Informed Refusal — Evidence Library

What it is

Informed refusal is the other side of informed consent. You can say no, or 'not yet,' to anything: a cervical check, continuous monitoring, an induction, an epidural, a routine IV, a vaccine, a repeat cesarean. A refusal is 'informed' when the care team has explained the risks of declining and you've been able to ask questions. Refusing recommended care can carry real medical risk, and it can also be the right decision for you — both can be true.

Evidence review links

Each link opens the full review on the publisher's site in a new tab.

Possible benefits

Protects bodily autonomy — no one can perform a procedure on you without consentReview sources ↓
Forces a clearer conversation about why something is being recommended right nowReview sources ↓
Often opens up alternatives that weren't offered initially ('if not that, then what?')Review sources ↓

Possible risks

Declining recommended care can carry medical risk; ask for specifics for your situationReview sources ↓
You may be asked to sign an 'against medical advice' (AMA) form — this documents the conversation and does not waive your right to change your mind or to future careReview sources ↓
Some settings pressure or coerce; naming what's happening ('I feel pressured — can we slow down?') can helpReview sources ↓

Alternatives

'Not yet' — decline for now, revisit in an hour or after another assessmentReview sources ↓
Ask for a modified version (intermittent monitoring instead of continuous, oral vitamin K instead of IM)Review sources ↓
Ask for a second opinion or the charge midwife/OBReview sources ↓
Put your refusal in writing in your birth plan and chartReview sources ↓

Current evidence

ACOG Committee Opinion 664 states clearly that a pregnant person's decision to refuse recommended care should be respected, and that coercion, threats to call child protective services, or court-ordered interventions violate ethical principles. The AAFP and AMA hold similar positions. Refusal does not end the clinical relationship: the care team should continue to offer support, monitor, and re-offer options as the situation evolves.

Where the evidence is clear · where people may choose differently

For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.

Educational only. Your care team can help you weigh what applies to your specific situation.