We explored village maternal deaths in an area of the East Sepik Province of Papua New Guinea where most women delivered at home. Postpartum haemorrhage, retained placenta and puerperal sepsis were common causes of death. Follow-up of a group of pregnant women showed that abnormal labour was frequent. 24% of multigravidae (95% CI 17-33) reported a labour that lasted longer than 24 hours. In 9% of all births (95% CI 5-15) the third stage lasted longer than one hour, or products were retained. Despite a high proportion of obstetric complications in apparently low-risk villages births, few women attend a health facility for delivery. Health centre attenders were a relatively privileged group. Some hospital users complained about staff attitudes. A poor reputation means that women are less likely to use health services for delivery. Providers need to improve the acceptability of the care provided, and communities should be encouraged to help with transport for their women to go to a health facility when they are in labour.