Introduction; The Ethiopian Demographic and Health Survey in 2011 reported maternal mortality ratio of 676 maternal deaths per 100,000 live births which made our country among the 10 highest contributors’ of maternal death. Many Thesis results showed that properly equipped and supported skilled birth attendance reduce many of these complications. However, only 11.5 % of Ethiopian mothers were supported by skilled birth attendant during their labour and delivery. Objective: - To assess prevalence and factors to utilize skilled birth attendants among mothers who gave birth during the last one year in Ankasha Guagusa district. Methods: - A mixed study design employing a cross sectional household survey with in-depth interview and focus group discussion were employed. A total of 373 women age 15 to 49 years who gave birth in the past one year were asked. The sample size for the qualitative method was determined by saturation of ideas. Descriptive summary measures and associations between the various factors with skilled birth attendance were done employing Binary and Multivariate Logistic Regression. Thematic analysis was also used for the qualitative study. Result- The study showed that the prevalence of skilled birth attendance utilization among women who gave birth for the last one year in the study area were 70(18.8%). Main determinant factors associated to low utilization of skilled birth attendance in the study district were; women residence, educational status, ANC visit, type of health facility near to them, problem during labour and respondent’s attitude towards pregnancy and labour service. The odds of skilled birth attendance utilization among urbanites were AOR=5.5:195%CI (2.23, 13.57), educational status 2nd and above AOR=6.27 :( 1.31, 30.05), numbers of ANC visit 4th and above AOR=12.96:95%CI (3.20, 52.51) and women who encountered complications during their labour AOR=61.97:95%CI (19.83, 193.65) times higher than those counterparts. On the contrary mothers reside near to health post and unfavourable attitude of mothers towards maternal health care services were 83% and 65% less likely assisted by skilled birth professionals during their delivery than those the opposite parts respectively. Moreover, cultural practices, beliefs and barriers were other concomitant factors for low utilization of skilled birth attendance. Conclusion Skilled birth attendance utilization in the study area was very low due to different barriers. Hence, to bridge this gap especially women’s educational and awareness towards maternal health care services and cultural influences; sustainable awareness should be created by designing appropriate strategies including provision of targeted information, education and communication and integration among health care providers and other stakeholder at the community and health facilities. Key-words - Home delivery, skilled birth assistant, skilled birth attendance.