What can be done to force reasonable accomodation with a doctor's note if it is not being granted?

"Reasonable Accommodation" is a concept found in the federal Americans with Disabilities Act (ADA) and its Texas counterpart.  Unfortunately, those acts apply only to permanent disabilities of which pregnancy is not one.  Said another way, your wife is not entitled to a "reasonable accommodation" due to her pregnancy.  However, that is not the end of the issue. The law does prohibit discrimination on the basis of pregnancy.  If her employer "accommodates" other employees with non-work-related temporary disabilities (broken bones, sports injuries etc.) then it cannot deny those same "accommodations" to your wife because she is pregnant.  Unfortunately the enforcement mechanism for this is a complaint to the EEOC or Texas Workforce Commission Civil Rights Division.  Your child will be born before they can resolve the matter.  Further, if she suffers no loss of pay or benefits, then the remedy for the discrimination is severely limited.   A better course of action might be for your wife to get a note from her doctor saying that she needs to be off on medical leave due to complications of the pregnancy.  Assuming your wife has been with the Company for at least a year and in that time has worked over 1250 hours, she is eligible for Family and Medical Leave Act (FMLA) leave.  The FMLA requires employers to 1) give employees up to 12 weeks of unpaid leave in connection with pregnancy-related issues and for the birth of a child; 2) continue any existing health benefits during such leave; and 3) reinstate the employee to the same or similar position upon return from such leave.  However the employee has to specifically request the Employer put her on FMLA leave and needs to have the medical documentation to support the request.    Good luck.