Introduction: Maternal health has emerged as a global priority because of a great gap in the status of mothers’ wellbeing between rich and the poor countries. Maternal mortality remains unacceptably high in Ethiopia. Ethiopia is unlikely to make much progress to reduce maternal mortality unless accelerated interventions are designed and implemented immediately.

Objective: To assess the prevalence and determinants of home birth practice among mothers who gave birth at home after ante natal care attendance with in the last two years before the study in Gozamin District, northwest Ethiopia, 2014.

Methods: Community-based cross sectional study design was carried out. A total of four hundred and ninety seven respondents participated in the study. Data entry was done using Epi data 3.1 and analysis was done using SPSS version 20. Binary logistic regression was done to see the impact of each factor on the pattern of home delivery.

Results: of the respondents, 374 (75.3%) gave birth at home. Respondents with educational status of unable to read and write were more likely to give birth at home compared to respondents with primary and above education [AOR = 6.91, 95% CI 1.99, 15.10]. Being farmer was also significantly associated with home delivery [AOR = 9.42 95% CI 3.29, 26.94].

Conclusion and recommendations: The prevalence of home birth after ante natal care attendance in Gozamin district was very high. Variables like mothers’ decision making power within the house hold, husbands’ preference where he want his wife to give birth, occupational educational status of study participants were found to be important predictors for home birth practice. The government of Ethiopia should strive to empower females and should also make the health facilities comfortable and give attention to cultural issues.