10/12/2026
ASK THE MIDWIVES - Informed Decision Making
What happens if I decline something my midwife recommends?
As we frequently say to our clients, YOU ARE THE CAPTAIN OF YOUR SHIP!
Informed choice is foundational in our practice, but that doesn’t mean your midwife never has an opinion. We do. We have recommendations, and sometimes we feel pretty strongly about them. Our responsibility is to explain what we recommend and why, talk through benefits and risks, answer your questions honestly, and make sure you understand what choosing or declining something may mean for your care. Your responsibility is to take that information, weigh it alongside your own values and circumstances, and make the decision that’s right for you. Good midwifery care leaves room for both a midwife who’s willing to give honest guidance and a client who remains the ultimate decision maker.
Anatomy ultrasound is a good example of how this works in our practice. We do recommend it. But I also understand why some families have questions about ultrasound, because once upon a time, I might have been the client declining it myself. That history matters, because part of being a good midwife is recognizing my own experiences and biases before I start counseling someone else. My job isn’t to dismiss a client’s concerns or convince them that my way is the only reasonable choice. It’s to understand what’s behind their decision, make sure they have accurate information, and help them weigh what we know against what matters to them. Sometimes informed consent starts with the midwife doing that self-check first.
When we recommend an anatomy ultrasound, it isn’t because we believe every pregnancy needs as much testing and intervention as possible. In fact, sometimes a little information helps us avoid bigger interventions later. An anatomy scan can show placental location, pick up on things about fetal development, or flag a situation where the safest birth setting might be different. I’ve cared for families who learned about a significant condition only after their baby was born, and I’ve seen how hard it can be to make major decisions in the middle of that kind of surprise. Knowing ahead of time doesn’t always change an outcome, but it can give you time to learn, ask questions, and make a thoughtful plan instead of having all of that thrust upon you.
If after that conversation you decide to decline the anatomy scan, we will respect that decision. We’ll document the conversation and your informed decline, and we’ll keep taking care of you. We’ll also make sure you know that if you change your mind later, we can revisit that. At the same time, part of honoring informed choice is being honest that declining something can change how we navigate certain situations later. For example, if we don’t know placental location and something unusual happens in labor, my threshold for recommending additional evaluation may be lower. Respecting your autonomy doesn’t mean pretending your choices have no clinical implications. It means we stay in relationship, tell you the truth as we see it, and keep caring for you respectfully.
Ultimately, we don’t believe consent is meaningful unless declining is truly an option. We want questions, we want to hear your hesitations, and we want you to take the time you need to decide. Sometimes you’ll choose exactly what we recommend, and sometimes you won’t. We may revisit a conversation if circumstances change, and we’ll always tell you when we have a serious concern. But disagreement doesn’t automatically mean the relationship has failed. Some of the strongest relationships we’ve seen are with clients who felt safe enough to say, “I’m not sure,” or even “no,” and who knew we would still show up with care and respect.
The midwife who trained me always said, “You made this baby together, you will birth this baby together, and you will raise this baby together… only you can decide what the right decision is for your family.”
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