Anja gave birth on the side of the road. Listen to the triple-zero call

Soli Adams’ birth was a miraculous fluke. He was born “en caul”, still encapsulated in his amniotic sac: a soft bubble of fluid that burst open in his father’s hands.

En-caul babies, according to folklore, are impervious to drowning. They are lucky omens, magical beings who can travel between worlds.

Anja Adams with her husband Ryan Adams and their children Soli and Audrey at the spot where Soli was born on the corner of Gorindah Road and Princes Highway, Falls Creek, NSW.Credit: Peter Rae

So rare are these babies – just one in 80,000 births – that most midwives and obstetricians have never seen one. No one saw Soli’s birth on the night of April 14, 2021, under the blinking glow of hazard lights as a semi-trailer roared down the Princes Highway three metres away.

“It was an amazing birth,” says Anja Adams, Soli’s mother. “But it could have gone very wrong.”

Soli is among an increasing number of babies born on the side of roads as maternity hospital closures and bypasses – where at-capacity services close to new patients – force women in labour to travel hundreds of kilometres across “maternity deserts” to give birth.

Being in active labour driving down a freeway for an hour is unbearably uncomfortable, as Adams can attest after her labour with Soli’s big sister, Audrey. But the risk of giving birth without a midwife or doctor puts women and babies at greater risk of serious complications, trauma and death.

The increasing risk of roadside births is indicative of a dual crisis threatening the viability of maternity hospitals: midwife and obstetrician shortages hobble public services as private units face collapse over soaring costs and declining birth rates.

Women who give birth on the roadside, in cars or ambulances en route to hospitals, account for a small fraction of all births statewide (0.7 per cent in 2022). But in the Northern NSW Local Health District, more than one in every 60 babies was born before arriving at hospital in 2022 (1.7 per cent), over double the rate in 2001, the latest available data from NSW Health shows.

In Western NSW, more than one in 80 births are on the roadside, three times the 2001 rate.

On the Central Coast – where the rate was one in 100 – doctors have warned the rate will rise sharply when Gosford Private closes in March. The region’s only remaining birthing service, the public hospital, faces a dire workforce shortage.

In the state’s north-west, major birthing hospital Tamworth has repeatedly gone on bypass due to a chronic midwife shortage. In Sydney’s Hills District, the planned $700 million Rouse Hill Hospital will have no birthing suites.

Nationally, over half of rural maternity services (more than 140) have closed in the past 20 years, Maternity Consumer Network founder Alecia Staines says.

“Muswellbrook [in the Hunter region] and Milton-Ulladulla [in Shoalhaven] are maternity deserts, and we are hearing constant concerns from staff and women across NSW,” she says.

“Once a maternity service closes, towns lose emergency care and operating theatres and effectively become geriatric units. In rural communities without maternity services, there are higher rates of preterm and stillbirths.”

Before Soli was born, Anja Adams and her husband, Ryan, didn’t reach their closest birthing service, Shoalhaven Hospital at Nowra, one hour’s drive from their Burrill Lake home.

They had to drive right past Milton-Ulladulla Hospital, 15 minutes from their home. That hospital stopped offering birthing services in 2016. The local health district said the hospital delivered just one baby a fortnight.

“I had an overwhelming urge to push and have the baby, and we had to pull over,” Adams recalls. “It was a dangerous location on a busy highway. But we didn’t have a choice.”

A truck zooms along the Princes Highway where Anja gave birth to Soli. Credit: Peter Rae

“My husband might not have been able to turn off the road safely, or we could have hit a wombat or a kangaroo – that stretch of road is notorious for [crossing] animals.”

As her husband called triple zero, Anja got on all fours in the back seat of their car.

On the emergency call recording, a NSW Ambulance Control Centre operator told Ryan to put on his hazard lights and that an ambulance is on its way.

Between groans of labour, the couple argued with the operator, who instructed Anja to push before she was ready.

Anja released one last primal roar. Ryan caught his son.

“Hello, hello,” Ryan said, holding their one in 80,000 en-caul baby.

“Baby born? Is the baby crying or breathing?” the operator asked.

“I think so … baby is breathing,” Ryan said as relief washed over the recording.

Anja and Ryan Adams with their son Soli in the back of the ambulance after Soli’s roadside birth.Credit:

“We were very lucky,” says Anja almost four years later. “It was my second birth, so I knew what I was doing, and we’re lucky Soli was born healthy. That’s not how all births go.”

The Maternity Consumer Network wants the federal government to deliver reliable access to maternity care, including Medicare-funded midwives for home births, and bundled funding across services and care providers. This was recommended by an independent review in October, which the government is considering.

Australian Medical Association NSW president and obstetrician Dr Kathryn Austin said the frequency of closures and hospitals going on bypass put mothers and babies at increasing risk of roadside births and serious complications.

“These services are often underfunded and underresourced,” Austin said, advocating for better pay, access to leave, education and training opportunities to attract midwives and obstetricians to crisis areas.

Fiona Faulks, a nursing and midwifery lecturer at Latrobe University’s rural and health sciences department, said rural women bore the brunt of closures, paying for travel and accommodation, and treatment delays.

“Maternity closures don’t only affect women,” she said. “When a community is unable to provide pregnancy and birth care, the number of young families ... declines and sustainability of rural towns overall is affected.”

A spokesman for NSW Health said babies are born before arrival at hospital for various reasons, including rapid labour, and the ministry was working with the federal government to boost the number of regional GPs with training in obstetrics.

The state government also offers healthcare workers – including midwives – bonuses of up to $20,000 to relocate to critical roles in regional and rural hospitals.

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