Deaths from maternal causes represent the leading cause of death among women of reproductive age worldwide. About 99% of the deaths occur in developing countries, including Tanzania. While maternal deaths are progressively decreasing in high-income countries with an average of 16 deaths per 100,000 live births, in most developing countries like Tanzania the estimates are still very high, with estimates of about 510 deaths per 100,000 live births for Sub- Saharan African countries despite efforts to reduce it. Objective The aim of this study is to determine the rate, trend and causes and associated factors of maternal mortality at the Kilimanjaro Christian Medical Center, Tanzania. Materials and Methods A structured data collection form was used to extract information of 172 maternal deaths from the hospital birth registry, patients’ files and from the MoH surveillance forms, between 2003 through 2012. Descriptive analysis was done to determine maternal mortality ratio, causes and factor associated with maternal deaths at KCMC. Results A total number of 34953 live births and 172 maternal deaths were recorded during the study period, giving an overall maternal mortality ratio of 492.1 per 100,000 live births. While the number of deliveries increased over years, there were no significant changes in maternal mortality ratios from 2003 to 2012. 107 (62.2%) women suffered direct maternal deaths while indirect maternal deaths were 49(28.5%) with 16(9.3%) of the deaths due to both direct and indirect causes. Hemorrhage was the leading direct cause of maternal death, accounting for 33(19.2%) of mortality, followed closely by Hypertensive disorders in pregnancy 31(18.0%). Other direct causes included Sepsis (11.0%) and Abortion 14(8.1%). HIV/AIDS was the leading indirect cause of maternal deaths by 15(8.7%), followed by Heart diseases 11(6.4%). Other indirect causes included Anaemia 7(4.1) Malaria 3(1.7%) and others 12(6.9%). Majority of deaths 67(38.9%) were attributed to type II delay followed by Type I delay 59(34.3%). Conclusion While worldwide data shows that MMR has dropped by almost 50% between 1990 and 2013, in Tanzania the ratio is still very high with the Hemorrhage and Hypertensive diseases as the major preventable causes of deaths. Efforts must be made to improve the management of hemorrhage and hypertension at the level of the community where most of these deaths are referred from. Further studies also need to be done at the community level to try to find out more possible factors associated with maternal deaths.