Sterilization is a prevalent form of contraception, yet not all women who desire postpartum sterilization undergo the procedure. This retrospective cohort study aimed to investigate reasons for non-performance of postpartum sterilization. These reasons included lack of documentation, no longer desiring the procedure, and desiring another form of contraception. Undergoing cesarean delivery significantly increased the likelihood of undergoing postpartum sterilization, suggesting a need for prioritizing sterilization access amongst patients delivering vaginally. Further research is warranted to explore clinical decision-making and patient uptake of postpartum sterilization in larger samples. Addressing documentation issues may facilitate shared decision-making and improve access to sterilization.