A 6-week prospective study of women referred to Korle Bu Teaching Hospital during labour and delivery was conducted to determine the sources of and indications for referral, and to assess the adequacy of various aspects of the referral mechanisms. Of 396 women referred, 86% were referred from polyclinics (which are state-owned) and private midwives. The commonest indications were failure to progress (21.5%) and hypertensive disease (15.7%). A total of 35 (8.8%) women were referred with third-stage or immediate postpartum complications. Referrals constituted 17.6% of hospital deliveries. Significant deficiencies were identified in the referral mechanisms. 72.7% of the patients travelled by public or private means of transport and 54.2% were not accompanied by any staff during transfer. Only 16.7% of those expected to have partographs came with one and 55.6% of women with complications of vaginal bleeding did not have intravenous infusions sited. However, in almost 90% of patients, the general condition on arrival in the hospital was good, and some referrals could probably have been avoided. Efforts must be made to improve patient transport and to evaluate labour management practices in the referring centres.