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To explore and describe the verbal communication patterns in antenatal consultations between pregnant women with diabetes and their midwives.Few studies have focused on the efficacy of communication during consultations between midwives and their clients, especially in a high-risk context.An explorative and descriptive study of antenatal consultations between midwives and their clients at four antenatal diabetes clinics in Norway.Thematic analysis was used to study verbal communication in ten woman–midwife consultations that were audio recorded and transcribed. The analysis was based on the following questions: (1) who talks and to what degree? (2) What are the topics discussed and who is the initiator? and (3) What characterises the dialogue in the consultations?The results suggest that there was a predominantly medical focus in the consultations, with the communication style characterised by a combination of informal and formal talk. The consultations were structured into three phases, each with its own conversation style.The communication patterns adopted appeared to limit the opportunities of mothers-to-be to express freely any concerns. It is suggested that a larger degree of openness to the emotional and psychological aspects of pregnancy should be incorporated into the consultations. To take advantage of the different competencies in this multidisciplinary diabetes team, the contribution of the midwife to this specialised antenatal care should be both recognised and defined.Awareness of each midwife’s own communication style, as well as their attentiveness to a woman’s implicit concerns, is required for the satisfactory support and understanding of the individual pregnant woman. It is necessary to support midwives in the continuous development of their communication skills, a task that should be included as part of midwifery education and undertaken by practitioners in the clinical environment.