Background: Facility-based maternal death review is one of the tools used by the government of Ghana to improve the quality of maternal health care and reduce maternal mortality. It is known that Ghanaian midwives participate in the implementation of the maternal deaths reviews in the country, but little is known about their contributions in this process. The aim of this study was to explore and describe the contributions of midwives in the process of facility-based maternal death review in selected health facilities in the Ashanti Region. Methods: The study used a qualitative descriptive design with individual semi-structured interviews. Interviews were conducted with 20 midwives from eight district hospitals, one regional referral hospital, and one teaching hospital. Interviews were digitally recorded and analyzed through thematic content analysis technique. Results: The results indicate that midwives are actively involved in the implementation of facility-based maternal review. Three major themes emerged from their contributions: (1) reporting and documentation of maternal deaths; (2) assessment of probable causes of deaths; and (3) implementation of interventions for improvement. Conclusion: This study brings insight into the roles played by midwives in the implementation of the facility-based maternal death review in Ghana’s Ashanti Region. It highlights the expanded roles of midwives in the absence of physicians and the need for advanced midwifery training in the country. Further research looking at the impacts of their contributions is needed.