One rural birthing unit "teeters on the brink" and goes from "one disaster to the next" due to severe staff shortages.
Another maternity service in a farming town of 15,000 closed four years after opening its doors, forcing specialists and medical workers out of town.
Fly-in-fly-out locum doctors prop up two birthing units in a prosperous agricultural district in northern NSW.
Those are some of the stories about the state of maternity care across rural NSW that have led a parliamentary committee to declare a looming crisis.
"A decline in rural maternity services is detrimental for women, their families and the broader health system in remote, rural and regional NSW," the parliamentary committee's report published on Thursday says.
"As a result of unavailable and/or understaffed birthing and obstetric services, the committee heard that women ... are being required to travel for up to hundreds of kilometres."
Many of those challenges are experienced nationwide, with half of Australia's birthing units closing between 1990 and 2015 and only 15 per cent of obstetricians working in rural areas.
The NSW committee has spent years looking into what progress has been made in rural health care since a damning 2022 inquiry found people in country areas have far worse medical outcomes.
Its second report, which largely focuses on access to maternity care, mental health services and paediatricians in the bush, paints an equally dire picture nearly three years on.
The committee found many pediatricians working in regional public hospitals no longer have the capacity to see non-emergency patients, leaving children with developmental conditions adrift.
Waiting lists to see a public pediatrician in the regions can vary from 18 months to six years.
Royal Far West, a charity connecting rural families to specialists, gave evidence that children with developmental delays are presenting at 10, by which time their conditions are much harder to address.
Rural mental health care and drug and alcohol services also did not improve since the 2022 inquiry, remaining at breaking point due to staff shortages, the committee found.
Although NSW Health executives gave evidence of reforms to improve rural care, the report says, there was a "significant divide" between the government's view and staff and patients' experiences.
"The committee's impression from the government response is that NSW Health is still not approaching some areas of regional health reform with an appropriate sense of urgency," it says.
The committee makes 32 recommendations, including an urgent assessment of rural maternity units to develop a plan to re-establish services.
After evidence that obstetricians consider rural work "dangerous" and "undesirable", the committee recommends NSW Health work with training colleges to identify and remove barriers.
Audits and investigations of cancer care, palliative care and drug and alcohol services are also recommended.
The NSW government will formally respond to the report at a later date.
