Obstet Gynecol
ACOG debuts guidance on pregnancy options counseling
Clinical Takeaway: Ob-gyns in every practice setting should be prepared to counsel on all pregnancy management options, refer when a desired service is unavailable, and avoid letting personal views or state restrictions narrow the conversation itself.
The American College of Obstetricians & Gynecologists' latest committee statement sets a uniform ethical framework for pregnancy options counseling, anchored in shared decision-making, patient autonomy, and unbiased information, that applies regardless of what care a clinician can actually provide.
Counseling should be ready to cover prenatal care, abortion, and gestating with or without plans to parent, along with the risks of each option, fetal status when known, and access to resources that may be limited by geography, insurance, or finances.
Clinicians should use nonjudgmental language and open-ended questions, avoid directive statements, and respect informed decisions even when they conflict with the clinician's views. Withholding information of clear medical benefit, such as abortion care for previable premature rupture of membranes, is described as unethical.
Patient preferences shape how much of each option is discussed. If a patient has expressed clear understanding and a firm decision, it is not person-centered to keep raising other options at every visit unless something material changes. Ambivalence is also a valid outcome.
The duty to counsel does not change when a clinician cannot provide some of the options. Specific recommendations for ob-gyns practicing under legal or institutional limits:
- Be prepared to counsel on all pregnancy options regardless of what is available in the practice setting, and refer when a desired service falls outside that scope.
- Know the specific restrictions and confidentiality limits in the state and communicate them to patients up front, since stigma and criminalization concerns can otherwise foreclose honest discussion.
- Do not let personal beliefs obstruct standard of care; transfer of care to access unavailable therapy or diagnostics is appropriate when needed.
- Involve ethics consults, maternal-fetal medicine specialists, and risk management for complex cases or unclear ethical territory.
ACOG acknowledges that clinicians constrained by local laws or institutional policies may experience moral injury, and recommends peer support along with institutional attention to the structural causes.
"Person-centered pregnancy options counseling is fundamental obstetric care," said Yasaswi Kislovskiy, MD, MSc, FACOG, a lead author. "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."
Source: American College of Obstetricians & Gynecologists. Obstet Gynecol. 2026 Apr 30. Person-Centered Pregnancy Options Counseling. Committee Statement No. 29