OBJECTIVE To compare across cultures the maternal reactions toward the birth of children with cleft lip and/or palate. METHODS An adaptation of When My Child Was Born, a Likert-type scale designed to assess reactions to the birth of a child, was used to survey the target populations. METHODS The surveys were administered between February 2006 and February 2008 at four hospitals: the Faculty of Medicine Hospital, Chiang Mai, Thailand; Sappasitprasong Hospital, Ubon Ratchathani, Thailand; the No. 5 Affiliated Hospital to Xinjiang Medical College, Urumqi, China; and Santa Monica Hospital,Pereira, Colombia. METHODS Thai (n = 22), Chinese (n = 25), Uygur (n = 15), and Colombian (n= 36) biological mothers completed the survey. A historical cohort of American mothers (n = 99) was used for comparison. METHODS The primary study outcome measure was the mean maternal affect score, which was calculated from the individual responses of study participants. RESULTS The mean maternal affect scores for the Thai, Chinese, Uygur, and Colombian mothers were 3.68 6 0.38, 2.97 6 0.52, 3.40 6 0.47, and 3.51 6 0.61,respectively. The American cohort score was 3.44 6 0.67. Analysis of variance testing indicated that these groups were not equal (p , .0001). There were statistically significant differences between groups (p , .05). CONCLUSIONS Maternal reactions to the birth of cleft children are different across cultures. These differences must be considered when administering care on international surgical missions.