The aims of this study were to describe the childbirth preferences of nulliparous women in early pregnancy and to develop a model of the predictors of those preferences. Participants were recruited with Facebook advertisements and data were collected from 344 women via online survey. Predictors were measured using the Utah Test for the Childbearing Year. Predictors of childbirth preferences (type of birth care provider, birth setting, mode of delivery, and use/avoidance of pain medication) were tested using structural equation modeling. Conventional content analysis was employed to analyze women’s reasons for selecting the type of provider and setting they expected for their delivery. Although the majority of respondents preferred physicians and hospital birth, the proportions of women who preferred midwifery care and planned home birth were higher than currently access those types of care in the U.S. More respondents preferred to use pain medication than to avoid it. Over 95% of respondents preferred vaginal delivery. Women who had an internal locus of control and perceived their childbearing role to be one of active participation were more likely than women who saw their role as a passive one to prefer midwifery care, home birth, vaginal delivery, and to avoid pain medication. Women who saw the provider’s role as dominant to their own were more likely to prefer physicians and hospital birth than those who viewed the provider’s role as a collaborative one. The more fearful/painful women expected birth to be, the more likely they were to prefer cesarean delivery.