One of the hardships faced by midwives in developing countries is dealing with maternal death. Taking care of pregnant women who end up dying makes midwives mindful of their own mortality and this experience provokes discomfort and anxiety. To determine the predictors of death anxiety among midwives who have experienced maternal death at work in order to recommend interventions to facilitate effective coping with the distress. An exploratory, descriptive design was used to collect data about death anxiety from 224 midwives working in two rural districts of Uganda. Death anxiety was measured using a subscale of the Death Distress Scale. The majority of participants were female (80 %) and with associate degree level professional education (92 %). Participant's mean age and years of professional experience were 34 (±6.3) and 4 (±2.1) years, respectively. Most participants (74.6 %) had moderate or high death anxiety. The predictors of death anxiety were: having witnessed two and more maternal death in the past 2 years [odds ratio (OR) = 3.175; p ≤ .01]; being in charge of four or more maternal deaths (OR = 5.13; p ≤ .01); lack of professional training in handling death situations (OR = 3.32; p ≤ .01); and coping with maternal death situations using methods such as: planning (OR = 4.90; p ≤ .01), active coping (OR = 3.43; p ≤ .05) and acceptance (OR = 2.99; p ≤ .05). Multiple exposure to maternal death situations is associated with an increase in death anxiety among midwives working in rural settings. Employers need to provide deliberate support to enable midwives to cope effectively with death anxiety at work.