In this chapter, we explore risk communication and ‘shared’, or ‘informed’ decision-making (SDM, or IDM) in maternity care, in the UK and in Canada, using mode of birth as an exemplar. UK National Institute for Health and Care Excellence (NICE) guidance on SDM outlines the benefits as empowering people to make decisions and providing them with choices about care and treatment. In practice, however, this approach can be difficult to use, and we explore some of the complexities that SDM presents within maternity care. In ‘mode of birth’ decisions, for example, the decision requires consideration of outcomes for both women and babies and is taken in the context of what has been termed a global epidemic of caesarean births. For those who make a choice of planned mode of birth, any preference which differs from clinical guidance may impact on the experiences of pregnancy and have longer term relationship consequences; we use sociocultural understandings of risk and theories about ‘identity’ risks to unpick some of these issues. We also begin to examine the relationship between informed decision-making and health inequalities and consider future directions in this field of practice.