Background Maternal nutrition during pregnancy affects the health of the mother and baby. Midwives are suitably well placed to offer nutrition education to pregnant women, however they may not be equipped with the necessary skills to deliver nutrition education to pregnant women. The aim of this study was to explore the midwives knowledge, confidence and skills to conduct maternal nutrition education (MNE) in an antenatal care clinic, Kampala, Uganda. Methods The study employed an exploratory qualitative design. Six in depth interviews, 6 direct observations for group education, and 12 observations of one-on-one midwife- pregnant woman interaction were conducted. The transcribed interviews and field observation notes were analyzed using latent content analysis. Results The midwives demonstrated good communication/facilitation skills during the sessions, and highlighted the nutrient rich dietary sources, increased nutrient demand, as well as food safety and hygiene requirements. Overall midwives’ MNE knowledge and skills were limited and had moderate confidence in performing the MNE. Midwives were ignorant about the maternal nutrition guidelines. Relevance of appropriate weight gain during pregnancy, guidelines for healthy habits, avoidance of substance abuse and nutrition precautions in special circumstances were missing in MNE. Information given to the pregnant women, MNE resources, infrastructural, and health systems gaps were identified. Conclusions There is need for alternative innovative MNE delivery models, and strengthening capacity of midwives in MNE.