Brian drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation