Background: Complex interactions occur among women and caregivers throughout labor. Analyzing women's birth stories provides a rich data source on these interactions. The purpose of this qualitative study was to clarify how decisions were made in labor by analyzing women's birth stories. Methods: A convenience sample of 15 primiparous and multiparous Midwestern women contributed a total of 33 birth stories. Qualitative methods were used, including analyses of the content and themes of stories. Results: The primary types of decision making that were identified ranged on a continuum from unilateral to joint (shared), and were associated with various emotions expressed by the women. Conclusions: A model of decision making was derived from the data that may help caregivers change practices in ways that will benefit women. Caregivers can also benefit by understanding women's critiques of the birth care they received, and can use this knowledge to improve women's experiences of birth and therefore their satisfaction with the process.