The Advanced Life Support in Obstetrics (ALSO) program helps pregnancy care providers learn the information and skills necessary to deal with urgent and emergent conditions that arise during pregnancy and delivery by using mannequins, mnemonics, and evidence-based approaches. Since its origin, the program has been disseminated internationally. Outside of North America, more than 18,000 clinicians have taken the ALSO course, and more than 1,200 ALSO individuals have been approved as ALSO instructors. Some of the international programs have become self-sustaining, others have not. Features of ALSO programs were analyzed in all countries in which ALSO has been introduced to identify characteristics associated with the program becoming self-sustaining. Characteristics of self-sustaining ALSO programs include a strong organizational structure, use of a train-the-trainer model to introduce the course, and encouragement of competing groups to work together. Overall, the program has been sustained by drawing on the expertise of international collaborators for medical content and by balancing customization of content against preservation of core information and skills. When the ALSO program is introduced to a new country or region, methods that have resulted in programs becoming self-sustaining should be used.