Conflicts between patients and physicians are a relatively recent phenomenon, a consequence of the rise to power of patient autonomy as the reigning principle in the physician-patient relationship. Nowhere is this conflict between patient autonomy and physician paternalism more poignantly portrayed than in the arena of consumer-driven obstetrical care. Here patients present with detailed lists of expectations and demands that not uncommonly limit a physician’s judgment and bind their ability to affect a safe delivery. Here, also, the physician is uniquely confronted with the need to address and balance the interests of two separate patients simultaneously – one consenting, and one unable to consent. This paper explores the issues of patient autonomy, the neglected element of physician autonomy, the insufficiency of informed consent, and the dilemma of balancing a third set of interests. It ultimately argues for a justified limited paternalism that respects the dynamic nature of patient autonomy, recognizes physician autonomy and responsibility, and seeks to balance both while providing for the safety of the unborn child.