Introduction: Patient's preference plays a significant role in determining the type of anesthesia used. This study aims to examine the reasons behind the refusal of spinal anesthesia among pregnant women undergoing elective cesarean section and to determine the incidence rate of such refusals. Methods: A prospective cohort study of 105 pregnant women candidates for cesarean section between January and May 2023. Participants were interviewed according to a structured pre-coded questionnaire by one of the investigators. In this study, we examined 15 likely risk factors affecting the acceptance of spinal anesthesia in pregnant mothers who are candidates for elective cesarean section. Results: The findings revealed a spinal anesthesia rejection incidence rate of 24.8%. The most common concern and reason for the patient’s refusal was the "recommendation of others not to choose spinal anesthesia." The next two reasons were“fear of back pain” and “fear of needlings”. The logistic regression model was statistically significant, χ2(4) = 46.483, p < .0005. According to the statistical data, the best regression model contained 3 preoperative factors (P < .05). Having a previous history of the cesarean section using general anesthesia, having a previous history of the cesarean section using spinal anesthesia, and increasing the knowledge of patients about different types of anesthesia affect the probability of not accepting spinal anesthesia by 3.17, 0.25, and 0.15 times, respectively, in pregnant patients who are candidates for elective cesarean section. Conclusion: The refusal rate of spinal anesthesia and the tendency to use general anesthesia among Iraqi pregnant women is still slightly higher than the spinal method and needs to be more considered when compared with the developed communities. This study has identified three significant independent predictors of having a previous history of a cesarean section using general anesthesia, having a previous history of a cesarean section using spinal anesthesia, and increasing patients' knowledge about different types of anesthesia.