This paper examines interaction at a midwives’ ante-natal clinic from the perspective of both participants and illustrates how speech and silence interact to construct the experience of ante-natal care in contemporary Ireland. Using a discourse analysis approach, the perspectives of the professionals and that of the women using the service are described, as are contrasting elements of these perspectives. Silence is defined as issues left unspoken, and three main issues are identified: the active role of women in labour, the possibility of alternatives and choices within and to the current system, and women’s subjective experience of pregnancy and birth. Challenges to the status quo through attempts to introduce topics usually left unspoken are also described. Women are shown to be adept at both introducing their perspective and at attempting to introduce a plurality of voices in the discourse. As midwives conduct the tasks at hand, challenges are quickly relinquished and ultimately the status quo of contemporary antenatal care in which the medical model prevails, is left intact.