Background <p>Improving the quality of maternity care is essential for reducing maternal mortality. However, gaps in confidence in using clinical skills may affect the quality of maternity care in low-resource settings. This study aimed to assess the status of maternity care practice and confidence in skill use among maternity care providers (hereafter referred to as healthcare professionals) in Dhading district, Nepal, and identify associated factors.</p> Methods <p>We conducted a quantitative cross-sectional study using self-administered questionnaires distributed to 129 healthcare professionals working in 62 health facilities for childbirth in Dhading district, Nepal. The collected information included maternity care experience, training and technical support, and maternity care practice and confidence. Multiple linear regression analysis was used to identify factors associated with confidence in maternity care practice.</p> Results <p>Participants reported relatively high confidence in managing postpartum hemorrhage and eclampsia but lower confidence in abnormal and advanced procedures, with the lowest median confidence scores observed for vacuum extraction and manual vacuum aspiration. Higher confidence was significantly associated with Skilled Birth Attendant (SBA) training attendance, higher total score for maternity care provided within the past 3 months, and better understanding of national maternal and newborn health (MNH) strategies/programs.</p> Conclusions <p>Low confidence was linked to limited Skilled Health Personnel/SBA training, scarce recent experience with high‑risk cases, and weak understanding of national MNH strategies. In low‑volume districts like Dhading, strengthening routine SBA training, providing structured rotations, and integrating simulation‑based training, particularly for high‑urgency emergency skills, may help build confidence and improve maternal care quality.</p>