Background: Cesarean section (C/S) and Vaginal delivery are two methods of delivery, Cesarean section sometimes indicted for obstetrical reason but primigravida might have a preference of the mode of delivery. Our aim was to explore the preferred mode of delivery chosen by pregnant nulliparous women visiting the out-patient Obstetrics Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A secondary aim was to identify associated factors and investigate reasons for their preference. Method: This was a cross-sectional study conducted at KAUH from October 2018–October 2019. All nulliparous women who were willing to participate were included. The questionnaire had 19 questions, containing six domains. Results: 104 primigravida women participated; their ages ranged from 18 to 41 years (mean \pm SD 27.31 \pm 5.41). 85.5% preferred spontaneous vaginal delivery (SVD) because they considered it to be natural (OR (95% CI) = 0.696 (0.575–0.842) P 0.001). They also preferred SVD because of a quick recovery (OR (95% CI) = 0.084 (0.011–0.670) P = 0.003). Pain or concern about the stress to herself or her baby did not affect the mother’s decision. The husband influenced the decision (OR (95% CI) = 11.944 (2.710–52.644) p = 0.002), more so than the influence of the woman’s mother (OR 95% CI = 0.225 (0.063–0.806) P = 0.029). The influence of doctors and friends was not significant (P = 0.132 and 0.627, respectively). Conclusion: The preferred mode of delivery chosen by primigravid pregnant women was SVD, only 13.5% preferred C/S. Factors that have a positive impact on the preference for C/S were anxiety, fear of labor pain, and negative labor experience.