The author analyzes maternal mortality in maternity hospitals and wards, compiling statistics on deaths from puerperal fever, peritonitis, pyæmia, haemorrhage, and other causes. Comparisons are drawn between hospital, workhouse, and home birth death-rates to estimate a baseline risk and to highlight higher institutional mortality in some settings. She investigates institutional contributors to infection such as crowding, poor ventilation, mixed wards, and attendants serving diverse classes of patients, and recounts a midwifery ward outbreak that led to closure. Practical proposals are advanced for building arrangements, infection control, and the organized training of midwives and midwifery nurses to reduce maternal deaths.