Call her Anna. She lived an hour's drive from Tamworth Base Hospital, went into labour in 2024, and was told the maternity unit — thinned to less than half its rostered midwives — could not safely induce her. The transfer plan sent her four hours south to Maitland Hospital instead, in a car, mid-labour, past the small towns whose own birthing units had already closed years earlier. She is a composite, not a named patient, built from cases the Northern Daily Leader and the NSW Nurses and Midwives' Association reported through 2024 and 2025 — but the four-hour drive is real, and so is the reason for it: a maternity ward that still exists on paper but was not there, that day, when she needed it.
Tamworth is not an outlier. In July 2025 both Tamworth and Gunnedah hospitals were placed on maternity bypass at once, diverting mothers hundreds of kilometres from home to give birth. Across the state's west and north, "bypass" — the term NSW Health uses when a unit cannot safely accept labouring women and redirects them elsewhere — has drifted from an emergency measure toward something closer to routine. For a family in Sydney, a full maternity ward means driving to the next suburb. For a family in the New England or the Far West, it can mean the difference between a birth attended by a midwife who knows them and a birth in a moving vehicle.
What the government did
New South Wales has been closing small rural birthing units for more than three decades, under governments of both colours, as maternity care consolidated into larger regional centres judged safer for complex deliveries. The Minns government, elected 25 March 2023, inherited that trend rather than starting it — Cooma Hospital's maternity ward, for example, closed abruptly in March 2022 for lack of staff, under the Coalition; the Minns government did reopen a rebuilt maternity unit at Cooma in March 2023 as part of a hospital redevelopment, evidence that restoration is possible, though it took a multi-year rebuild to reverse a closure that had taken weeks. The underlying pattern has continued on Labor's watch regardless: the 2025 Tamworth-Gunnedah double bypass, and a Tamworth midwifery staffing deficit that union figures put at roughly 50%, blowing out to 60% in some rosters, sit squarely within this government's term.
The government's response has been substantial on paper. NSW Health published Connecting, Listening and Responding: A Blueprint for Action — Maternity Care in NSW in March 2023, drawn from consultation with more than 18,000 women. It created a new Chief Midwife role, announced in August 2025 in response to the state's Birth Trauma Inquiry and filled by Donna Garland, a midwife with more than 40 years in the NSW system including rural postings. From 30 September 2024 it ran a $20,000 relocation bonus to attract midwives from the city and interstate into rural and remote posts, later extended to September 2026. That sits inside the broader Rural Health Workforce Incentive Scheme, first introduced in July 2022 under the previous government and continued under Labor, which NSW Health says had recruited 3,044 health workers and retained a further 11,337 in hard-to-fill rural and regional positions by September 2024. And the 2025-26 Budget, handed down 24 June 2025, included an $83 million maternity and family-care package: $44.8 million for midwifery continuity-of-care models, funding an additional 53 full-time-equivalent midwives across regional NSW, and $26.8 million to maintain seven family care centres and five mobile services.
The strongest case
Small units are not always safer, and the money on the table is real
Consolidation is not simply cost-cutting dressed up as reform. The clinical case for concentrating complex births in larger units is genuine: a birthing unit delivering only a handful of babies a month cannot keep an obstetric team, an anaesthetist and a special-care nursery on call around the clock, and the 2022 parliamentary inquiry into rural health itself heard evidence that some closures were driven by patient safety, not budgets — a unit without fast access to an emergency caesarean is a real risk to a mother with an unpredicted complication. The workforce shortage behind the bypass events is also national, not a Minns government invention: rural and remote Australia has struggled for a generation to keep midwives, GP obstetricians and rural generalists, and the NSW Auditor-General's own reporting on Visiting Medical Officers has flagged how heavily regional and rural hospitals lean on a shrinking pool of contracted specialists. Against that backdrop, an $83 million Budget line, a dedicated Chief Midwife, and a $20,000 relocation incentive are not token gestures — they are the tools available to a state government that cannot, on its own, train more obstetricians or compel clinicians to live in Gunnedah.
The evidence
The scale of the underlying service loss is disputed at the edges but not in direction. The Legislative Council's Portfolio Committee No. 2 rural health inquiry, which received more than 720 submissions and tabled its report on 5 May 2022, concluded plainly that women in rural, regional and remote NSW do not have access to the same standard of maternity care as women in the city, and made 44 recommendations, accepted by the government that September. By NSW Health's own account, 25 of those 44 were complete as of its September 2024 progress report, with the remaining 19 still in train more than two years after acceptance. The Bureau of Health Information's Insights Series on healthcare in rural, regional and remote NSW, drawing on roughly 100 separate measures from hospital and survey data, is the state's own ongoing scorecard for exactly this gap — evidence NSW Health collects but has not always acted on at the pace the data implies is needed.
Campaigners go further. The Bush Babies 2025 campaign, run from Armidale by perinatal mental-health worker Jen Laurie, states that roughly half of NSW's rural and regional birthing units have closed since 1990 — around 140 services — and that rural, regional and remote women face a maternal death rate many multiples higher than their city counterparts. NSW Health has not published a figure verifying that specific closure count, so it should be read as an advocacy claim, not an audited one. What is independently verified is the AIHW's national data: women in remote and very remote Australia die in childbirth or the postpartum period at a rate of 19.5 per 100,000 women giving birth, more than three times the major-cities rate of 5.7, aggregated over 2014 to 2023 because annual maternal deaths are too rare in any single state to report reliably year by year.
The rural workforce crisis behind it
The bypass events are a symptom. The underlying problem is a workforce pipeline that has been thinning for years. Midwifery and rural generalist obstetrics are demanding, on-call specialties, and NSW competes for the same small national pool of clinicians as every other state offering its own relocation bonuses. Indemnity insurance for GP obstetricians who deliver babies in small rural hospitals is expensive relative to the number of births they attend, which has pushed many rural GPs out of intrapartum care over the past two decades — a structural, Commonwealth-linked problem no state Budget alone can fix. NSW does run a Rural Generalist pathway meant to train doctors who can provide anaesthetics, obstetrics and emergency care from a single rural posting, but building that pipeline takes years, and it cannot retrofit a midwife shortfall that is already showing up on this week's roster. Locum reliance fills some of the gap but is costly and denies a labouring woman continuity with a midwife she has met before — the exact model of care the Blueprint itself identifies as central to safety and dignity in birth.
The consequence shows up hospital by hospital. Tamworth Base Hospital's maternity unit, at various points through 2024 and 2025, ran with midwifery vacancy rates the local nurses' and midwives' union put at 50 to 60%, cut its available beds from 20 to 12, and spent more than 20 days on some level of bypass in a single stretch. Gunnedah's smaller unit, feeding into Tamworth as its main referral point, was caught in the same bypass event when Tamworth itself could not take patients — leaving women across the New England and North West with nowhere within a practical driving distance. A relocation bonus can move an existing midwife from Sydney to Tamworth; it does not, by itself, create the extra midwife the system needs.
A birthing unit that spends twenty days a month on bypass has stopped being a service a woman can plan her labour around.
The critique
None of the government's measures is wrong in isolation, but together they have not yet closed the gap between announcement and delivery. Nineteen of the 44 rural health inquiry recommendations remained incomplete more than two years after the government formally accepted them, on its own September 2024 account. The 53 additional midwives promised in the 2025-26 Budget were announced without confirmed postings at the time, prompting the local MP for Tamworth, Kevin Anderson, to call the commitment "smoke and mirrors" until the government names where those staff will actually work. A relocation bonus, meanwhile, mostly redistributes an existing, static supply of midwives from one part of the state to another; it does not enlarge the national training pipeline, so a bonus that fills Tamworth's roster this year can just as easily hollow out a smaller unit elsewhere next year.
There is an equity dimension the government's own documents do not fully confront. Aboriginal families are over-represented in the rural and remote communities that have lost birthing services, and AIHW's national data records Aboriginal and Torres Strait Islander perinatal death rates of 8.9 per 1,000 livebirths for mothers in very remote areas against 3.7 in major cities — a gap this government inherited but has not closed. And the drift from "bypass as emergency" to "bypass as scheduling reality" has continued on this government's watch even as it has published a Blueprint, funded midwives and created a Chief Midwife role: the reforms are real, but on the evidence of 2024 and 2025, they are running behind the erosion, not ahead of it.
The risk to the future
A maternity system that keeps outrunning its own workforce
NSW's rural population is not shrinking as fast as its access to birthing services is. If the current trajectory continues — bypass events treated as routine, inquiry recommendations still open years after acceptance, relocation incentives moving a fixed pool of midwives around rather than growing it — more country women will face the choice Tamworth's mothers already face: drive for hours in labour, or plan a birth away from home weeks in advance and hope it goes to schedule. Every unit that closes or spends long stretches on bypass also removes a training and clinical placement site for the next generation of rural midwives and GP obstetricians, deepening the same shortage that caused the closure — a feedback loop that gets harder, not easier, to reverse the longer it runs. The government has named the problem correctly and funded a real response; whether that response arrives faster than the next bypass event is the test rural NSW is now watching.