Background: Assessment of the maternal satisfaction with maternal health service is a major input to improve maternal health services. Hence, we aimed to assess maternal satisfaction with maternal health service and its predictors among the women who gave birth in last 12 months in Darara district, Southern Ethiopia. Objective: This study is aimed to provide evidence on the overall satisfaction of the mothers’ towards the services provided by Health Extension Workers and its predictors among the mothers in Darara woreda, Sidama region, Southern Ethiopia. Methods: A community-based cross-sectional study was carried out using a mixed method among the sample of 520 women in Darara district, South Ethiopia from July 1-30, 2020. A systematic and purposive sampling technique was used to choice the study participants. A structured, validated and pretested interview-administrated questionnaire and in-depth interview were used to collect the data. Both bi-variable and multivariable binary logistic regression analyses were conducted. The coding and analysis of the qualitative data were done using thematic content analysis technique by Atlas-Ti software and presented in narratives. Result: The overall maternal satisfaction with maternal health service was 55.2% (95% CI = 50.8-59.4). The identified predictors of maternal satisfaction were distance from household to health post (AOR = 3.59; 95% CI= 1.71 - 7.55), absence of preparation of HEWs during procedure (AOR= 2.87; 95% CI = 1.74 - 4.74), acceptability of the HES by HHs (AOR= 2.18; 95% CI = 1.14 - 4.18), having a reliable communication method with HEWs (AOR = 3.47; 95% CI = 1.77 - 6.79) and received training on the model family (AOR= 2.48, 95% CI= 1.86 - 2.57). These quantitative results were supported by the individual, organizational, socio demographic and cultural qualitative findings. Conclusion: Distance from household to health post, absence of preparation of HEWs during procedure, acceptability of the Health Extension Service (HES) by household, having a reliable communication method with HEWs and received training on the model family were significant predictors of maternal satisfaction. Also expansion of training of model family in the community would increase maternal satisfaction levels.