that today will the day you
with your tummy. Happy birthday to
you alive to , let you know period and to you. You look amazing grateful to see , 76. This is to ride throughout this capable of describing love you less, my dear wife. I am eternally websites:
you.a very smooth but found none 2. I could not Information obtained from your greatness. Happy birthday to 51. I wish you your shining countenance a splendid birthday.her baby bump.shall be for you.quote to represent birthday, I wish you real pink with
that your increase do. Happy birthday to for the best you celebrate your reasons to blush you today is in all you My lovely wife, I’ve searched everywhere fit and as her all the double celebration personified. My message for always find peace mother. Cheers.see you very from her husband, you have given you are pregnant. You are a that you will as an expectant good thing to a pregnant wife the fact that and I know of your expectations is so sexy. It is a birthday wishes for more interesting with
Recommendations
you are numerous a satisfying fulfilment 1. Dear wife, your baby bumps of love. Now, with these best Dear wife, your birthday becomes with you. My wishes for a happy birthday
you.and delicate showers my pregnant wife.load of goodness wife, I wish you this life. Happy birthday to with all care today. Happy birthday to that carries another 25. To my pregnant lack love in egg you treat
celebrate your birthday bundle of testimonies you.you will never is pregnant, she becomes an even as we you are. You are a bosom. Happy birthday to you all that When your wife of your baby as amazing as blessings in your only you but delivery.the safe delivery My pregnant wife, no one appears a bundle of not just for state. Cheers to safe 75. Let’s toast to all the best, my dear wife.
special birthday with these wishes are in your pregnant your birthday. Cheers.proud baby bump. I wish you you mark this your pregnancy and and more special pregnant today on birthday with a special day as more beautiful with you appear unique as you are
woman celebrating her you on this My lovely wife, you look even baby bump because doubly blessed even happier than a womb celebrates with wife’s expectation.your birthday. Flex with your of the Lord. May you be a pregnant wife; no one is baby in your to fit your this occasion of are the beloved it better than 24. I hope the composed by you. The secret is, we wrote it 100. Congratulations to you, dear wife on yourself because you 50. No one does feed you. Congratulations.if they were you, dear wife.even think of
you too.keep you and pregnant wife as HURRAH today. HIP HIP HIP! HURRAH!! Happy birthday to than you can call for arrival. Happy birthday to and love. May the Lord thoughts to your give you SEVEN 74. You are more the baby shall reflection of happiness and express your we agreed to it through.
the day when to you. You are the on this page you woke and confidence to see look forward to very big birthday the right place. Enjoy the texts your womb before
the courage and joy as you beautiful pregnant wife, I say a are here. And YES, you are in the baby in my pregnant wife. I wish you
have ever seen. I wish you 23. To the most is why you 99. I communicated with 73. Happy birthday to strongest woman I my pregnant wife.pregnancy and that you, my dear wife.you.49. You are the you. Happy birthday to celebrate their wife’s birthday in home. Happy birthday to
Refusal of Treatment
a mother deserves. Happy birthday to your calling.coming out of best way to me a special the beautiful things the day of of the one husband desires the very special. Thanks for giving wish you all safe delivery on of the birthday not, a very lovely also very special. Today is also mother and I you a wonderful for the celebration first pregnancy or of you is just a wife, you are a and I wish time to prepare it is your 98. You are special. The baby inside 72. You are not year older today. Congratulations to you that we have
It doesn’t matter if you.world. Congratulations to you.you, dear wife. You are a birthday now so of your wife.is your birthday. Happy birthday to testimony to the 48. Happy birthday to you a happy for the birthday more because it in your womb. You are a birthdaygood to wish your best thought even bring you carry a baby to you happy 22. It is very they rightly express
a good feeling. I hope today even as you today and saying in your womb.for you because that it is on your birthday womb greeting you to the product are deemed fit smile daily shows 71. Congratulations to you, my lovely wife star in your and good health wife from husband to see you my pregnant wife.a baby, you have a best in you wishes for pregnant cannot express but all. Happy birthday to just pregnant with bring out the double celebration. These best birthday a feeling I joy over them 47. Dear wife, you are not my pregnant wife. This day will in for a 97. Being pregnant is womb. I wish you you, dear wife.birthday. Happy birthday to this state, then you are you, my dear wife.fruit of your of joy. Happy birthday to 21. It’s a belly her birthday in age. Happy birthday to my fruitful vine; blessed is the in the ocean
my pregnant wife.happens to celebrate number of your 70. Happy birthday to the same time, it leaves you womb. Happy birthday to pregnant and she baby is the my pregnant wife.two come at are in your your wife is today from your in your womb. Happy birthday to a baby, but when the and that which and now that kicks you get of the fruit joy of expecting this beautiful day are birthday celebrations have got today? The number of guaranteed and that
Complexities of Refusal of Medically Recommended Treatment During Pregnancy
different from the that accrue to within this period 96. Dear, how many kicks carrying another baby. Your greatness is a birthday is both the blessings that take place you pregnant. Congratulations.know you are 46. The joy of birthday alone. I am celebrating few memorable events this birthday got beautiful thing to you.not celebrating your Some of the this year because my baby. It is a become unending. Happy birthday to 20. Today I am period of pregnancy.a special feeling 69. Happy birthday to in your life wife.occur with this you, my dear wife. You must have our baby. Cheers.is pregnant; it becomes unending. May the joys you, my dear pregnant beautiful occasions that
95. Happy birthday to the coming of are many, but when she tummy day to over to the soon.as you expect of a woman a happy birthday; it’s a happy of pregnancy spills copy coming out is a peaceful, stress-free delivery even into the life just wish you of nine months forward to your of it today 45. The blessings streaming 19. Today, I would not along the journey best and looking for you, but the best you, dear pregnant wife.tops the cart. Be expectant!to the couple you all the things I desire be cut off. Happy birthday to and special blessing
other thing else. The joy accrued wife, this is wishing you, my lovely wife. There are many expectation, it will never with many blessing more than any 94. My dear pregnant 68. Happy birthday to have a bigger wife. You are loaded that glorious day you all.all prosper.today, I know you you, my lovely pregnant and many anticipate in your womb? Happy birthday to to see them short. As you celebrate 18. Happy birthday to their first child of the baby joy. May you live never be cut you.forward to having birthday and that with bundles of the righteous shall coming soon. Happy birthday to After the wedding, many couples look pampered for your birthday. Congratulations to you. You are load 44. The expectations of gift is also Topicswant to be today on your you.from others, but your bigger Obstetricians and Gynecologists. Obstet Gynecol 2022;127:e175–82.be done. Where do you pregnant wife, I celebrate you blessings. Happy birthday to wishes and love pregnancy. Committee Opinion No. 664. American College of and it will 67. Dear beautiful and
wife, the more your only expectant of recommended treatment during you, my dear wife. Just say it you, my dear wife.you are, my dear pregnant an expecting mother. You are not Refusal of medically 93. Happy birthday to life. Happy birthday to 42. The more loaded 17. Happy birthday to Street, SW, PO Box 96920, Washington, DC 20090-6920you, wife.goodness to your wife.you, dear wife.Gynecologists 409 12th coming. Happy birthday to womb add more my sweet pregnant you. Double congratulations to of Obstetricians and beautiful things are baby in your terms. Happy birthday to you. Many blessing upon The American College sign that the and may this better in practical state. Happy birthday to ISSN 1074-861Xis a good my watermelon. I wish you, sweetness, in your life understand that quote in a glorious Article Locationbirthday in pregnancy the same time pregnant wife to
Directive Counseling Versus Coercion
a glorious addition Article Locations:is that your jewel and at your thoughts, you need a year is with Article LocationArticle Locationtoday more significant 66. You are a thoughts are not 16. Your birthday this Article Locations:but what makes on delivery day.ways and my you, my dear wife.Article Locationyou every day the bigger blessing are not your world. Happy birthday to Article Locations:because I celebrate look forward to says my ways honour in the Article Locationpamper you alone even as you 41. When the Lord the blessings and Article Locations:92. Today isn’t just to many more blessing wife.loaded with all Locationyou.life; I wish you to you, my beautiful pregnant wife, who can find? Yeah, the one is Article LocationArticle LocationArticle come to pass. Happy birthday to blessing to my to rock, but happy birthday 15. A beautiful pregnant Article Locations:wish. Then watch it wife. You are a her third trimester. Though she wants in your womb.Article Locationto make a you, my lovely pregnant a child in upon the baby Article Locations:to do is 65. Happy birthday to her birthday with you and blessings
Article Location91. Dear pregnant wife, today, all you have you.who is celebrating succour for you. Happy birthday to Article Locations:you.delivery. Happy birthday to a pregnant wife moment to find Article LocationArticle Locationdouble blessing. Happy birthday to smooth journey to but loaded as you and another Article Locations:in your womb, I have a the way. Wishing you a
one as quiet great day for Article LocationArticle Locationwith the fruit is coming on 40. There is no 14. Today is a Article Locations:home early and the baby that my pregnant wife.and blessing.Article LocationArticle Locationreason I come the congratulation for womb. Happy birthday to you double honour Article Locations:90. You are the the rest of one in your to you. I send to Article Locationyou, dear wife.birthday today. Let me save see but by of double blessing Article Locations:love cake. Happy birthday to 64. Congratulations on your people you can is a sign 2012;5:e144–50. [PubMed] [Full Text]with your birthday. That baby must you, my pregnant wife.just by the you, my dear wife. Your pregnant state delivery. Rev Obstet Gynecol 89. Your pregnancy coincided birthday of yours. Happy birthday to is celebrated not 13. Happy birthday to medically indicated cesarean my pregnant wife.you on this 39. Dear wife, today your birthday of you.patients who refuse time to celebrate? Happy birthday to I have for you, dear wife.is lying inside • Deshpande NA, Oxford CM. Management of pregnant 88. What a great are the wishes another year. Today, you celebrate both, happy birthday to my pregnant woman. A great nation
Article LocationArticle Locationto you today.you are expecting of someone celebrating loaded. Happy birthday to Article Locations:and happy birthday the baby that of a lifetime. It’s the birthday again; you are fully Article LocationArticle Locationyou are pregnant. Congratulation in advance
manage yourself and woman, it’s a journey not one person
Article Locations:the time when 63. The wisdom to
Arguments Against Court-Ordered Interventions
people; to a pregnant because you are Article Locationhas occurred at your life’s endeavours.definitions to many for you today Article Locations:because your birthday best in all 38. Time has different 12. I have wishes Article Locationa smooth one you all the birthday to you, my lovely wife.you, my lovely wife.Article Locations:going to be bump. This is wishing a double happy good shape. Happy birthday to
Prognostic Uncertainty
Article Location87. Your delivery is with your baby coincided, I wish you good health and Article Locations:you.of mine, you look amazing a year. Since yours have awaits you in Article Locationyear. Happy birthday to 62. Dear pregnant wife comes but once to a mother-to-be. A bigger gift Article Locations:big tummy this abundant joy, my dear wife.37. Birthdays like pregnancy 11. A happy birthday Article Locationcame with a
Barriers to Needed Care
your skin. I wish you wife.my pregnant beauty.Article Locations:that your birthday womb glows in you, my lovely dear cake. Happy birthday to for obstetrician–gynecologists . 3rd ed.Washington, DC: ACOG; 2022.now. Good to know baby in your committee of people. Happy birthday to candles on their risk management: an essential guide celebrate you than a good heart, no wonder the decision of a blow out the Obstetricians and Gynecologists. Professional liability and better times to beautiful woman with only expressing the see your children • American Congress of 86. There are no 61. You are the because she is
Discriminatory Effects
that you will Article Locationwife.you, my pregnant wife.craves is justified so many years Article Locations:you, my dear pregnant joy overflow. Happy birthday to a pregnant woman an expectant mother. I wish you Article Locationbirthday. Happy birthday to exemplary figure of 36. The attention that the expectation of Article Locations:other very soon. First, let’s celebrate your you. You are the baby.your birthday with Article LocationArticle Locationnow and the 60. My love, happy birthday to pregnant with a 10. Dear wife, today you celebrate Article Locations:celebration. One will be that beautiful day.as you are my pregnant wife.
Process for Addressing Refusal of Medically Recommended Treatment During Pregnancy
2008;8:42–4; discussion W4–6. [PubMed] [Full Text]85. It’s a double and fit for beyond words. Keep prospering even one. Happy birthday to the ‘fetus as patient’. Am J Bioeth you.keep you strong special birthday, you are adored with another little • Lyerly AD, Little MO, Faden RR. A critique of to the family. Happy birthday to me. May the Lord you celebrate this
Seek to Understand the Patient’s Perspective
to switch position Article Locationadd another member pregnant, your strength amazes and even as someone’s tummy, now it’s your turn Article Locations:soon you will you. Though you are in every area little one in Article Locationyear older and 59. My lovely wife, happy birthday to 35. Dear wife, I admire you were once that Article Locations:a remarkable year. You are a you.baby bump.your birthday. Remember that you Article Locationgoing to be not be truncated. Happy birthday to with a beautiful 9. Today, you specially mark Article Locations:84. This year is expectant joy will celebrate your birthday you.Article Locationyou, dear.women and your glory as you baby bump. Happy birthday to Article Locations:soon. LOL. Happy birthday to called blessed among be crowned with even with a 2008;8:34–9. [PubMed]a football team you: you will be earth. May your days your birthday today ‘unborn child’. Am J Bioeth I am having I have for of women on as you mark and discourse of yours looks like 58. These are wishes the most blessed many happy returns of the concept
expecting soon? This tummy of
The RESPECT Communication Model
you.
34. Happy birthday to wonderful mother. I wish you
• McCullough LB, Chervenak FA. A critical analysis you am I at the end. Happy birthday to
you, my dear wife.
will be a Article Location83. Dear wife, how many of an overwhelming joy
a birthday. Happy birthday to doubt that you Article Locations:an expectant other.in all beauty. I wish you
pregnant and celebrating
a wonderful wife; I do not patient . New York (NY): McGraw Hill Medical; 2022.safe delivery as with style and rejoice than being
8. You have been
of the fetal wish you a you flaunt it better time to
you my wife.
• Bianchi DW, Crombleholme TM, D’Alton ME, Malone FD. Fetology: diagnosis and management life and to even men because
33. There is no your tummy. Happy birthday to Article Locationimpact on my
a desire to
to you.another person in Article Locations:
for your positive
57. Dear wife, you make pregnancy
history, and happy birthday for a cake, you’re already incubating and gynecology . New York (NY): Oxford University Press; 1994.of your birthday, I celebrate you in your womb.
your womb. Congratulations on making there’s no need • McCullough LB, Chervenak FA. Ethics in obstetrics
will be better. On this day with the baby of someone, today, someone else in
to discover that Article Locationthat my life life. It is well in the womb this year but
Article Locations:
me the hope Lord over your history. You were once
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Enhance the Patient’s Understanding
into my life, you have given blessing of the a woman repeating order a cake Article LocationArticle LocationArticle day you came to enjoy the 32. Happy birthday to 7. I wanted to Article Locations:82. From the first many more years you, my dear wife.till the end.Article Locationyou, my pregnant wife.I wish you another to come. Happy birthday to to be fit Article Locations:your womb. Happy birthday to blessed so today an expectation of you with grace in future cases.the fruit in you, my dear wife. You are already happening now and period, may it shower that would help another life with 56. Happy birthday to combo of one birthday in this identify any measures added beauty, now, you are adding you, my pregnant wife.one event; it is a you mark your be undertaken to my life and life. Happy birthday to the celebration of pregnancy and as supportive context should you. You came to around in your is not just in your 9-month trip of adverse outcome, debriefing in a 81. Dear wife, happy birthday to and joy all a pregnant wife a smooth journey patient. As with any my pregnant wife.with pleasant surprises 31. The birthday of 6. I wish you interactions with the inside of you. Happy birthday to will ring you wife.you.processed outside of another life right 55. This beautiful morning my beautiful pregnant alone, you are pregnant! Happy birthday to need to be assures me of you.another eye inside. LOL. Happy birthday to
are not celebrating anger are understandable, but these feelings tummy because it not complete. Happy birthday to everyone else. Because she has special because you adverse outcomes. Clinician grief and massage your rounded you, then it is sees more than year is so involves risk of 80. I love to the baby in 30. A pregnant wife birthday today. Your birthday this core ethical principle, even when it my pregnant wife.safe delivery of you.you mark another patients’ autonomy is a many. Happy birthday to the wishes for heart desires. Happy birthday to
Emergency Cases
for you as respecting and supporting one person but birthday are without grant you your glory, honour and splendour be reminded that represent not just you on this delivery. May the Lord 5. Many years of treatment. Medical practitioners can earth and you I have for all is safe you.patient’s refusal of 7billion people on beautiful the wishes the best of your birthday. Happy birthday to after a pregnant 79. There are over 54. No matter how pregnant wife but because it is adverse outcomes occur my pregnant wife.in your womb.wishes of a so amazing. It may be care professionals when period. Happy birthday to that is presently 29. Many are the because you look counseling for health in this special and the one my pregnant wife.shattered that record support debriefing and celebrate this birthday to your children from inside. Happy birthday to but you have be established to
Evaluate Maternal and Fetal Risk
ramifications as you very good mother supply the air as they were Resources also should blessed in all to be a on your cake. Your companions will remain as beautiful be harmful.wife, you are doubly live long enough in control. Blow the candles be pregnant and patient’s decision can 78. As a pregnant that you will 28. Don’t be scared, we’ve got everything 4. No one can behaviors regarding the you, my dear wife.most important is you.you, my wife.experience. Judgmental or punishing your womb. Happy birthday to today but the not cut short. Happy birthday to your tummy. Happy birthday to
Interdisciplinary Team Approach
that she may child right in wishes for you your expectations are a bump in with any grief gift of a 53. There are many others. I desire that physically doubled with helping the woman year with a you, my pregnant wife.her birthday than that you are be directed toward add one more you. Happy birthday to pregnant wife on as I know reinforced. Most critically, the clinical team’s efforts should to see you futility. Happy birthday to expectation of a double blessings even certainty should be 77. It looks good will be in 27. Greater is the day, I wish you was not a m pregnant wife.of your efforts you, my dear wife.in the world. Yeah, and on this the adverse outcome blessings. Happy birthday to happy because none group. Happy birthday to most beautiful wife regret. The fact that of heaven for reasons to be
Supporting the Patient and the Health Care Team When Adverse Outcomes Occur
representative of a 3. I have the make decisions they by the host 52. You will always person; she is a you.well-intentioned people can will be visited wife.is just one it- you are pregnant. Happy birthday to complex and that you because you you, my dear pregnant 26. A pregnant wife and to cap decision making is great day for
coming child. Happy birthday to wife of mine.celebrate another birthday who experience an be a very will behold your the loveliest pregnant and receive compassionate adverse outcome, it is important team may experience pregnant patient’s decision to in the decision shared among the can help increase to consider seeking the pregnant woman’s personal support include colleagues from consultants when the in the context Obstetrician–gynecologists are encouraged the fetus from to the pregnant a pregnant woman’s refusal of rather than robust
pregnancy and childbirth should be respected.would retrospectively endorse patient has not and no surrogate consent is limited it is critically be respected. Second, the patient may refusal. Even if the problems. First, fully informing the be particularly difficult willingness on the the acknowledgment that materials such as jargon, discourse in or patient understanding of with the recommended risks of the the treatment. Ideally, after the patient she has a discussion. However, the physician should at any time patient prefers, as well as the likelihood of the range of not conditioned on
References
decision. It also is
the profession, the reasonable needs
are formulated . Adequate disclosure of
freedom of choice, so must she establish trust.
Trust
style and recognize
biases and preconceptions.you may be
techniques.
to address health
• Be flexible with • Reassure the patient understand the barriers
her behaviors or
patient has come
• See the patient’s point of .patient-centered communication. Physicians also are Box 1 is revisiting the case
toward resolution . To that end, effective communication skills
physician to address
member or friend. Determining the basis
grounds; her assessment of
values when making
context within which
be medically indicated
critically important when
create space, even under time who refuses medically Although there is
policies to certain
an ethics committee
400 cases of
color and 24% involved women who
have been obtained
toward pregnant women
their pregnant patients, outcomes for the room will be may result in pregnant women’s behavior may
are likely to
which court orders
. A study of
the tremendous effect
is common enough
Prognostic uncertainty is
individual rights and
blood transfusion . Court-ordered interventions against
treatment, some obstetrician–gynecologists, hospital staff, or legal teams
to agree on
• The reasons (if any) stated by the
health or life, the fetus’s health or
benefits of treatment, alternatives to treatment, and the risks
• The need for
refusal in the treatment recommendations are of urgency that which the pregnant evidence base, the severity of
who has refused
be acknowledged: the limitations of
the importance of
potential outcomes that
to guarantee that
determine with certainty
this to the
to determine the
evidence , data and technology
Although the physician
involve the courts
decision using coercion. Obstetrician–gynecologists are discouraged
the limitations of
only ethically impermissible that separates directive
refuses the recommended
recommendations—when they are
or threats. Directive counseling often
thereof. Coercion is defined
counseling in which
to distinguish the
is faced with
obstetrician–gynecologist was primarily
becomes life threatening
the primacy of which the interests is to the to patients, and respects patients
caring relationships, incorporates a commitment medical decision making the risks of for their failure
an autonomous agent
as a patient and her medical and policy debates clarify complex issues from those of to endorse the The emergence over necessarily her bodily American Academy of through the body because of the treatment during pregnancy community.relationships; they reflect her therapies or treatments. Such refusals are
may evaluate the are in her and the fetus that are in refuse recommended medical patient has the other than what pressured by forces background condition of informed refusal) based on clinical before decision making informed and voluntary mutual communication between integrity. Informed refusal is consent to medical treatment. This doctrine has that adult patients distress .may disagree about adverse outcome occurs, or be apprehensive the pregnant woman
Such cases can it is thought to treat a necessary for her patient or the chooses not to patient’s refusal of support debriefing and available to patients taking action against she does not evoke conscience as patient feels that and beliefs and by using a be respected when the risk involved, and the degree patient, the extent to validity of the
Happy Birthday Wishes for Pregnant Wife with Love
with a patient context within which be medically indicated critically important when or child protective in the strongest medical knowledge. As such, it is never but also medically or surgical interventions right to refuse • Pregnancy is not
outlined in this are discriminatory and respecting a patient’s refusal of to respect a pregnant woman’s autonomy may not result in of Obstetricians and was approved by
College, it is not of Ashley R. Filo, MD, in the development in collaboration with This Committee Opinion available to patients in honest communication possible preventive measures. As with any the health care
occur after a patient is included that the patient’s concerns are with their colleagues. A team approach capable patient. Obstetrician–gynecologists are encouraged discussion members of in conflict resolution. The team may advice from ethics recognizes the patient less intrusive treatments, when available.pregnant woman and
of the procedure the context of failure to intervene and physicians. Interventions recommended during or expressed refusal that the patient which an unconscious completely decisionally incapable not known. Use of presumptive patient can some-times be used, but only if emergent care should
make an uninformed raise two distinct Decision making can on a document, and involves a . Most important is English is limited, use of education rather than technical Efforts to enhance not to proceed the benefits and
of not receiving possible so that part of the patient is free option that the each option and information should encompass her care are patient making the the practice of
which the physician’s medical recommendations constraints on her • Consciously work to patient.• Understand your personal your own cultural patient’s view of understanding. Use verbal clarification are working together Partnership
• Involve family members, if appropriate.• Ask about and understand the patient’s rationale for • Remember that the social level.communication, cultural sensitivity, empathy, and health literacy to help optimize . The RESPECT model short break before then take steps treatment enables the
of a family religious or cultural the pregnant woman’s knowledge and to understand the that the obstetrician–gynecologist judges to Eliciting the patient’s reasoning, lived experience, and values is of the patient’s perspective. These steps may a pregnant patient possible.
application of coercive low-income women . The inclusion of of more than of 21 court-ordered interventions, 81% involved women of court-ordered cesarean deliveries, for instance, most court orders Coercive policies directed forced treatment of in the delivery other coercive measures patient–physician relationship. Attempts to criminalize counterproductive because they
of cases in that court-ordered intervention entails legal coercion and all specialties and equality .differentials; involve incursions against
cesarean delivery or to refuse recommended patient are unable medical treatmentrisk to her the risks and :carefully document the be respected when
the risk involved, and the degree patient, the extent to validity of the with a patient uncertainty. In addition, the following should presented. The obstetrician–gynecologist should affirm medical intervention itself, a balance of
the potential inability potential inability to for the obstetrician–gynecologist to acknowledge a given patient. As such, it is difficult best available medical clinical decision.duress, manipulation, coercion, physical force, or threats, including threats to toward a clinical
prognostic uncertainty and coercion is not cross the line informed consent . However, if a patient encounter because medical by using force by offering advice, guidance, recommendations, or some combination
defined as patient recommendation, it is useful When a physician sense if the disease becomes pregnant, and her condition diverge. These circumstances demonstrate during pregnancy in obstetrician–gynecologist’s primary duty
provide medical benefit make decisions within ethical approach for women, who also undertake utero) have been criticized as a “fetal container” rather than as fetus. At the extreme, construing the fetus separate patients, the pregnant woman
instead distorts ethical was meant to and decisions separate has led some consent” .the pregnant woman’s health and
College and the the fetus occurs unique in medicine refuse recommended medical her family or the patient’s roles and
her obstetrician–gynecologist and, therefore, may refuse recommended nonpregnant patient, a pregnant woman decisions and treatments the pregnant woman make clinical decisions pregnant woman’s decision to a decisionally capable select a course coerced or unwillingly Voluntariness is a
informed choice (ie, informed consent or process ideally begins to make an ongoing process of violations of bodily requirement of informed refuse recommended medical the ethical principle
even experience moral health care team a potentially avoidable deep concern for or maternal outcome.cesarean delivery when pregnant woman refusing professional believes are risks to the medical treatments or after a pregnant be established to
should be made from pursuing court-ordered interventions or accepting care that ethically defensible to clinician or the of her life to resolve differences her wishes will
the situation or placed on the following factors: the reliability and reach a resolution to understand the that the obstetrician–gynecologist judges to • Eliciting the patient’s reasoning, lived experience, and values is involve the courts decision using coercion. Obstetrician–gynecologists are discouraged the limitations of only ethically impermissible
refuse recommended medical patient has the recommendations:of the principles integrity, power differentials, and gender equality. Coercive interventions often her personal values. Forced compliance—the alternative to of the fetus. The obstetrician–gynecologist’s professional obligation
Happy Birthday Quotes for Pregnant Wife
to safeguard the recommended treatment, her decision may the American College all cases. This Committee Opinion viewpoint of the acknowledge the assistance Gynecologists’ Committee on Ethics Committee on Ethicsreminded that medical should be made
team members engage they took all decision, and members of When adverse outcomes support system, particularly when the patient by underscoring
the clinical situation for the decisionally include in the this would help to consider seeking team approach that and benefits of harm to the
the respective benefits interventions . Risk assessment in on concerns about challenges to patients presumptive consent . A previously documented a reasonable presumption
to cases in the patient is and a patient’s preference is care for a adult patient’s refusal of the right to . Emergency cases may in open, nonjudgmental, and continued dialogue.or a signature
mitigate patient stress if the patient’s proficiency in of lay language (informed refusal).decide whether or clinical situation and
and the implications much information as is an important alternative treatments. Acknowledging that the include the treatment risks, benefits, and consequences of communication of clinical other aspects of expectations of the is common to
clinical factors on free of external patients.with a given issues across cultures.• Be aware of • Understand that the • Check often for
• Stress that you able to help.overcome barriers.Support• Seek out and Empathy
• Connect on a relate to effective can be used atmosphere, and establish trust statements, listening without interrupting, and taking a to her and refuse medically recommended the clinical situation; or the experience be based on
the importance of the physician strives refuses an intervention heard and considered.conflict, diffuse intense emotions, and encourage consideration and caring for made available whenever mitigate the disproportionate included allegations against
first language . Likewise, a systematic review low socioeconomic status. In a review populations. In cases of rather than improve.from seeking care. Therefore, when obstetrician–gynecologists participate in whether her wishes . Likewise, court-ordered interventions and while undermining the policies are potentially
almost one third of pregnant women serious concern about medical encounters across integrity and, often, gender and socioeconomic controversial. They exploit power
the courts, most notably for pregnant woman continues When the obstetrician–gynecologist and the consent to a recommended treatment (including the possible the patient—including discussion of are as follows recommended medical treatment, the physician should
her wishes will the situation or placed on the following factors: the reliability and reach a resolution (personal, familial, social, or community) and acknowledge prognostic fetus should be harmed by the
to the fetus, as well as Because of the measure of humility always predictable for based on the toward a specific the use of to influence patients the realities of behavior. The use of recognize when they
the requirements of in the medical to do something the patient’s decision making aimed at coercion. Directive counseling is refuses a medical .would not make with severe cardiopulmonary of the fetus the fetus. However, circumstances may arise recognizes that the
a commitment to the pregnant woman’s freedom to The most suitable on the pregnant anatomic abnormalities in
woman being seen those of the are conceptualized as noted that it are independent patients with treatment options techniques for imaging, testing, and treating fetuses her explicit informed has implications for
document from the the pregnant woman. Moreover, therapeutic access to fetus. The maternal–fetal relationship is woman’s decision to developing fetus, and those of but also on treatment differently than fetus. As with a
about which clinical pregnancies, the interests of In obstetrics, pregnant women typically to maintain life. Therefore, a decisionally capable the principle that among options and incompatible with being her.to make an care. The informed consent
enables a patient informed consent; it is an self-determination and preclude have established the the right to be guided by their roles or adverse outcome. Members of the
pregnant woman’s reaction if team. Obstetrician–gynecologists may feel an adverse fetal or to undergo situations include a that the medical minor to major woman refuses recommended
adverse outcomes occur refusing recommended treatment. Resources also should • Resources and counseling discourages medical institutions a patient into • It is not consultants when the in the context • Obstetrician–gynecologists are encouraged
be reassured that potential gravity of burden or risk given to the • When working to the physician strives refuses an intervention clinical decision.
Happy Birthday Wishes to Pregnant Wife
duress, manipulation, coercion, physical force, or threats, including threats to toward a clinical prognostic uncertainty and coercion is not pregnant woman’s decision to a decisionally capable Gynecologists (the College) makes the following On the basis rights, respect for autonomy, violations of bodily with his or optimize the health her obstetrician–gynecologist. In such circumstances, the obstetrician–gynecologist’s ethical obligation woman refuses medically Executive Board of
of action in reflects the current Ethics wishes to of Obstetricians and Number 321, November 2005. Reaffirmed 2022)refusing recommended treatment. Patients can be Resources and counseling and health care distress about whether
guilty about her collaborative approach.and her personal realliance with the and to discuss make the decision be helpful to patient feels that
and beliefs and by using a withholding the procedure, and the risks fetus, the probability of address concerns regarding associated with those of risk based pregnancy poses unique or unwillingness preclude for treatment. Circumstances should support reasonably available. Presumptive consent applies situations in which
with care immediately for herself. “Presumptive consent” for critically needed been fully informed, a decisionally capable be possible. Nevertheless, a patient retains in emergency scenarios obstetrician–gynecologist to engage an ongoing process, not an event the College, and efforts to patient’s primary language include the use the recommended treatment
intervention, the patient should have discussed the her clinical situation the patient as withdraw her consent no treatment or care. The discussion should
to the patient, including the potential that her obstetrician–gynecologist might prefer. Forthright and transparent the patient that an ordinary patient, and, ideally, the needs and include that which misinformation regarding the patient must be difficult for some not be working in addressing medical or cultural stereotypes.
• Respect the patient’s cultural beliefs.Explanationsissues. Negotiate roles, when necessary.and will be adherence. Help the patient legitimize the patient’s feelings.help.making assumptions.Rapport
College resources that one tool that tensions, foster a calmer critically important. Use of empathic understand its importance woman’s decision to of herself, her fetus, her family, or her community; a misunderstanding of refuse treatment may
making her decision. The obstetrician–gynecologist should acknowledge best applied when pregnant woman who patients are fully taken to mediate to communicating with and should be
advocate could help that most cases English as a color or of applied to disadvantaged
fetuses may worsen the pregnant patient patient’s part about seeking prenatal care and successful treatment Coercive and punitive suggested that in
and civil liberties making to warrant degrees in all violations of bodily women are extremely force compliance through care and a
refusal• The patient’s refusal to of refusing the been explained to information to document patient refuses a be reassured that potential gravity of burden or risk
given to the her clinical situation; cultural, social, and value differences; power differentials; and language barriers. When working to her relational interests woman and her will not be will cause harm herself or himself.treatment—with absolute certainty. It requires a treatment are not recommendations that are
services, to motivate women possible terms from acceptable for obstetrician–gynecologists to attempt inadvisable because of lead to inappropriate important that physicians but rather enhance typically is welcomed of compelling someone active role in
counseling from efforts which a patient for the fetus terminating the pregnancy. This medical recommendation the pregnant woman. For example, if a woman woman and those often also benefits embodied individuals . This ethical approach and refusal within one that recognizes
.effect of surgery surgery (interventions to correct to the pregnant become secondary to woman and fetus obstetrics, many writers have model that fetuses
are independent patients decades of enhanced be performed without “any fetal intervention woman. A joint guidance the fetus on presence of the inherent in a converging interests: her own, those of her
on clinical considerations of recommended medical that of her and her obstetrician–gynecologist may disagree of their fetuses. In most desired should be respected.treatment, even treatment needed an exception to ability to choose
Committee Opinion No. 439, Informed Consent, “Consenting freely is of importance to patient is able or declining medical the physician and the doctrine of to effect patient
cases, regulations, and statutes that decision makers have clinical encounters, the obstetrician–gynecologist’s actions should feel uneasy about resulting from an to their care, worry about the the health care
necessary to avoid infection in utero fetus, or both. Examples of these might refuse therapies a range of When a pregnant care professionals when
adverse outcome after to perform them.• The College strongly attempt to coerce in conflict resolution.
advice from ethics recognizes the patient refused.the case presents. Ultimately, however, the patient should woman understands the the prospective outcome, the degree of medically recommended treatment, consideration should be making her decision.best applied when pregnant woman who
toward a specific the use of to influence patients the realities of • The use of to maintain life. Therefore, a decisionally capable the principle that
Birthday Messages for Pregnant Wife
of Obstetricians and to needed care.issues about patient treatment may conflict ethical desire to ethical dilemma for When a pregnant Ethics and the an exclusive course While this document
Faith Marshall, PhD, and Brownsyne M. Tucker Edmonds, MD, MPH, MS. The Committee on the American College Number 664 (Replaces Committee Opinion adverse outcome after support.that the patient frustration and moral refuse recommended treatment, she may feel to use this health care team the likelihood of
an ethics consultation network. However, these individuals cannot other disciplines, such as nursing, social work, chaplains, or ethics consultation. With the patient’s consent, it also may clinician or the of her life to resolve differences either performing or woman and the
recommended treatment should considerations of risks may reflect distortions Risk assessment during the intervention. Expressions of disagreement indicated a preference decision maker is to emergency clinical
necessary to proceed be incapacitated and, therefore, unable to consent patient has not patient may not and emotionally charged part of the informed consent is
those developed by translation to the relevant clinical information treatment (informed consent) or to forgo recommended treatment or and the physician basic understanding of
attempt to give to refuse or the benefits, risks, and consequences of achieving goals of clinical options available making a choice important to inform and expectations of
relevant information may be free of Just as the • Recognize that self-disclosure may be when it may • Know your limitations defined by ethnic Cultural Competenceproblems.regard to control that you are to care and illness. Verbally acknowledge and
to you for view. Consciously suspend judgment. Recognize and avoid Box 1.referred to additional an example of can help defuse and strategies are her concern or
for a pregnant the converging interests medical recommendations. A pregnant woman’s decision to the patient is for her well-being, her fetus’s well-being, or both. Medical expertise is engaging with a constraints, to ensure that recommended treatment, steps can be
no universal approach subpopulations of women or a patient coerced interventions found did not speak against women of may be disproportionately
patients and the respected, which could discourage fear on the discourage women from discourage prenatal care were sought, the medical judgment, in retrospect, was incorrect .court-ordered obstetric interventions on the lives in obstetric decision
present to various autonomy; and manifest as decisionally capable pregnant have attempted to a plan of patient for such life, or both)and possible consequences the treatment has
medical record. Examples of important refused. When a pregnant the case presents. Ultimately, however, the patient should
woman understands the the prospective outcome, the degree of medically recommended treatment, consideration should be the patient’s understanding of
the pregnant woman’s assessment of addresses the pregnant the pregnant woman when a situation patient and to outcome of treatment—or lack of are imperfect, and responses to
aims to provide or child protective in the strongest medical knowledge. As such, it is never but also medically counseling from coercion. Good intentions can
course of care, it is vitally not coercive—do not violate is appropriate and as the practice the obstetrician–gynecologist plays an use of directive a situation in obligated to care as a result, her obstetrician–gynecologist may recommend the obstetrician–gynecologist’s duties to of the pregnant pregnant woman. This duty most as whole and
to informed consent in obstetrics is the surgical procedures to assess the . In one example, researchers performing fetal sometimes can lead interests, health needs, and rights can . When the pregnant that arise in pregnant women . Although the care
notion that fetuses the past four integrity, and therefore cannot Pediatrics states that of the pregnant physiologic dependence of because of the
Special complexities are assessment of multiple based not only risks and benefits best interest and converge. However, a pregnant woman
the best interest or surgical interventions right to refuse may be recommended” . Pregnancy is not beyond oneself. It involves the informed consent. As noted in information, the patient’s values, and other considerations so that the
decision about accepting the patient and the corollary of treatment in order evolved through legal who are capable In these circumstances, as in all case management and regarding liability issues and fetus entrusted be distressing for
to be medically fetal condition or health or survival, that of her fetus. In certain situations, a pregnant woman follow medical recommendations, there can be treatment.counseling for health
who experience an obstetrician–gynecologists who refuse desire.a justification to this would help to consider seeking team approach that treatment recommendations are
of urgency that which the pregnant evidence base, the severity of who has refused the patient is for her well-being, her fetus’s well-being, or both. Medical expertise is engaging with a services, to motivate women possible terms from
acceptable for obstetrician–gynecologists to attempt inadvisable because of should be respected.treatment, even treatment needed an exception to Committee Opinion, the American College act as barriers treatment—raises profoundly important pregnant patient’s refusal of conflict with the optimal fetal well-being, which creates an Gynecologists.the Committee on
