Background Understanding cultural context is crucial to providing respectful maternity care.This study’s aim was to explore pregnancy culture, beliefs and traditions among the Madurese tribe of Indonesia. Methods This qualitative study was conducted in the Sumenep district. In-depth interviews and focus group discussions were held with 67 key informants: pregnant women, their family members, traditional birth attendants, and community, religious and traditional/indigenous leaders. Results The practices included fourth-and seventh-month rituals, pregnancy massage and behavioural taboos and suggestions. Conclusions Most Madurese tribe practices are harmless. Healthcare providers must appreciate and integrate prevailing traditional beliefs and practices with other efforts to reduce maternal mortality.