Obese pregnant women (BMI > 30kg/m²) are at increased risk of developing complications during pregnancy, labour and birth. Furthermore, their offspring are at risk of short- and long-term health complications. Midwives are ideally situated to inform women about risks and to support them in optimising their health. How midwives raise and maintain dialogue with women about this health issue is not well understood. A qualitative research study was conducted drawing on the principles of social constructionism to explore how midwives practiced and maintained dialogue with women about the risks of living with obesity. Data were analysed thematically, three themes emerged: ‘situational context of practice’, ‘constructing partnerships with women’, ‘midwife as a public health agent’. Midwives appeared to have learnt their communication skills informally, ‘on the job’ but utilised institutional questionnaires as a mechanism for opening ‘sensitive’ conversations. This approach appeared to guide appointment dialogue and risked providing woman-centred care to individuals while concurrently inhibiting development of professional autonomy. Providing educational opportunities for midwives with respect to consultation education in midwifery curricula may strengthen midwifery practice with respect to discussing sensitive topics.