In Kenya, maternal mortality ratios remain high and the number of births attended by skilled health attendants hovers at just 44%. Using both qualitative and quantitative data, a study was conducted to determine the uptake of antenatal care and skilled attendance in Malindi District and to explore factors that contribute to the low use of maternal health services during delivery. It was found that after the first antenatal visit attendance to health facilities begins to decline ending in low rates of births attended by skilled care and that socio-cultural and economic factors play a larger role than access alone in women’s health-seeking behavior during childbirth. A pervasive lack of birth preparedness and the view that health facilities are for the treatment of complications added yet another barrier to the uptake of skilled care. We conclude that the eradication of TBAs is not a realistic measure in the context of poverty and traditional practices.