Over half a million mothers still die annually from obstetric complications and associated diseases. Indeed, most maternal deaths are linked to delivery. How can this be, ten years into the Safe Motherhood Initiative? What strategies would reduce maternal mortality rates (MMR)? And why is determining the best way forward so difficult? Innovative empirical research at the London School of Tropical Hygiene adds to the international debate and asks: surely a shift to skilled attendants at delivery is the best way forward?