In rural northwestern Zaïre nurses at Karawa and Wasolo hospitals were trained to do caesarean sections, laparotomies, and supracervical hysterectomies. In Karawa 278 of 321 caesarean sections were done by nurse-surgeons in 18 months, with two deaths. In Wasolo all 32 caesarean sections in 13 months were done by the nurse-surgeons, with 1 death. Of the 37 laparotomies done in both centres, 16 were by nurse-surgeons, and there were two deaths. Four of the five deaths were attributable to protracted labour with septicaemia (1), postoperative infection (2), and protracted labour with no blood pressure on admission (1). Obstetric operations could safely be performed by specially trained nurses in rural areas of developing countries and the high maternal mortality rate in such areas could thus be reduced.