Over the years Birthrate Plus® has been approached by a number of international health agencies to see whether the methodology can be applied to their maternity services. We are now established in two Australian states and have been used by the health department in the Republic of Ireland to review staffing needs in their maternity units. Beijing University used Birthrate Plus® to assess staffing needs as part of the country’s maternity strategy, describing it as the “gold standard” in maternity workforce planning. Most recently we have been supporting a research programme in Holland applying the methodology to the Dutch maternity system and have been in discussions with a health authority in Italy as well as planning to work with a service in the Republic of Ireland. Whilst adaptions to the approach is necessary to reflect the different organisation of maternity services, it is possible to amend the methodology to be used in different systems.