A largely roadless country with barely 60.000 inhabitants in more or less rural environments and adverse climate, Greenland poses extreme challenges for childbirth and midwifery. Greenland possesses a modern hospital structure, but the training of midwives and physicians takes place in Denmark. Thus, like many other countries on the periphery, Greenland remains locked in a technological development with competence permanently transferred from the West instead of based of local needs. In an ethnographic study, following midwifery practice, it is described how this affects child delivery care and the localization of childbirth. Perinatal mortality and infant mortality in Greenland has long exceeded the rates in Denmark. Therefore, high security in obstetric care is considered essential. Greenland women do not give birth at home but in hospitals. These hospitals, however, are rather like primary care centres. For many years these hospitals have been staffed with Western surgeons and physicians spending a few months in Greenland. Normal deliveries were assisted by so called birth assistants, with shorter domestic training in general health care. In-depth interviews with the midwives revealed the pregnant women come from small villages and feel frightened by being far from their families. Due to the adverse topographic and climatic conditions the women have to stay in the hospital or with relatives in the capital 3 – 4 weeks before the expected delivery. The study shows that the combination of geographical factors and the dependency on foreign staff affects the structure of care as well as the women’s experience of giving birth.