Introduction Millennium development goal 5 (MDG 5) is to reduce the maternal mortality rate by 75%. Due to the shortage of medical doctors in sub-Saharan African countries, midwives have been compelled to take an important responsibility for the outcome of delivery. Therefore, to achieve MDG 5, strengthening midwives’ /professional ability is essential. However, less attention has been paid to the quality of midwifery care. Objective This study investigated the process of delivery care provided by midwives in the labor room at a public hospital in Tanzania and assessed the quality of midwifery care. Methods 1.Data collection from delivery records 2.Observation of delivery care at the point of delivery in the labor ward. I conducted an observational study in the delivery room of Mwananyamala Hospital in Dar es Salaam, the capital of Tanzania, for a total of 43 hours over 7 days. 3.Semi-structured interviews were conducted with 10 midwives at the hospital. In our evaluation and analysis, the classification of practices during normal birth published by WHO were used as a benchmark. Results There were 257 deliveries during the 7days of observation. Still birth occurred in 15 cases. The average maternal age was 23.8 years old and 55.5% were primiparas. Since only 3 midwives working in three shifts conducted all deliveries, the shortage of staff was obvious.We noted three issues of midwifery care as follows: 1.Delivery care was not mother-centered. 2.Continuous and careful monitoring of labor was not performed. 3.Medical treatment and drugs were administrated inappropriately and may cause rupture of the uterus and hemorrhage. Conclusion To achieve the goal of MDG5, it is necessary not only to focus on the outcome indicator but also to improve the quality of midwifery care.