BACKGROUND Since 2000, in the context of the Millennium development goals, Benin has reinforced its obstetric referral system in order to reduce maternal mortality. However, structural, sociocultural and economic problems continue to affect this strategy. The Cotonou University gynaecology and obstetrics clinic (CUGO), at the top of the health pyramid, is emblematic of this situation. This study was designed to elucidate the stakes involved in referral to this hospital based on analysis of the perceptions and experiences of referral personnel. METHODS Essentially qualitative data collection was conducted by means of in-depth semi-structured interviews from July to December 2015 involving 37 people, including referred women, healthcare personnel and caregivers. RESULTS The poor quality of information given to women concerning the reasons for referral, the fear of caesarean section, considered to be inevitable, and the difficult relationships with health workers contribute to failure to comply with referral. Rumours concerning reception, waiting times and hospitalization conditions are other factors that must be taken into account. Finally, the distance from the woman's home is a decisive element in acceptance of referral by women and their families. CONCLUSIONS Referral is generally perceived as necessary in the case of complications during pregnancy, by both referred women and healthcare personnel. However, differences in points of view are observed when the woman is referred to CUGO.