BACKGROUND: An increase in perinatal mortality prompted a review of services to pregnant women in remote northern and western Queensland, Australia. In order to address the needs of the indigenous population in particular, a range of service changes was implemented to improve outcomes. OBJECTIVE: This article aims to highlight the changes made in the delivery of local and regional antenatal services. DISCUSSION: Mt Isa Hospital is the supplier of obstetric services for the north and west of Queensland. Poor antenatal access rates and other service issues for Indigenous patients were identified as contributing to these poor outcomes. Consultation with Indigenous patients and health service providers prompted changes in modes of delivery of services that in the short term seem to have improved results. The models for delivery of services include primary health care clinics in remote communities. Aboriginal community controlled health services, and flying obstetrician clinics.