We took a group of women on a study tour to Australia to view in detail what we considered one of the best and most comprehensive state-sponsored maternal health programs. We were extremely impressed with what we saw and developed a vision for a redesign of the US approach to maternity. In Australia, the state supports women and families according to need (financial, behavioral, medical, social, material) from conception through post partum until the family unit is stabilized and secure. We recognized the critical role of midwives and doulas in bringing support to marginalized and wary ethnic, religious, and linguistic communities. We have organized statewide (and participated nationally) in efforts to extend scope of work and achieve fair compensation. We have become ardent supporters of a strengthened and expanded state WIC program and have organized a statewide coalition. We have engaged legislators, community agencies and other health funders in Pennsylvania to join with us in this effort. Early on we produced an issue of our magazine Roots that traced the history of maternity practices in the US and considered how the medicalization of childbirth has had both good and bad effects–some unintended. I think this brought a lot of attention to the critical social/cultural/behavioral influencers of pregnancy outcomes.