NHS trusts are required to demonstrate the actions they are taking to reduce the risks for obese pregnant women. To this end, health professionals often use the body mass index to identify women at risk. While the aim of risk management is to increase safety, taking an ‘absolute risk’ approach of considering risk in terms of what can go wrong is arguably narrow and does not take into consideration individual factors. This article considers an alternative approach to risk management in maternity services—‘tolerable risk’ management in which midwives can help to successfully address the issue of maternal obesity through a partnership approach based on women's individual needs.