? (i.e. was it appropriate that she was still hours away from the nearest secondary facility?), given the presentation on the morning and the infrastructure that was present, both the midwifes' equipment and that available in the hub, was it appropriate that the woman was transferred? (i.e. the potential benefit of getting to secondary on time outweighed the risk of either birthing in the hub or the risk of a birth in the ambulance)."
The DHB's chief nursing and midwifery officer Jane Wilson wrote back saying: "I believe this line of questioning will be viewed very strongly as directly challenging the LMC and other professionals involved".
"Or blaming the women in their planning and timeliness to get closer to secondary care or another PBU - rather than looking at whether there was any impact (or not) from the changes in the context of all support and equipment available at the time."
Walker says the email from the CEO is a disgrace and the mother deserves an apology.
The other review surrounded the roll out of the maternity hubs in Southland. It painted a damning picture of the process. It found there to be no clear definition of what a hub would actually be and what services it would provide, criticised the SDHB's "informal" management processes and said there was an "inconsistent delivery of service".
National says it would reinstate full services to the centre within its first 100 days if elected to Government.
"This whole saga has been a complete trainwreck, the Government haven't even listened to their own advisors, they haven't listened to Ministry of Health advice, they haven't listened to their own MPs," Hamish Walker said.
"This is every mother's worst nightmare, to give birth in the middle of the night on a rural Southland road, on the side of the road in an ambulance to a 10-pound baby. I don't think that's acceptable".
Health Minister David Clark wouldn't comment, Associate Health Minister Julie Anne Genter was approached for comment.
Newshub.
