Client’s satisfaction is a fundamental tool used to assess quality of health services. Little is known about level of satisfaction and associated factors in public health institutions of Oromia Region. Cross-sectional study design was conducted to assess the level of client satisfaction with skilled delivery services and associated factors among women who gave birth in public health institutions of Oromia region, from January-01 to February-28, 2018. A total of 1,483 women were randomly selected from 10 hospitals and 30 health centers. Data was collected using an interview administered questionnaire. The collected data were analyzed using SPSS version 21. The proportion of women satisfied with skilled delivery services was 55.35% [95%CI: 52.9, 57.8]. Rural residence (AOR, 1.35; 95% CI: 1.04, 1.76), higher monthly income (AOR, 2.03; 95% CI: 1.34, 3.08), delivery attended by physician (AOR = 2.29; 95% CI: 1.53, 3.42), and delivery attended by midwives (AOR, 3.09; 95% CI: 2.29, 4.17) were factors associated with client satisfaction with skilled delivery services. It is better to provide delivery services by either physician/midwifery. Moreover, advancing service standard, particularly in facilities of the urban setting and empowering women to improve their economic status are areas to be considered for intervention.