Objective To explore optimal handover processes in maternity care to address service quality and women’s safety. Design Mixed-methods study. Setting Maternity hospitals in Banjul, The Gambia. Sample 110 shift-to-shift handovers across maternity wards. Methods Handovers were observed and compared against a standard, investigating content and environment alongside semi-structured interviews and focus group discussions with doctors, midwives and nurses. Main outcome measures Number of information topics handed-over categorised by SBAR, description of handover environment, supported by qualitative themes on barriers and facilitators. Results Only 666 of 845 women (79%) were handed over. Doctors had no scheduled handover. Shift-leads alone gave/received handover, delayed [median 35 minutes, IQR 24-45] 82% of the time; 96% of handovers were not confidential and 29% were disrupted. Standardised guidelines and training were lacking. A median 6 of 28 topics [IQR 5-9] were communicated per woman. Information varied significantly by time, high-risk classification and location. For women in labour, 10 [IQR 8-14] items were handed-over, 8 [IQR 5-11] for women classed ‘high-risk’, 5 [IQR 4-7] for ante/postnatal women (p<0.001); >50% had no care management plan communicated. 21 interviews and 2 focus groups were conducted. Barriers and facilitators surrounding three health service factors emerged; health systems, organisation culture and individual clinician factors. Conclusions Maternity handover was inconsistent, hindered by contextual barriers including delays, lack of team communication and guidelines, with some women omitted entirely. Findings alongside clinicians views demonstrate feasible opportunities for enhancing handover, thereby improving women’s safety globally. Funding Arthur Thompson Trust and BMedSc student funding.