There is no universally agreed definition of quality of care (QoC). However, we assumed that the QoC in a London teaching hospital is high and could be used as a benchmark QoC with which to compare the practice in Cairo. We aim to highlight differences in the frequency of adverse outcomes attributable to differences in the QoC between two maternity teaching hospitals in Cairo and London, in low risk, standard primiparae (SP) delivered in 1999. In Ain Shams Maternity Hospital in Cairo and St Mary's Maternity Hospital in London, the caesarean section rate was 9.1% and 22.5%, respectively (OR = 0.34, p < 0.0001); the instrumental delivery rate was 4.1% and 26.8%, respectively (OR = 0.12, p < 0.0001), and the induction of labour (IOL) rate was 1.1% and 16.7%, respectively (OR = 0.06, p < 0.0001). Third degree perineal tears occurred in 0.3% and 8.2%, of the vaginal deliveries (OR = 0.14, p = 0.002) and the still birth rate was 0.78% and 0.1%, (OR = 7.96, p < 0.01) in the Cairo and London hospitals, respectively. This is the first time the SP method has been used to compare similar institutions in developed and developing countries. Intervention rates were significantly higher at St Mary's and so was the improved fetal outcome. A trade-off of improved fetal outcomes for more interventions is difficult to establish. Residual differences in case mix and patient preferences may explain some of the results