Abstract: This NHMRC funded investigation began as an exercise in testing a Canadian developed maternity services planning tool for its utility and validity in Australia. Careful work with our statisticians and with around 170 rural and remote birthing facilities across Australia demonstrated that we can develop a mathematically valid planning tool for Australia. While this is useful we also learned that the application of this requires not only judgement but also contextual analysis. So we also developed, scrutinised and assisted by an expert group, a toolkit to apply this planning tool. What we found in our field work across four states and territories was surprising. This was not only an absence of evidence in relation to planning decisions about whether a service existed or not, but jurisdictional differences. Some states were more likely to have services than others. The ones that did had fewer services and did not appear to tie their decision making to “need”. This was also more surprising than we expected. Population vulnerability, that is sociodemographic or clinical need did not determine the existence of or nature of services. We learned about the challenges of applying and evidence based tool through fieldwork which also taught us lessons that were not necessarily anticipated. For example the struggle to get good clinical governance of rural and remote health services. The absence or poor quality of networking, in many cases, of regional services to small services or any networking at all; compounded the problem of clinical governance. The value of networks that reach out from regional hubs appear to be common sense and essential and their absence was surprising. Finally a fallacious sense of risk that often governed decisions that in and of themselves added risk.