Where good advice turns into pressure
ACOG draws this line itself, in five words at the end of a paragraph.
Advice is not the enemy. A doctor who tells you plainly what she recommends, and why, is doing her job. ACOG says so directly.
From the section headed Directive Counseling Versus Coercion: Directive counseling is defined as patient counseling in which the obstetrician-gynecologist plays an active role in the patient's decision making by offering advice, guidance, recommendations, or some combination thereof. Coercion is defined as the practice of compelling someone to do something by using force or threats. Directive counseling often is appropriate and typically is welcomed in the medical encounter because medical recommendations, when they are not coercive, do not violate but rather enhance the requirements of informed consent. However, if a patient refuses the recommended course of care, it is vitally important that physicians recognize when they cross the line that separates directive counseling from coercion. Good intentions can lead to inappropriate behavior.
That last sentence is ACOG's own summary of the whole problem. Good intentions can lead to inappropriate behavior.
On what it means to consent freely, ACOG quotes its own earlier document, since replaced by the 2021 consent opinion: Consenting freely is incompatible with being coerced or unwillingly pressured by forces beyond oneself. It involves the ability to choose among options and select a course other than what may be recommended.
The first is counselling, and you want more of it. The second is where the line sits. ACOG says the doctor should be the one who notices. In practice, you may notice first.
"Is there time for me to think about this, or is this an emergency?"