In some regional communities, women are having babies on the side of the road and staff shortages have led to maternity ward closures.
But one community in central Victoria, where safety concerns several years ago prompted a review, has turned its service around to tell a different story.
Five years ago, three incidents in Maryborough District Health Service's maternity ward triggered the service to request a review by Victoria's healthcare safety authority, Safer Care Victoria.
The safety systems health check report included recommendations which Safer Care Victoria says have now all been implemented.
Maryborough District Health Service is celebrating one year of a new model of maternity care that has attracted midwives, increased birth numbers and is viewed as a standard other regional health services can follow.
And local mums are grateful they can access maternity services close to home too.
Forming relationships
It's been three months since Georgie Lovel gave birth to baby Ezra at Maryborough and District Hospital.
The Avoca mum had her first two children in Ballarat, a 70-kilometre drive from home, so choosing Maryborough, a 20-minute drive, for her third baby had benefits.
"It made things a lot more easier to birth in Maryborough. It was just a quick trip over and a quick trip back," Ms Lovel said.
Under the Midwifery Group Practice (MGP) model, which is known for continuity of care, Ms Lovel was matched with midwife Anna Bianchi from the beginning of her pregnancy and formed a strong relationship throughout the journey.
When her waters broke, she called Ms Bianchi directly to meet her at the hospital.
"In my previous two births, you just got given whatever midwife was on," Ms Lovel said.
Ms Bianchi has remained in contact with Ms Lovel and baby Ezra through home visits and phone calls in the three months since.
"My pregnancy wasn't tough at all, but my life was tough at the time," Ms Lovel said.
"I'm just so grateful that I met Anna. She really helped me through."
Attracting staff
Ms Bianchi, who has been a midwife for 18 years, said she was attracted to work at Maryborough District Health Service because of the new model of care.
"Women are birthing on roadsides across Australia, because they're having to travel so far to access birthing services," she said.
"To be able to offer the local women here somewhere that they can have the continuum of care through their pregnancy and birth lends itself to a safe model, and to women having that safety and security."
Previously, midwives worked on a registered nurse roster caring for regular patients during their shifts and switched to maternity for labour and birthing when required.
Long journey
Maryborough District Health Service CEO Nickola Allan said when staff shortages worsened in 2019 and the existing model of maternity care wasn't attracting midwives, it needed a shake-up.
"We knew midwives didn't want to work looking after general patients, they wanted to work in midwifery. So how could we do things differently?" Ms Allan said.
A working group was formed including Safer Care Victoria, the department of health, GP obstetricians, the Australian Nursing and Midwifery Federation and hospital partners in Ballarat and Bendigo.
They met regularly for two years to design the new model based on research and feedback from community members.
Under the new model, if there are complications in a woman's pregnancy, they are referred to larger hospitals at Bendigo or Ballarat for safety, similar to previously, but continuity of care can remain at Maryborough pre and post birth.
Change proves popular
Booking numbers at Maryborough's maternity ward have doubled since the model was launched 12 months ago.
Eighty families have had their baby under the model, with 33 of those birthing at Maryborough Hospital.
Ms Allan said the new maternity model was a part of the health service's vision to change the region's health story.
The Central Goldfields Shire, which encompasses Maryborough, is the second most disadvantaged local government area in Victoria, according to the Australian Bureau of Statistics.
Maryborough ranks poorly in many health outcomes.
Ms Allan said she hated to think about what the reality for local mums would be if the Maryborough maternity service didn't exist.
"We know that our community struggles in terms of access to transport, the cost of living and the inability to get to their appointments … all of those really important parts of the pregnancy would be at risk," she said.
Replicable model
Other regional Victorian hospitals have also redesigned their maternity services, including Castlemaine Health, which had implemented an MGP model, and Cohuna District Hospital, which launched its new MGP model earlier this month.
Australian Nursing and Midwifery Federation (ANMF) Victoria branch maternity services officer Nicole Allan said she was working with health services in Portland, Swan Hill, Yarrawonga and Benalla to review their models of maternity care.
"The whole collaborative professional structure of maternity services in regional Victoria is struggling with numbers," she said.
"But where we have services that are prepared to work together with key stakeholders and look at models of care that can work, we're seeing successes, including at Maryborough.
"The Maryborough model is one that can hopefully be expanded to other services."
