In the United Kingdom the law and medical guidance is supportive of pregnant people making choices in and about childbirth. National Institute for Health and Care Excellence guidelines are explicit that a competent pregnant person’s informed request for MRCS (maternal request caesarean section) should be respected. However, in reality pregnant people are routinely denied MRCS in the United Kingdom, and this has escalated during COVID-19. In this paper I argue that there is nothing about decisions in childbirth that mean the ethical norm of respecting patents’ sufficiently autonomous choices is or ought to be displaced. Thus, the starting presumption is that all informed choices regarding MRCS should be respected. I argue that the most common justifications in the literature against MRCS are insufficient to displace the presumption in favour of autonomous choice in childbirth, and that we must do more to reduce the lottery in access to choice in childbirth in the UK.