A baby was born in a car park outside Lumsden Maternity Centre last night, sparking fresh calls for better maternity services in the area.
Former midwife Nicky Pealing said a midwife helped the woman alone, about 1am on a "wet and windy" night, because no backup was available.
Midwives have made repeated calls for Southern District Health Board to reinstate 24/7 midwifery at Lumsden Maternity Centre, which was downgraded from a primary birthing unit in April, Ms Pealing said.
It was not safe for a midwife to be alone at a birth, with no support, she said.
"I'm a bit dismayed they still haven't put in place an adequate backup for these two midwives who are left holding the baby literally," Ms Pealing said.
"They are playing Russian roulette and I don't think that's very satisfactory in this day and age."
Southern District Health Board chief executive Chris Fleming said the overall service in the region had been improved and more was being spent on maternity services.
It was "simply not realistic" to have a backup midwife available at all times at the Lumsden centre, because less than one birth a week took place there on average, he said.
Ms Pealing said she had worked as a midwife for 35 years, but stopped because of the lack of backup available.
Lumsden maternity hub was now unstaffed and local midwives lived significant distances away, she said.
"It's too scary - there is nobody who's got your back any more. The DHB has taken every bit of support we had away," she said.
"In my professional opinion, it's totally unacceptable to have so few midwives available in a large area without the ability to have somebody on call and available in a reasonable time."
Clutha-Southland MP Hamish Walker has been petitioning the government to reinstate the Lumsden Maternity Centre as a primary birthing unit.
Three babies had been delivered outside primary birthing units in the area since the Lumsden centre was downgraded, despite strong community opposition, he said.
"The hub model that was introduced a couple of months ago is not fit for purpose," Mr Walker said.
"I'm pleading yet again to the prime minister - is it going to take the preventable, needless death of a baby before they reinstate full services at the Lumsden Maternity Centre?"
However, Mr Fleming said Southern District Health Board was confident maternity services across the whole district had been improved after its recent changes.
New birthing hubs had been created in Te Anau and Wanaka, making the service better overall, he said.
"Maternity services in remote places are always challenging to provide," Mr Fleming said.
"We've enhanced the services across the entire district, so we've minimised the risk overall."
There will be a review to check on the implementation of the new service arrangement.
"We're still wanting to work with the midwives in the Lumsden-Te Anau area around ensuring that there's an appropriate backup arrangement," he said.