Birth by vaginal delivery is an evolutionary process refined over millennia to create a sustainable and safe method of human reproduction. A key argument against requiring consent for vaginal birth acknowledges that from an evolutionary point of view, vaginal delivery has successfully accompanied human development and remains the natural and default form of human birth. Concern has been raised by the Montgomery court case in the United Kingdom; however, the ruling does not mean consent is required for normal birth. What it does reaffirm is the need to engage patients in their care decisions when complications occur in pregnancy and delivery. Effective communication, rather than a legalistic consent pathway, is required for positive healthcare outcomes.