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Introduction Routine prophylactic antibiotic use is not recommended following uncomplicated vaginal births because of the global threat of antimicrobial resistance (AMR). The study was conducted to determine the magnitude and underlying reasons for routine antibiotic use following uncomplicated vaginal births.Methods We conducted an explanatory sequential study among women with uncomplicated vaginal births. We interviewed 370 women following facility discharge using interviewer-administered questionnaires. Eight in-depth interviews were conducted among midwives and clinical officers. Descriptive statistics and thematic analysis were used to analyse the data. The study obtained ethical clearance.Results The median age of the participants was 25 (interquartile range 20–30). Out of the 370 women, 34% (n=127/370) had perineal tears, 19% (n=69/370) had preterm prelabour rupture of membranes and 6% (n=23/370) had preterm labour. Almost all (99%) women with uncomplicated vaginal births were prescribed prophylactic antibiotics during facility discharge. A combination of amoxicillin and metronidazole (49%, n=181/366) and ampiclox and metronidazole (40%, n=147/366) were the commonly prescribed drugs during discharge. Antibiotics were routinely given to prevent puerperal infections. Perineal tears, episiotomies and unsterile environment were additional justification given for antibiotic use. Sterility was seen to be untenable which necessitated antibiotic use to cover for gaps in maintaining infection prevention and control measures. In some cases, antibiotics were considered necessary regardless of the absence of medical indications and the risk of AMR. Healthcare providers had inadequate awareness of the risks of AMR and the guidelines on antibiotic use during discharge.Conclusions Widespread routine antibiotic use after uncomplicated vaginal births reflected practices of overmedicalisation of childbirth and limited awareness of AMR. Developing local policies, strengthening infection prevention and control measures and innovating antimicrobial stewardship initiatives may be critical in reducing unnecessary antibiotic use after delivery.