Background: In an effort to reduce maternal mortality rate required an effective referral system, especially for cases of complications. One of the fundamental aspects of primary health care is a good relationship among levels especially with above level that refl ects as an effective referral system. Method: An observational study with cross sectional design carriedout in Tambakrejo and Tanah Kali Kedinding health centers Surabaya in 2013. Respondent were head of the health center and the midwives' coordinator. Collecting data with in depth interviews, structured questionnaires and study documents of maternity referral cases period of 2010 - June 2013. Data were analyzed descriptively. Result: The implementation of maternity referral cases in Tambakrejo and Tanah Kali Kedinding health centers consisted of clinical and administrative procedures. Clinical procedures have been implemented well, on the other hand, there were some administrative procedures that had not been implemented yet, these were 1) record for patients in register books; 2) giving a referral feedback letter to health facility and worker that refer the patient; 3) There is no procedure of receiving back referred. Coordination for maternal referral among health facilities has been implemented with limitations. Implementation of maternity referral cases and childbirth cases' handling are in accordance with medical indication primary health care authority. Conclusion: Maternity referral cases in Tambakrejo and Tanah Kali Kedinding health centers has been implementing well enough with limitations, i.e. there is no referral back from hospital to primary health care facility. Recommendation: To implement the policy of back referral, the hospital should make a written standard procedures for the return of referrals. In addition, public health centers have to make standard procedures for receiving back referred patient from hospital and returning back them to other primary health care, sub health centers or midwife.