Background: Women who plan an out of hospital birth in developed countries are generally classified as low risk. Nevertheless, during birth, unexpected complications may arise, which need competent decisions from the responsible health professionals. Aim: The aim of this study is to document the process of decision making when complications arise during homebirth from midwives and women's perspectives. Design: A grounded theory study consisting of problem-centered interviews. Methods: Qualitative data were collected by interviewing 20 independent midwives and 20 postpartum women working or living in two language regions (French, German) in Switzerland. Findings: The results point to the central role of leeway in decision-making in that the decisions must be flexible enough to consider both clinical situation and respect the women’s perspective. Factors that may impact the decisions made under complex birth situations, such as the urgency with which a decision must be made or the midwives’ experience, were found to reduce and expand flexibility, respectively, in the decision-making process. In sum, this study is a nuanced analysis of the process of collective decision making in the context of complex birth situations and thus represents an important contribution to midwivery studies.