Background: Pregnancy and childbirth and their consequences are still the leadingrncauses of death, disease and disability among women of reproductive age in developingrncountries more than any other single health problem. Nearly 536 000 women die eachrnyear from pregnancy and childbirth related complications globally. Effective antenatalrncare use has been shown to influence womenâ€™s use of delivery services, probably thernmost effective intervention in reducing maternal mortality in the developing world.rnSupporting women at delivery is an essential part of public health care.rnObjective: This study assessed practices of women during pregnancy and childbirth withrnthe perspective of HEWs role in this regard.rnMethodology: A cross sectional community based survey supplemented by qualitativerndesign was conducted in Gubalafto Woreda, North Wollo zone from February to Marchrn2009. Multistage cluster sampling technique was used to select the sample of 841rnwomen. Data were collected through structured, pre-tested questionnaires. The data werernentered in to Epi Info version 3.5.1 and analyzed on SPSS version 13 computer software.rnA univariate, bivariate and multivariate analyses were done using frequencies, chi-squarernand binary logistic regressions respectively. The study was conducted after approval ofrnInstitutional Review Board of faculty of Medicine, Addis Ababa University and byrnascertainment of informed verbal consent from study participants.rnResult: The result of the study revealed that 63.4% of ANC attendance and 8.4% of HFsrndelivery to their last pregnancies of the respondent women. Harmful traditional practicesrnthat are commonly experienced during pregnancy and childbirth like abdominal massagernand leaving the cord untied were found prevalent. Around 35% of mothers and morerndiscussants expressed their dissatisfaction with HEWs less involvement in conductingrnnormal labor and most of the HEWs themselves described as they had never attendedrnnormal labor. Multivariate analysis had shown that maternal age, marital status, age atrnfirst pregnancy, perceived pregnancy and childbirth risks and womenâ€™s decision makingrnstatus were significantly associated with ANC attendance. Women who were able torndecide by themselves for health service utilization were found to utilize ANC more thanrntwo times than their counter parts (AOR=2.53, CI= 1.86, 3.45). In this study, previousrnANC attendance and ever delivered at HF prior to the last pregnancy are found to bernsignificant predictors of health facility delivery. Women who had antenatal carernattendance at least once were almost three times more likely to give birth in the healthrnfacility than who did not have any ANC attendance (AOR= 2.86, CI= 1.34, 6.11).rnConclusion: The main reasons mentioned for ANC non attendance and not giving birthrnin the HF were associated with the maternal low awareness of the need of care, andrnsocio-economic factors. In line with this, HEWs inability to attend normal laborrncontributed to the very low HF delivery. As a result, IEC/BCC to increase womenâ€™srnawareness on obstetric risks and general health seeking behavior, promotion of prenatalrnand delivery care service utilization, training for HEWs, equipping and staffing HFs arernrecommended. Keywords: Practices, pregnancy, childbirth, HEWs