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Background: Accessibility to maternal health care services for women in marginalized urban slum areas poses a huge public health problem. Many women do not go for institutional deliveries in spite of physical accessibility. Home-based care by Traditional Birth Attendants (TBA) is detrimental. Inappropriate early infant feeding practices are not uncommon. This study aimed to determine the existing maternal health care practices in an urban slum and to identify barriers to utilization of health services by mothers in the year 2010. Methods: This Cross-Sectional study was conducted in an urban slum area of Salatwada, Vadodara in India. Mothers who had delivered babies in last one year were contacted for the participation in the study. A total of 127 mothers were interviewed at home. Maternal health care practices and reasons for utilizing or not utilizing health services were investigated during the interview. Data were tabulated and analyzed using SPSS version 11.0. Results: Analyses showed that 74.8% of mothers had received antenatal care. However, this did not translate into safe delivery practices as 57.5% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (50.7%) or related to financial problems (24.6%). A total of 76.7% of the deliveries were conducted in the squatting position and in 37% of the cases, the edge of a broken cup was used to cut the umbilical cord. Although breastfeeding was started, inappropriate early infant feeding practices were common. A few mothers had breastfeeding problems. Conclusion: Inadequate utilization of available services leads to hazardous maternal health care practices in urban slums. [ABSTRACT FROM AUTHOR]