In this article, we describe a study using a qualitative, naturalistic grounded theory design to explore sterilization decision making by pregnant obese women. Semistructured interviews of women who intended to undergo sterilization at the time of delivery were conducted in the third trimester of pregnancy (n = 15) and again postpartum (n = 11). The decision for sterilization was based on personal criteria for family composition and the nature of each woman's relationship with her partner. The process of decision making began with developing a personal comfort with cessation of childbearing, followed by social confirmation, informing the provider, and then awaiting the procedure. Sterilization was seen as reversible, despite a desire for "something permanent." Obesity was rarely viewed as related to any part of the decision for or against sterilization, and was rarely discussed by providers. Participants made sterilization decisions in their personal and social contexts, and then shared the decision with their providers, whom they often perceived as challenging that decision.