From the Research
Yes, a pregnant woman can leave the hospital against medical advice (AMA), but this decision may carry significant risks to both her health and her baby's wellbeing. As an adult with decision-making capacity, a pregnant woman retains her autonomy and legal right to refuse medical care or leave a healthcare facility, even when healthcare providers recommend continued hospitalization 1. However, this decision may lead to complications like preterm labor, uncontrolled bleeding, infection, or fetal distress that could go unmonitored.
Before leaving AMA, she should understand the potential consequences for both her health and her baby's wellbeing. The hospital will typically ask her to sign an AMA form documenting that she understands these risks. Even after leaving, she should maintain contact with her healthcare provider, continue any prescribed medications that are safe to take, monitor for warning signs requiring immediate attention, and consider scheduling follow-up care.
Some of the reasons that may lead a pregnant woman to leave the hospital AMA include extrinsic obstacles such as childcare, familial responsibilities, and other obligations, as well as intrinsic obstacles like disagreement with the provider regarding the medical condition or plan, emotional distress, mistrust or discontent with the care team, and substance use 1. Healthcare providers and institutions can implement strategies to ameliorate these structural barriers and partner with patients to prevent discharges AMA, which would improve maternal and infant health and progress towards reproductive justice.
It is essential to note that the term "AMA" casts blame on individual patients and fails to represent the systemic barriers to staying in care 1. Therefore, it is crucial to address these underlying issues to reduce the incidence of AMA discharges among pregnant women. By doing so, healthcare providers can promote better health outcomes for both mothers and babies.
In terms of liability protection, a properly executed AMA discharge can provide significant legal protection from liability risks 2. This includes proof that the provider's duty to the patient ended with discharge and that the patient assumed the risk of a subsequent complication. However, this should not be the primary concern when dealing with a pregnant woman who wants to leave the hospital AMA. Instead, the focus should be on ensuring that she understands the potential risks and consequences of her decision and providing her with the necessary support and resources to make an informed choice.
Ultimately, the decision to leave the hospital AMA should be made after careful consideration of the potential risks and benefits, and healthcare providers should strive to create an environment that supports patient autonomy while also promoting the best possible health outcomes for both mothers and babies.