Objectives: to identify the factors that influence Hong Kong Chinese women's decision to have an elective caesarean section.To explore Chinese women's perceptions of their autonomous involvement in childbirth decision-making. Design: a qualitative exploratory design. Setting: a postnatal ward of a private hospital in Hong Kong. Participants: a purposive sample of six postnatal women who had undergone an elective caesarean section. Findings: four thematic categories were identified including: avoiding fetal and maternal risks, exercising autonomy to make an independent choice, Chinese belief systems, and rejoicing and regretting. Key conclusions and implications for practice: we propose the provision of a 'named' midwife and continuity of care. Improving the availability of information on caesarean sections, accommodating a Chinese belief system in the planning of midwifery services at the international level and establishing post caesarean section peer support groups are recommended.