In many low-resource settings an estimated one-third of all births take place unsupervised with traditional and non-traditional villager birth attendants the only providers of care during pregnancy and childbirth. The training of village birth attendants (VBAs) in Milne Bay Province began in 1991, and has continued during a period of significant shifts in national and international public health policy. As part of a wider provincial-wide review of the VBA program we undertook 6 focus group discussions, 13 in-depth interviews and 8 key informant interviews in three districts in Milne Bay Province in 2014. In this paper we describe the role, responsibilities and function of VBAs, and the challenges facing both VBAs and those involved in their training and in supporting their work in the community. In this setting, VBAs continue to assist women during childbirth, and are frequently having to try and manage difficult obstetric complications with little or no support from their communities or local health facilities. Some VBAs reported being called too late by the community, with insufficient time to refer women on to a health facility, resulting in maternal deaths. Many VBAs continued with their practice, motivated by a heartfelt desire to serve, despite feeling ‘neglected’ and ‘overlooked’, while others continued because of their religious convictions and dedication to help their communities. There is an urgent need to better define what VBAs can and should do in this setting, what communities can realistically expect of their VBAs, and how professional health care workers can work more constructively with this long-standing cadre of lay health workers. There is a need for all health facilities and VBA trainers to support their VBAs, and to fully recognize the often difficult situations VBAs are required to work in while continuing to advocate for supervised, health facility births.