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Background: Cesarean section (CS) is a common obstetric intervention worldwide, with rising rates prompting ongoing debate about its appropriateness and implications for maternal and neonatal health. Understanding how expectant mothers perceive and approach CS is crucial for developing effective, patient-centered maternity care strategies, particularly in low- and middle-income settings such as Peshawar, Pakistan. Objective: To explore the perceptions, attitudes, and decision-making processes of expectant mothers regarding cesarean section at a tertiary care hospital in Peshawar. Methods: A qualitative descriptive study was conducted between May and October 2024, enrolling 20 pregnant or postpartum women aged 18–40 years through purposive sampling. Data were collected via in-depth, semi-structured interviews held in a private hospital setting. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed using Braun and Clarke’s framework to identify key themes and subcategories. Results: Analysis revealed four central themes: limited knowledge and prevalent misconceptions about CS, emotional distress and powerlessness during decision-making, substantial influence of healthcare providers and family members on delivery choices, and dominant reasons for selecting CS such as fear of labor pain and prior negative birth experiences. Many participants reported inadequate antenatal education and insufficient counseling by medical staff, leading to confusion and heightened anxiety about delivery options. Conclusion: Significant gaps in knowledge and communication regarding cesarean section among expectant mothers in Peshawar impact their attitudes, increase emotional distress, and hinder informed decision-making. Enhanced antenatal education, culturally sensitive counseling, and structured shared decision-making processes are recommended to empower women and improve maternal health outcomes in similar settings.