Informed Choice and the Choice to NOT Know
What Montgomery vs Lanarkshire Means for Birth Choices
In 2015,
a landmark court case quietly reshaped
how consent works
in maternity care
— and it’s something every woman,
and every midwife should know about.
The case, Montgomery v Lanarkshire Health Board,
confirmed that
women have the right to make fully informed decisions about their care,
based on what matters to them
— not what a doctor or midwife assumes is best.
💬 What the Court Said
Healthcare professionals must:
Take reasonable care to ensure women understand the material risks of any recommended treatment or intervention.
Explain any reasonable alternatives, including choosing to do nothing.
A material risk is one that a reasonable woman in that situation would want to know about,
or one the clinician should recognise this particular woman would attach significance to.
💡 In Practice
True consent is a conversation, not a form.
It means exploring what’s important to each individual,
what she values, and how she wishes to be cared for
— especially during pregnancy and birth.
It also protects the woman’s autonomy
— including the right to say,
“I’d rather not discuss that now,”
or
“I don’t want that information.”
The law recognises that women have the right not to know,
just as much as the right to be fully informed.
💭 An Example from Practice
There are occasions where a woman’s decisions have already been thoroughly discussed and documented with her consultant team, yet when she enters labour, these decisions are revisited again.
For instance,
a woman who has planned a homebirth may go to a lot of trouble
- attending unwanted obstetric appointments to have all her care “signed off” in advance.
When a midwife who has not previously met her arrives
— often due to a lack of continuity of care by design of services;
— the midwife may feel professionally obliged to restate hospital recommendations
and ask whether the woman is
still “refusing” to transfer.
Although intended to ensure clarity and uphold professional standards,
this can unintentionally disturb the hormonal flow of labour
and heighten anxiety at a time when calm and privacy are essential.
Such situations often arise not from individual practice but from systemic gaps in continuity.
When midwives do not know the women they attend,
it becomes far harder to uphold previously agreed wishes while meeting institutional expectations.
This highlights the tension between policy and physiology
— between defensive practice and woman-centred care.
⚖️ Exceptions Are Rare
The only times information can be withheld are:
In a genuine emergency when the woman cannot be consulted, or
In the very rare “therapeutic exception” where sharing it would cause serious harm.
🌿 Why It Matters
Understanding Montgomery helps women feel confident that their choices
— whether about place of birth, pain relief, or interventions
— must be respected.
Good maternity care should always begin with
trust, relationship, and open dialogue
— the foundations of safety for both women and midwives.
Want to explore your birth options and learn how to navigate informed decisions with confidence?
Join my next Class,
where we explore communication,
birth physiology, and tools for self-trust at every stage of labour.