Risk has become a defining concept in maternity care research and practice but is rarely examined with reference to gender. When gendered risk remains unexamined, we fail to appreciate how assumptions about the female body inform care in pregnancy and birth. Ignorance of the connection between risk and gender can also introduce new risks. For example, when we assume that all pregnant and birthing people are of a specific gender (female) or sexuality (heterosexual), we introduce risks to the self-identities and experiences of trans men, non-binary persons, and lesbian women. We argue here that maternity care is characterised by what Kelly Hannah-Moffat and Pat O’Malley refer to as the ‘risk/gender nexus’. This consists of an interlocking set of oppressions and inequalities, including sexism, racism, and heterosexism, which can pose risks to bodily autonomy, undermine the capacity of birthing people to have a voice in decisions about their care, and obscure that the gendering of risk is also a matter of reproductive justice. We maintain that gender is a vital prism through which perceptions of risk and uncertainty are refracted and conclude with consideration of the risks of ‘obstetric violence’ that arise from structural violence against women and gender minorities.