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Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery has been shown to be one barrier to facility delivery, yet previous studies have focused solely on reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care from the same hospital were recruited to participate in in-depth interviews regarding their perceptions of care during labor and delivery. A semi-structured interview tool and qualitative field interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction between midwives and their patients is analogous to a mother/daughter relationship, including both a knowledge imbalance and the need for disciplinary action when necessary; and 2) Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting women were reported as common occurrences in the labor and delivery ward. However, each was undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings suggest that the issue of patient maltreatment in low-resource labor and delivery settings is complex and may be undertaken in what is perceived to be the laboring woman’s best interest. The exploration of alternative strategies to facilitate labor and delivery is warranted, as well as the provision of adequate support and resources for practicing midwives in rural settings.