If she desires something other than what her hcp offers, she either should change her stance or she should go elsewhere. If there's no where else to go, then she should either conform to the hcp's recommendations or she has the right to choose to go without care. I completely support firing patients for going against important recommendations. For example, I know of patients who have been fired from their hcp's for refusing the rhogam shot. Absolutely. I absolutely support that. And that's not the hcp's fault if the woman ends up without care. That's the woman's fault because she didn't accept the shot. I know of kids who have been fired from pediatric practices for not getting shots. I completely support that as well. What I provide is a service. It's my license. I control what I provide. If you want something that I don't provide, you do not have the right to force me to provide it (unless you are covered by EMTALA). I also have agency.
Taking a chance and jumping in here. I have read the whole thread and been following along. Something you said, Holly, stuck out at me. I agree that you have the right to make decisions about how you practice, but what happens if a woman desires something other than what you have to offer? What if she goes into the community and finds that there are no options for hcps who will "allow" her to do what she believes to be best for her and her baby? There are areas in which, even though something is "evidence-based", or even more dubious, the "standard of care", the alternative choice is still a reasonable one. If a woman cannot find a hcp who will provide care, then she either has to consent to something she doesn't really want (not exactly "informed consent" if the alternative is to be dropped from care, right?) or take a chance with a type of hcp that might not be optimal for her situation but will respect her ability to make her own choices.
For example, in many parts of this country, there are vbac bans in all hospitals within a reasonable driving distance (I'm talking within, say, an hour). So what is a woman to do in that circumstance? Either she consents to surgery that she may not feel is the best and safest choice for her and her baby or she hires someone that you might consider to be inadequate to provide care for her. Another example would be antibiotics for GBS, frank breech presentation, induction at x weeks, the list goes on. The issue becomes that when most or all of the available providers in an area make a decision about what they will do, it directly impacts what choices are available to the women in that area.
There are benefits and risks and the only person who should get to say what course of action is appropriate is the patient, with full information. What you as a health care provider would consider the optimal choice for you, in your evaluation of the risks and benefits, may not be what your patient believes is the right choice for her. All testing and interventions come with both benefits and risks and a health care provider should be able allowed to dictate the course of care for the patient, even if the hcp truly believes that what the mother is choosing is detrimental to herself or her child. That's not their job. If you, as a midwife, do not offer space for women to make their own decisions, then they will find someone who will support them, and the person who will do so may not be the best choice for their situation. And the responsibility for that will be partly on you.