Introduction: Enhancing women's participation during pregnancy and childbirth is in line with the call of the World Health Organization and is linked to effects on user satisfaction, clinical health outcomes and better management of health care providers. Objective: To discover women's needs for participation in decision making during pregnancy and childbirth.Methods: Secondary analysis of a descriptive qualitative study with hospitalized women from the puerperium service of two hospitals in Santiago, Chile. The data analysis was carried out using the method proposed by Grounded Theory.Results: Twelve women participated in two focus groups. The relational analysis showed that participation in the reproductive process is interfered by two groups of factors linked to cultural meanings and to the violation of women's rights.Conclusions: Women's participation in clinical decisions during pregnancy and childbirth is still scarce and power is still held by health professionals, perpetuating practices of institutional violence. To advance in obstetric practice centered on women, it is important to recognize the active role that women want and can play in order to have a positive and satisfactory experience.