ACOG Releases New Guidance on Pregnancy Options Counseling

Washington, D.C.-The American College of Obstetricians & Gynecologists (ACOG) has released new guidance for ob-gyns on how to provide patients with ethically sound, person-centered pregnancy options counseling in a challenging and ever-changing reproductive care landscape.

In the latest committee statement, ACOG defines pregnancy options counseling as "a person-centered process providing information regarding management options in continuing a pregnancy or not and seeks to understand a patient's values, beliefs, preferences, concerns, and/or ambivalence regarding pregnancy."

"Person-centered pregnancy options counseling is fundamental obstetric care," said Yasaswi Kislovskiy, MD, MSc, FACOG, a lead author of the committee statement. "Many clinicians are providing this care already, but multiple obstacles to reproductive autonomy are constraining how it is provided, including state legal restrictions, limited access to reproductive health options, and institutional policies or limitations. This guidance underscores that ethical, person-centered pregnancy options counseling centers patient autonomy and supports clinicians everywhere."

Ideally, ob-gyns should have the unrestricted ability to discuss all options for reproductive health care, including information about prenatal medical care, abortion, and gestating with or without plans to parent. Counseling should also address the risks associated with continuing or terminating the pregnancy; fetal status to the extent possible; and access to needed resources or resources that may be limited by factors such as geography, insurance coverage, or finances.

"A shared decision-making model should be used when exploring a patient's desire to be pregnant or not or to parent or not," said Mara Black, MD, FACOG, a coauthor of the guidance. "It's important that ob-gyns avoid making assumptions about how a patient may feel about their pregnancy and avoid directive statements about what they should or shouldn't do. In some cases, a patient may be ambivalent or undecided on how they want to move forward, and that is reasonable. However, when a patient does express an informed decision after receiving counseling, it is our job as ob-gyns to respect it and help plan for the appropriate provision of care."

ACOG's guidance states that the clinician should not allow their beliefs or medical opinion to unduly influence counseling, even when a patient's informed decision is not in line with them. For example, the clinician should not withhold information that would have clear medical benefit or obstruct standards of care. If necessary, clinicians should bring in specialists for a patient who wishes to continue a high-risk pregnancy or make a referral in situations where they are unable or unwilling to provide certain types of care, such as abortion care. Pregnancy options counseling should always be accurate and unbiased regardless of a clinician's perception of a patient's circumstance or resources.

Some patients may unintentionally present at facilities that are not aligned with their reproductive desires. As examples, a patient may visit a so-called "crisis pregnancy center" due to misleading marketing, or they may visit a facility where the desired service is not possible due to the practice setting's capabilities. Regardless of practice setting, clinicians still have an ethical responsibility to discuss all pregnancy options, even those that exist outside of the facility, and should be prepared to refer patients when necessary.

"There are several factors that can make a patient vulnerable within the context of pregnancy, including limited local resources, mental health disorders, disability, lack of transportation access, lack of financial resources, substance use, incarceration, and local laws," said Dr. Kislovskiy. "It's important for ob-gyns to examine the way their own biases may potentially contribute to systemic inequities in care and work to eliminate those biases. Pregnancy options counseling should never be counterproductive to building trust in the doctor-patient relationship, especially among populations that have already experienced injustices."

Committee Statement 29: "Person-Centered Pregnancy Options Counseling" is available now.