Maternity care is at ‘critical juncture’ and strained, Health NZ says - Where are the gaps?

Thursday, 30 April 2026

Workers and experts say there are clear gaps that must be addressed to help keep mothers and babies safe. Nicholas Jones reports.

Health NZ documents warn the maternity sector is at “a critical juncture”, and “experiencing significant strain due to a shortage of midwives and obstetricians”.

Stuff has obtained the documents as part of a wider investigation that has also revealed multiple baby deaths have been linked to staffing issues or pressure.

Health NZ says lessons are learnt after such cases and improvements made, and the vast majority of women and babies receive safe, high‑quality maternity care.

It is, however, planning significant reforms, which will be guided by a maternity national clinical network, made up mostly of healthcare professionals and leaders.

Health NZ declined an Official Information Act request for documents produced by or for the group since January 2025, saying more than 300 existed. It instead released terms of reference and a workplan for 2025-2027, which have not been made public until now.

The workplan document states that, as of May 2025, Health NZ “is navigating a complex landscape in maternity services, marked by workforce shortages, service restructuring, and ongoing efforts to address longstanding inequities”.

“The maternity sector is experiencing significant strain due to a shortage of midwives and obstetricians. This shortage has led to service downgrades in some regions,” it says.

“HNZ’s maternity services are at a critical juncture, balancing the need to address workforce shortages and service restructuring with the imperative to improve equity and access to care.”

What needs to change?

Dr Emma Jackson is the NZ vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), which trains and accredits doctors in the specialties of obstetrics and gynaecology.

Jackson says NZ’s maternity system is safe and staffed by skilled, committed workers, but workforce pressures are often a contributing factor when substandard care does happen.

There are hospitals with staffing vacancies, she says, but those are “the tip of the iceberg”, because the number of funded positions - including in midwifery - “often doesn’t reflect the actual staffing required to provide a quality service”.

RANZCOG has long advocated for the government to use a clear and agreed process to properly calculate what each hospital or clinic needs to be safely staffed, Jackson says.

“There's been talk of it happening, but it's never really happened.”

Roll out of information system ‘stalls’

Some of the cases identified by Stuff in which babies died involved instances of workers on busy shifts not handing over or having quick access to vital patient information.

For example, a baby boy died after his 2016 birth at Middlemore Hospital, and a coroner later identified multiple times when his care should have been escalated, but wasn’t.

Hard copy clinical notes were not available when the newborn was sent to the maternity ward. Neonatal vital signs were marked on a physical feeding chart, but this was kept with the mother.

“The baby's post-natal condition and risk factors appear to have been lost during one of the handovers. There was genuine confusion,” the coroner found. “This resulted in no one taking clear responsibility for him, and a breakdown in the transfer of information through handovers.”

Jackson says RANZCOG wants a nationwide maternity information-sharing system, to be a single and real-time clinical record for each pregnancy, even if multiple health professionals (such as a community midwife and, later, a hospital obstetrician or ED doctor) are involved.

Jackson says a version of such a system, called BadgerNet, is in about 50% of hospitals, but its rollout has stalled, “and I understand that’s due to fiscal constraints”.

Asked if this is accurate, Kiley Clark, Health NZ’s interim national chief midwife, said the system was live in 12 districts, covering 14 hospitals, 19 primary birthing units, and about 43% of community lead maternity carers (such as midwives).

Funding approvals had moved to “regional decision-making”, Clark said.

“All district rollouts remain on the national roadmap … while further rollout has been sequenced as part of broader digital infrastructure prioritisation and budget planning, hospitals and maternity providers continue to use established local clinical information systems to ensure safe, effective care.”

A lack of independent oversight

Dr Peter Stone, an emeritus professor in obstetrics and gynaecology at the University of Auckland’s School of Medicine, said the cases identified by the Stuff investigation were deeply troubling, and getting a handle on levels of avoidable harm had become much harder.

The Perinatal and Maternal Mortality Review Committee (PMMRC) was established in 2006 to monitor such cases and systemic problems. In 2023 it was disestablished, and its functions rolled into an overarching national mortality review committee.

In December 2024 Stone wrote to then Health NZ Commissioner Dr Lester Levy and Dr Shane Reti, the Health Minister at the time, asking for the PMMRC to be resurrected, and its recommendations made binding, and supported by ring-fenced funding.

Asked about this, Clark told Stuff that responsibility for the PMMRC sat with the Health Quality & Safety Commission, but Health NZ “continues to maintain comprehensive and relevant quality and patient safety functions across its services”.

“Health New Zealand remains committed to strengthening maternity quality and safety, addressing inequities, and supporting continuous improvement in care delivery for pregnant women, pēpi and whānau,” Clark said.

“We work closely with HQSC and other system partners to ensure learning from reviews, data and quality improvement activity informs practice at local, regional, and national levels.”

Jenn Hooper, founder of Action to Improve Maternity (AIM), which helps families affected by poor maternity care, strongly supports the reestablishment of the PMMRC, saying, “they were the only ones that collected any investigative data”.

Hooper - who was made a member of the NZ Order of Merit in 2020 for services to maternity care and people with disabilities - says another problem is that coroners scrutinise a minority of newborn deaths that should be investigated, because guidelines now require only “unexpected” deaths to be notified.

AIM has supported dozens of families whose babies’ deaths didn’t result in a notification to the Coroner, Hooper says, including because they were in a very poor condition when transferred for neonatal intensive care, and therefore their death wasn’t “unexpected” - despite the fact the baby was thriving until labour began.

Hooper began her advocacy because of her own experience. Her first child, Charley, was born unresponsive, and midwives botched resuscitation attempts.

Every part of Charley’s brain was damaged; now 20, she can’t see or move a single muscle in her body, and doesn’t know who her mum, dad or two brothers are.

Hooper and her husband Mark both gave up work to care for her, and in the almost two decades since, she has helped close to 1000 other families fight for answers, accountability and support. That need shows no sign of reducing, she says.

“More ‘attention’ is not what we need. What more does it take to actually get some action? Women’s health is a low priority - women are placed last on the food chain of who gets what.

“And this isn’t just women, this is babies too - our future, and a costly one if the baby manages to survive, but is really brain damaged. That is $55m per kid [in lifetime ACC costs]. Imagine what that could buy us, if it wasn’t paying for kids like Charley.”

Harm ‘almost normalised’

Professor Bev Lawton, whose work leading women’s health research and initiatives saw her named the 2025 Kiwibank New Zealander of the Year, told Stuff “the time has come to sit around the table and design a service that is fit for purpose”.

“It must be appropriately funded, which it is not at present. It needs to be an integrated, seamless, quality service, which it is not at present.”

Francesca Storey, a senior research fellow who works with Lawton as deputy director of the Victoria University’s National Centre for Women’s Health Research Aotearoa - Te Tātai Hauora o Hine, says official statistics undercount “many areas of concern”, including preventable harm and neonatal encephalopathy (brain injuries).

“In general, harm associated with maternity has almost become normalised. This is not good enough.”

Storey says the sector has been divided into silos, and too often any call for change was taken as a criticism of individuals or each group.