This paper examines factors contributing to maternal mortality in Nairobi County of Kenya. Data are from a study that involved a review of 93 records of maternal deaths at health facilities as well as verbal and social autopsy interviews with 71 caregivers of women who died of maternal-related causes in the community. Results showed that most maternal deaths occurred to women who were young, married, with low levels of education and those having at least two births. In addition, maternal deaths in the County were mostly due to poor health-seeking behaviour, delays at the household level in seeking care, poor referral mechanisms between facilities, poor provider attitudes, and lack of skilled human resources. The findings suggest that programs aimed at improving maternal health in the County need to focus on empowering households to recognize danger signs early, improving referral mechanisms, and enhancing the capacity of providers to offer quality services.