Rural women are travelling hundreds of kilometres to give birth amid a health care crisis which is set to worsen with a severe shortage of specialists and midwives.

Public maternity units across regional NSW are under enormous pressure, putting patient safety at risk, obstetrician Lilach Leibenson told a state inquiry on Monday.

"The situation is dire," said Dr Leibenson, representing the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Tamworth Hospital, which covers much of north-west NSW, is at a 58 per cent deficit in its midwifery staff, while half of on-call consultant and registrar shifts are covered by locum doctors, she said.

The midwife shortage is likely to worsen to a 64 per cent deficit by September.

Dr Leibenson said other major regional hospitals such as Dubbo and Orange are in similar positions.

The widespread shortages mean smaller rural hospitals often have to go on bypass when staff are sick or on leave, forcing women to travel long distances to give birth in larger regional centres.

"We have patients driving for four hours, sometimes in their own car, to get to Tamworth," Dr Leibenson told the inquiry sitting at parliament house in Sydney.

The use of locum doctors also means there is no continuity of care, which is known to improve outcomes for mothers and babies, as well as healthcare workers.

"This is a very unsafe practice that does not provide the needs for the carers nor for the patients," Dr Leibenson said of the reliance on locums.

A parliamentary committee is investigating progress on recommendations from the damning 2021-22 NSW health inquiry, which found country people have worse health outcomes than their city peers.

Many witnesses across medical, education and allied health organisations have told the committee there has been very little change since those findings were handed down in May 2022.

Better pay and conditions are needed to attract doctors to the bush, along with bolstered support networks, the hearing was told.

Shortages across the sector were affecting rural doctors' ability to get life-saving care for their patients, Australian Salaried Medical Officers' Federation assistant secretary Michelle Moyle said.

One rural doctor recently reported being unable to transfer a critically ill cancer patient to a larger hospital due to a lack of air ambulance pilots, Dr Moyle said.

"Why would you go to the bush where you're a lone wolf and making life-threatening decisions on a daily basis, with no immediate help available to help you make those decisions?" she said.

There were some examples of progress, including community-led models of care in the far west, NSW Rural Doctors Network chief executive Richard Colbran said.

"This system is in crisis, but there are people who are working very, very hard and 24/7 to give their best to it, whatever role they're in," Mr Colbran said.