Introduction: Pakistan is a country where home delivery is a cultural norm despite of high Maternal mortality ratio (MMR) of 178 per 100 000 live births (lb) (WHO, 2015).1These statistics become more worrisome when the disproportion between the rural and urban areas is compared. The rural areas have higher rate of home birth. The aim of this study was to explore in depth the prime rationale for home delivery norm in rural area of Sindh, Pakistan. Material and Methods: A cross sectional study was carried out in 2015 in District Khairpur Mirs, Sindh, Pakistan. Trained interviewers used a semi-structured questionnaire to interview 439 women of child bearing age (18-45 years) selected through random sampling. The data were analyzed using SPSS version 20 and Microsoft excel. Results: The mean age of the sample was 29.6__ampersandsignplusmn; 6.9 years.Three forth (64.7%) of the respondents had no formal education, with half of the sample (51%) an agricultural background for earning. Two third (70%) sample had home delivery for their last baby. For almost half (53%) cases, place of delivery was a husband dominated decision, while prime reason behind was the trust on dais (70%) for their privacy, 64% distance from health care facility, half (49%) of the sample__ampersandsignrsquo;s reason was cost of hospitalization, (3%) following traditional values, and (12%) of them thought place of delivery is not important. Conclusion: Home delivery choice was prevalent among 70% of the women of child bearing age (18-45 years), in District Khairpur Mirs, Sindh, Pakistan. Most of the reasons identified through our study, were cultural values, financial unaffordability and accessibility. Among these reasons culture bound impediments were sizable whichincluded trust on dais (unskilled traditional birth attendants), husband dominated decision and familytradition. The distance from hospital was physical accessibility constraint while financial issue was also one of the leading causes for home birth preference. The findings of the present study can not be generalized due to the limited sample. Still, the study provides evidence of paradigm related factors, being the main constraint of the cycle. Future research is needed to formulate compelling public health interventions to create awareness for paradigm shift to reduce high MMR in the low and middle income countries like Pakistan.