Objective: To generate greater awareness of the contextual and relational factors that influence women's capacity to participate in shared decision-making during childbirth. Methods: A three-phase participatory action research approach involving in-depth interviews and co-operative inquiry meetings. Setting: Dublin, Ireland in a large maternity hospital. Participants: Five postnatal women who gave birth to live healthy babies, and attended obstetric or midwifery-led care and 13 practising midwives. Findings: This paper presents the findings from the third phase of a three-phase action research study exploring the action's women consider necessary to embed informed choice, into practice. The findings reveal that multiple organisational and relational factors influence how women can participate in shared decision-making including the model of care they attended, continuity of carer, power dynamics, hospital policies and trust in self and others. Women's relationships with maternity care professionals reveals that exercising choice is not only defined by but contingent on the degree of trust in their relationships with maternity care professionals.