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A survey of a convenience sample of 24 grassroots birth activist groups based in several countries revealed remarkable similarities despite differences in culture and maternity care systems. With few exceptions, they began with a few individuals, generally women, who were dissatisfied or angry with an obstetric management system that failed to provide safe, effective, humane maternity care, that suppressed alternative models of care and nonconforming practitioners, or both. Responses indicated that organizational structures tend to fall into a limited number of categories, and strategies intended to accomplish reform overlap considerably. All groups have experienced difficulties resulting from the hegemony of conventional obstetric management and active opposition of practitioners within that model. Most groups are volunteer based, and all struggle under the handicap of limited resources compared with the forces arrayed against them and the scope of what they hope to accomplish.