Clinical decision-making is an important element in midwifery practice. Midwives are required to have a sound knowledge to manage complications during childbirth. Any misjudgement by a midwife may lead to adverse birth outcomes. The aim of this paper is to review factors that contribute to clinical decision-making of midwives. This was achieved by reviewing published research articles. Studies have shown that shortage of human and material resources, poor skill mix, absence of mentors and lack of autonomy are some of the contributing factors that may affect midwives’ decision-making.