Objective To explore midwives’ experiences and views of amniotomy. Design A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12. Setting and participants Sixteen midwives working at delivery wards at three hospitals in the south of Sweden. Findings Three categories emerged: “Promote, protect and support the physiological process of labour”, “To make the decision -to do or not to do” and “Unpredictable response”. The overall theme linking the three categories was “We become our decisions”, portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy. Conclusions Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.