This article reports an ethnographic study of the intrapartum care of women who were expecting normal births in an Egyptian hospital. The study involved observations of labouring women, and interviews with them shortly after they had given birth. The data were synthesised into three themes: the epistemology of hospital care, characterised by ‘technical touch’; women's experience of hospital childbirth, which was contrasted unfavourably with home birth experiences; and women's epistemology of birth, which was characterised by ‘helping from the heart’. This latter concept expresses the participants’ preferred way of doing birth. We describe the impact of the paradigm clash experienced by these women, and propose an approach to the provision of childbirth care in Egypt and beyond which combines the clinical safety of evidence based and experientially developed technical skills with the emotional safety of trusting, respectful, loving relationships. We have termed this ‘skilled help from the heart’.