The study was performed in small holder dairy cows in and around Nekemte town from October, 2011 to May, 2012 to determine major postpartum reproductive health problems in the area through retrospective data analyses, questionnaire survey and clinical follow-up study. A total of 2295 recorded reproductive cases were examined in the retrospective study of which, reproductive health problems accounted over all prevalence of 11.2% (N=256). Of the 256 affected dairy cows, retained fetal membrane accounted for 4.84%, where as abortion, dystocia, prolapse (uterine or vaginal) and metritis accounted for 2.48%, 1.83%, 0.9% and 0.8%, respectively. Of a total of 385 cows included in the questionnaire survey (N=355) and clinical follow-up (N=30), 102 (25.1%) were found with major reproductive health problems. The major reproductive health problems obtained were retained fetal membrane, followed by dystocia, repeat breeding, abortion and metritis with prevalence rates of 10.9%, 7.5%, 3.1%, 1.82%, and 1.04%, respectively. The prevalence rates of major reproductive health problems were significantly different with respect to breed, (p=0.013), age (p=0.000), body condition (p=0.028), management (p=0.000) and parity number (p=0.0183) of dairy cows. Risk factors analysis revealed that prevalence of the major reproductive health was higher in adult cows (OR=3.6; 95%CI=1.72, 7.55), primi para cows (OR=4.3; 95%CI=2.17, 8.5), cows kept intensively (OR=3.2; 95%CI=1.93, 5.4), cows with poor body condition (OR=0.65; 95%CI=0.390, 1.066) and those exotic breeds (OR=1.9; 95% CI=1.13, 3.14) than those corresponding animals. In Conclusion, retained fetal membrane, dystocia, repeat breeding, abortion and metritis were found to be the major reproductive health problems in and around Nekemte town, west of Ethiopia.