Background: Maternal and foetal mortality is unacceptably high in most resource-limited countries and the practice of obstetric anaesthesia has an important influence on outcome for both mother and baby. The much needed close co-operation and collaboration between obstetricians and obstetric anaesthetist providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. The current global maternal mortality is approximately 400 per 100,000 deliveries, with a range of 7 - 740 deaths per 100,000, demonstrating the inequality between the rich and poor countries. Many of the deaths could have been prevented by better essential obstetrics services including safe anaesthesia and surgery, provided such services are made available in a timely manner. Conclusion: Maternal mortality in low resource countries has its basis complex social, economic and political factors, underpinned by a lack of resources. Many of these factors are difficult and slow to resolve and are not specific to maternal health. Comprehensive essential obstetric care services at the district hospital level (first referral level) should include all the above plus safe surgery, safe anaesthesia, and blood transfusion. Government, donor agencies and all stakeholders must recognize the crucial role of anaesthesia in providing emergency obstetric care in hospitals. Advocacy by all concerned will help direct the scarce resources to the appropriate areas of need which includes provision of adequate facilities and manpower for safe anaesthesia.