There are multiple global initiatives to improve access to health care for pregnant women and their newborns in order to achieve Millennium Development Goals 4, 5 and 6 by 2015.But how and where services are delivered, the types of services provided to women and the economics effecting service delivery is impacting directly on the type of care women are receiving.As increased access to hospital deliveries and medical technologies become available in low-resource communities there are unforeseen consequences.Suddenly many low-resource countries are experiencing sky-rocketing cesarean section rates and a new world where normal birth has become a technological event even in the most rural and remote settings.This keynote will review these emerging global trends and examine ways to achieve the delivery of resource appropriatehigh quality maternal and newborn services in all our countries.