Preterm birth initiative at risk as funding ends

Dr Lynelle Taylor, consultant obstetrician and gynaecologist at Bay of Plenty Hospital in Tauranga, has had a good day.

“This morning I put a cervical suture into a woman,” she tells me, talking about a stitch placed around the neck of the womb to help prevent a baby being born too soon. It’s a relatively straightforward procedure aimed at saving high-risk pregnancies – and it’s one Taylor had done in the past. But until recently it was performed mostly at larger hospitals; infrequently at a regional centre like Tauranga, she says.

But a new Community of Practice providing support and mentorship for obstetricians and midwives to learn together in order to understand and deal with preterm birth risks in their communities has changed that.

Earlier this year, Taylor attended a Community of Practice hands-on training day in Auckland about cervical cerclage (as the stitch around the cervix is more commonly called). Auckland-based maternal fetal medicine specialist Dr Lisa Dawes, one of the organisers, collaborated with a local company to develop a model the attendees could train on. Each model cost less than $600, as opposed to the more than $10,000 she’d been quoted from an overseas company.

But the Carosika Community of Practice is far more than cervical cerclage. It was established in August 2024, led by Dawes and her colleague Professor Katie Groom, along with PhD student Dr Briar Hunter at the University of Auckland’s Liggins Institute.

Seventeen of the 20 hospitals providing pregnancy care in New Zealand have committed to the Community of Practice, with 36 senior obstetricians and midwives taking part – all looking for education, mentoring and peer support.

As well as two in-person training days during the year, the Community of Practice members have participated in monthly online educational hui and a secure chat group where clinicians seek and give advice, highlight the latest research, and get much-needed support for challenging clinical situations.

Taylor says the woman she performed the cervical suture on that morning had had one very preterm birth, and a second pregnancy where she had moved her whole family to Auckland so she could receive specialist care.

For the third pregnancy, her midwife again referred her to Auckland.

“Katie [Groom] had the first consult with her and then said: ‘Actually we are supporting this great service in Tauranga now, and I can refer you to my colleague Lynelle.’ And then she picked up the phone and gave me a call, and I went ‘Sure, I can see her.’ 

“And that means this woman and her whānau can continue to have all their care safely in Tauranga.”

A stubborn problem

Preterm birth is defined as a baby being born before 37 weeks of pregnancy, though there are various types, from extremely preterm babies born before 28 weeks of gestation, to late preterm birth, from 34 to 37 weeks.

There are 4500–5000 premature births in New Zealand annually, which is about eight per cent of total births.

Being born too early is one of the biggest reasons babies die in Aotearoa, Dawes says, and it can cause sickness and disability for many survivors.

Unfortunately, where people live – rural or urban, and in which city – makes a big difference to their chance of having a preterm birth, she says; rates vary by region from 6.8 percent to 10.6 percent. 

Preterm birth rates also differ by ethnicity, with Māori, Pacific and Indian families experiencing less privilege in both the chance of and outcome after preterm birth than European families.

Groom and Dawes want to change these inequities. They are both leaders of the Carosika Collaborative, which was launched in 2020. The name Carosika was gifted by the whānau of a baby who was born at 23 weeks and died shortly after her birth.

One of the first Carosika initiatives was Taonga Tuku Iho, a Best Practice Guide for Equity in Preterm Birth in Aotearoa.

“Every midwife and every doctor wherever they are in the country, whatever time of day, will have access to the best evidence guidance and the resources they can use to prevent, predict and manage preterm birth,” Professor Katie Groom said at the launch.

But Dawes says having the information available isn’t always enough to help doctors and midwives working outside the biggest hospitals feel confident to manage pregnancies at high risk of preterm birth.

“It can be complicated. There are so many different risk factors, and various treatment options, and care needs to be individualised.

“We were often asked for advice and help by specialists in regional centres but sometimes this was not until a family had lost two or three preterm babies. We wondered: if those women had been able to access optimal care close to home after the first loss, could it have been a different story?

“We wanted equity in access to high-quality care for all, and obstetricians and midwives were telling us they wanted to be actively supported as they took on the new guidelines and developed new skills.”

Christchurch is the biggest tertiary hospital in the South Island, but until recently didn’t have a specialist preterm birth clinic, says one of the city’s newest consultant obstetrician and gynaecologists, Dr Alicia Mulligan.

The lack of a clinic meant mums who might be at high risk of delivering their babies early went through the general antenatal clinic and might or might not get the specialist care or referral they needed, she says.

“It was a bit ad hoc.”

In 2024, Mulligan came back from a fellowship in Melbourne passionate about what the Australians were doing to reduce the preterm birth rate.

That, combined with the Community of Practice, spurred Mulligan to set up the first preterm birth clinic at Christchurch Women's Hospital.

“I got an immense amount of support from Katie and Lisa and all the other members of the Community of Practice. We were getting education through the webinars, including reviewing ultrasound scans each month. And we could talk about our work and get advice from each other about difficult cases. It was incredibly helpful.”

The Christchurch-based clinic started in April 2025.

Search for funding

But funding for the Community of Practice, as for other Carosika Collaborative initiatives, has been a sticking point.

Dawes and Groom obtained funding for the Carosika Community of Practice from the Health Research Council of New Zealand as a 12-month pilot programme. A lot has been learnt from this research study, Groom says, but funding ended in August.

Now Carosika Collaborative leaders are looking to Health New Zealand or another donor to "maintain this essential community long term".

Preliminary results from the pilot programme, released this week, show 100 percent of Community of Practice members agreeing or strongly agreeing that participation was valuable for their hospital or unit. 

Participants also reported their "confidence in the management of people at high risk of spontaneous preterm birth had increased" over the course of the programme, and called for the community to continue.

As one participant said: "It's an incredible initiative which has built an amazing network of individuals who share a passion for preterm birth prevention.

"It is wonderful to feel like a member of a small army across the country striving for excellence and equity together in our own units.”

In Christchurch, Dr Alicia Mulligan says even without funding, the secure chat will likely continue. But the ongoing education sessions and the practical hands-on courses will stop.

She worries clinicians arriving in the country – and the profession – won’t get a chance to be part of the community.

Without those connections, people may be less likely to use the network for advice and support, and may feel isolated in smaller centres, she says

“The education part was so important for me to develop those skills, but it was also important to develop connections with other clinicians around the country. It might be someone’s got a tricky case and we can talk about it and come up with a New Zealand perspective on it. 

“It’s been incredibly helpful for me.”

And what helps her, helps her patients, she says.

“Seeing the volume of women and whānau coming through the new preterm birth clinic we can see there was a huge need that wasn’t really being looked after before.” 

Mulligan says Christchurch isn’t the only city where a new preterm birth clinic has been set up with the support of the Community of Practice.

“It has provided a really good foundation for preterm birth services around Aotearoa.” 

The crazy thing, Dawes says, is the Community of Practice can run on a modest amount of money – less than $100,000 a year.

"And that’s a drop in the ocean compared to the enormous cost of keeping preterm babies in neonatal intensive care for weeks or months, if we can prevent them from being born early." 

Dawes and Hunter are leading the research work, which will provide quantitative and qualitative data on the success of the Community of Practice pilot programme.

Katie Groom says health services overseas, including in Australia and the UK, are putting significant amounts of money into bringing down rates of preterm birth, and the Carosika Collaborative initiatives are incredibly important for New Zealand families. 

“Even as a pilot programme we believe it’s made a real difference in improving outcomes for babies and their whānau – for now and for the longer term, because the knowledge and skills people have gained will be ongoing.”