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The Southern District Health Board commissioned two midwives to examine the births, which took place over a six-week period earlier this year.
Two of the four women involved declined to be interviewed for the review. The midwives found that the other two births were "unavoidable".
"There will always be babies born in unintended locations.
"This is not an infrequent event, especially in rural areas. However, the frequency that this does occur is the measure of an accessible maternity service."
A contributory factor in both births was the unforeseen rapid progress of each labour, the report said.
"An additional contributory factor pertaining to one woman was the lack of essential equipment available in the Lumsden hub in the presence of specific risk factors which could constitute the need for full resuscitation capacity."
Prior to the SDHB's region-wide review of maternity services, the women would all likely have given birth at the former Lumsden Maternity Centre.
Carrie Adams, a trustee of centre owners the Northern Southland Medical Trust, did not think the review's findings that the births were unavoidable would surprise anyone.
"The trust's view is that the question remains is the SDHB OK with the continued influx of such birth outcomes? Because the trust, for a lot of reasons, is not.
"There are still a lot of questions remaining ... such as will these reports change anything?"