This thesis explored the cultural and power aspects that influence decision-making of Puerto Rican women during childbirth, focusing on women’s role in the decision making process, their negotiations of decisions and choices during pregnancy and labor and women’s understanding of medical risks. Qualitative methods included in-depth interviews with 10 adult Puerto Rican women and 5 maternal care providers. Thematic analysis was used to analyze the interviews. The analysis draws on the feminist critique of medicalization, and provides a gender perspective. The overarching finding of this research is how decisions and choice during pregnancy and childbirth are intricately connected to medical hegemony, the use of technology, the medicalization of childbirth and authoritative knowledge. The findings point to the power inequality that exists between women and their health care providers, and the mistrust present in women who seek maternal care. This mistrust is driven by a too high incidence of cesareans and the intricacies of the private health care system. These findings support the feminist critique of medicalization where women’s choice in birth is limited and lies within the medical system.