A Māori birthing unit recommended for Hawke's Bay is languishing in a queue of work Te Whatu Ora has had to pick up after District Health Boards were folded into the entity.
It was suggested in a damning review into how Hawke's Bay Hospital treats whānau Māori in maternity care, following a highly publicised uplift of a child in 2019.
The recommendations from the Hau Te Kura report, including a Māori birthing unit, were accepted by the DHB in June 2022, Te Whatu Ora said in a statement.
"Consideration of this recommendation has since transitioned to the commissioning function within Te Whatu Ora.
"This will occur within the context of the wider health reforms, including maternal and infant health outcomes."
But there was no telling where it sat in the queue; Te Whatu Ora was tight-lipped on a timeline.
Māori midwife and Ngāti Kahungunu health service Choices chief executive Jean Te Huia said the lack of progress was a sad indictment on meeting the needs of Māori.
"If we are serious in this country about addressing the appalling statistics that affect our Māori women and babies, then this is the right thing to do."
Those statistics were stark.
The latest perinatal and maternal mortality review found wāhine Māori and Pacific women were disproportionately more likely to die while pregnant or soon after birth, termination or miscarriage.
Wāhine Māori were almost three times (2.91) more likely to die by suicide than New Zealand European women.
And babies of Māori, Pacific and Indian mothers had higher perinatal death rates (from 20 weeks' gestation to seven days old).
An indigenous approach - like the successful Toronto Birth Centre that Te Huia visited - would help address those problems, Te Huia said.
"Not only would we have a way to meet clinical and cultural needs of our Māori and Pasifika birthing population, but we could also have an opportunity to look at the workforce development needs for Māori midwives, which is also a problem in this country."
But now, Te Huia was losing hope anything would happen - despite there being options on the doorstep, like teaming up with the new private hospital Kaweka, across the road from Hawke's Bay Hospital.
Kaweka was opened last year by managing director Dr Colin Hutchison, and built with funds from Hawke's Bay families. It could run that same model for a Māori birthing unit's bricks and mortar, Hutchison said, and he would be "delighted" to do so.
"That makes it a very streamlined discussion with Te Whatu Ora, because we're not going and asking for tens of millions of dollars for buildings. We're just saying 'hey look, we're here, we'll build the building, provide you a facility,' and then it can help expand healthcare in the region."
Public-private partnerships could help ease Te Whatu Ora's heaving workload and ensure the community got the services it needs, Hutchison said.
"Te Whatu Ora's always got a huge amount on its plate, and it simply can't do everything in a given year. And that's where partnership with community groups like ourselves can work really well, in that we can move part of the equation forward quickly for them."
Napier resident Trixie-Lee Marshall Bingkrathok said it was a service she would love, especially after birthing her son Leo with a Māori midwife and a kaupapa Māori approach.
The umbilical cord was tied with a flax muka tie she made herself, and cut with pounamu.
During her pregnancy, she used rongoā, traditional Māori medicine. It was a less sterile, more natural approach - as much as was possible within a hospital setting - and made her feel connected with her Māori side.
"It was empowering. I felt really good, in that moment, holding baby on my tummy, and Crissy [midwife Crissy Coromandel-Timu] and my husband cutting it [the cord], it made me feel proud."
She was due to have another baby in December, and having access to a full Māori birthing facility would be a dream, she said.
But with that off the cards, she hoped one day her younger cousins would be so lucky.