South Africa is struggling to improve maternal and perinatal outcomes, resulting in failure to achieve the Millennium Goal for maternal health. Staff attitudes and skills have been identified as a factor affecting deaths and adverse outcomes in mothers. Huge training efforts are required from health departments to ensure that staff have the required skills to provide the services. The integrated approach to training of nurse professionals, which includes midwifery as a part of undergraduate training, has a devastating effect on the quality of midwifery. Training of midwifery is unfocused and forced upon those who have no interest in improving maternal outcomes. Maternal care is provided in professional silos by professionals who are not equipped with appropriate skills. Unless this systems design error is corrected, and a single-output training model introduced to professionals providing maternal care, we are unlikely to see a a major change in our maternal outcomes. New models based on inter-professional training and task sharing need to be developed for the country, including redefining of professional accountability for maternal care.