“Sometimes the runway is just a dusty paddock.”

Sarah, a midwife with more than a decade of rural experience, says it with a gentle laugh — but she’s only half-joking. “It might be red dirt, it might be gravel, it might be a road the council cleared for us. You land where the mother needs you.” She pauses. “And out here, they need you.”

Across remote Australia, far from maternity wards and city hospitals, a small group of midwives travel by road, light aircraft and sometimes helicopter to provide antenatal, birthing and postnatal care. In regions where the nearest birthing unit might be hundreds of kilometres away, these midwives aren’t just clinicians — they are lifelines.

When Sarah arrives in the tiny community of Warruna, she already knows most of the women by name. “Everyone waves as you drive in. You’re not a stranger — you’re part of the rhythm here.” She sets up in the community hall: a fold-out table, blood pressure cuff, Doppler, portable scales. Women drift in between school drop-off, mustering, shop runs or childcare.

One expectant mother, Jess, says the visiting midwife appointments are the only way she can get regular antenatal care.

“I’ve got two little ones already. My partner works away. Getting to town is a six-hour round trip. If Sarah didn’t come here, I’d probably just miss half my appointments.”

Jess’s story is common. Antenatal attendance drops sharply with distance. Travel means organising childcare, leaving family support, or losing crucial hours of farm work. For many women, a service that comes to them is not a luxury — it’s the only realistic option.

Most flying midwives don’t plan to assist births outside a hospital — but they prepare for it every time they step onto a small aircraft. “Babies don’t care how far you are from the nearest ward,” says Amali, another midwife working across Far North Queensland. “I’ve delivered babies in people’s homes, in roadhouses, once even in the back of a troopie on the highway.”

She smiles at the memory. “The mum was incredible. Calm as anything. The dad was white as a sheet.”

Behind the humour lies a serious reality: when labour progresses quickly, retrieval services might still be hours away. Midwives must stabilise mother and baby, manage complications and prepare for transfer — all without the specialist-supported environment of a birthing suite. “Out here, you’re the midwife, the educator, the emergency team and the reassurance — all at once,” Amali says.

For many Aboriginal women, culturally grounded maternity care is essential. Midwife Kara says the knowledge shared with her by Aboriginal health workers and Elders has shaped her practice, helping her understand the deep cultural meaning woven into pregnancy and birth.

“I was taught how important it is to sit first. Not rush. Birth is cultural — not just medical.”

She recalls a visit to a remote desert community. “There was an aunty holding this young woman’s hand, singing quietly. You feel the privilege of being allowed into that space.”

Flying midwives build continuity across vast distances, returning to the same communities again and again. Trust grows, and with it, safer care.

The work is not without its challenges. Weather closes airstrips, floods wash out roads, dust storms ground aircraft. “It’s not glamorous,” Sarah says. “You pack everything twice — and sometimes still can’t get there.” Telehealth helps on those days, but only to a point. “You can’t palpate a belly over a screen,” she says. “You need hands.”

Two weeks after Jess gives birth, Sarah returns to Warruna for a postnatal visit. She checks Jess’s blood pressure, weighs the baby and asks how she’s coping. Jess’s eyes well up. “It means everything that you came back.” Postnatal visits are critical for catching complications early and supporting families who’ve had to travel far from home to give birth.

None of the midwives pretend the work is easy. “You’re away from home a lot,” Amali admits. “You miss birthdays.” But her expression softens. “You get to see women become mothers on Country. That makes everything worth it.” Kara puts it simply: “The responsibility is huge — but the connection is bigger.”

Flying midwives rarely make headlines, yet their impact is profound: they bridge distances, catch problems early and ensure women aren’t forgotten because of geography. They are anchors, advocates and companions on one of life’s biggest journeys — travelling wherever the runway might be.