Bridging the Ultrasound Gap – New Ultrasound Training Project for Rural Midwives

In April, ten midwives from across rural Aotearoa gathered in Dunedin for a pilot workshop in Point of Care Basic Early Pregnancy Ultrasound for Midwives. Hosted by the University of Otago’s Department of General Practice and Rural Health, this workshop has been specifically designed for midwives working in rural settings in Aotearoa.

The workshop is the product of a nine-month collaboration between the New Zealand College of Midwives, the University of Otago and the Rural Midwifery and Maternity Chapter of Hauora Taiwhenua I Rural Health Network. It is a proactive response to a pressing issue—the substantial barriers many rural whānau face in accessing early pregnancy ultrasound, a fundamental aspect of safe and responsive maternity care.

Timely access to ultrasound in early pregnancy can be used for assessing fetal viability, confirming gestation and planning appropriate care, including abortion care. Yet, access remains inconsistent. While rural hospitals and clinics are often equipped with portable ultrasound machines, a national shortage of trained sonographers has impacted rural communities where access to local ultrasound services were already limited. Long travel distances, waitlists and limited appointment availability can result in delayed or missed scans, making this a rural health equity issue.

In September 2023, the Midwifery Scope of Practice was expanded to include Basic Early Pregnancy Ultrasound. This was intended to improve care access; however, uptake of this expanded scope has been hindered by the lack of a New Zealand-based training pathway, and by the fact that midwives are not currently able to claim for the service via the Primary Maternity Services Notice (2021). As such, the potential of this scope change remains unrealised.

The ultrasound training pilot seeks to address the training pathway, offering both theoretical and practical components of the Certificate of Allied Health Performed Ultrasound (CAHPU) in New Zealand via the Australasian School of Ultrasound Medicine (ASUM), which is the accreditation pathway approved by the Midwifery Council of New Zealand. Participants in the pilot hail from Te Tai Tokerau to Southland and will use their training to provide early pregnancy ultrasound in areas with known access issues. In a rural setting, where an urban-based appointment can involve hours of travel or logistical planning, this is a game-changer.

The potential benefits for rural communities have also been recognised by rural primary care organisations and Health NZ | Te Whatu Ora. Midwives’ course and attendance costs have been generously supported by Health Workforce New Zealand, Pinnacle Health, Palmerston North City Council, Waitaha Primary Health Trust and WellSouth Primary Health Network. If successful, it is hoped that the University of Otago workshop will evolve into a regular offering, helping to grow a workforce of ultrasound-capable midwives across Aotearoa.

Ultimately, the vision is clear: equitable, local, midwife-led care that meets the needs of rural whānau—ensuring that they are supported in the earliest and most vulnerable stages of pregnancy.