The ability to express concerns in a team is a foundational construct of a safety culture. This study used simulation to explore the dynamics of speaking up behaviors across team hierarchy during an obstetric care incident that included clinician decision errors and lapses in team respect. Participants used different strategies for raising concerns across team roles. The result found direct communication of concern disruptive to the team and patient trust, suggesting the importance of less assertive mechanisms for raising concerns in interprofessional teams.