In Britain maternal mortality remained at a disturbingly high level from the late nineteenth century until the mid-1930s, and then began to fall rapidly. Was Britain unique in this respect? A comparison of maternal mortality between 1870 and 1950 in certain European countries, Australia, New Zealand, and the USA suggests that although the levels of mortality often differed widely, the trends were broadly similar. The same angry debates and accusations of obstetric incompetence showed that maternal mortality had, by the 1920s and 1930s, become a matter for public concern in many countries, and a crying scandal in a few. Through the examination of national trends and their relationship to geographical, socio-economic, and clinical factors, it is hoped to explain the secular trends in maternal mortality and reach a closer understanding of the historical epidemiology of deaths in childbirth. The evidence suggests that between 1870 and 1935 it was usually safest to be delivered at home by a well-trained midwife rather than in a hospital by a doctor; but it was no safer to be rich rather than poor. Although high maternal mortality was often associated with areas of poverty, the link was indirect. Socio-economic deprivation per se was not an important determinant factor in maternal mortality, but the place of delivery and the care and skill of the birth attendant were.