Adapted from: Perrucci A. Options Counseling 2012.
When providing pregnancy test results, some patients will be surprised while others will have taken a test at home and only seek confirmation. In either case, the patient may or may not require support in their decision-making process. Our role is to listen and provide them with the appropriate level of support to come to a decision about this pregnancy, if they have not already (Singer 2004). When providing positive results:
- Be explicit: “Your pregnancy test came back positive, which means you are pregnant.”
- Allow some time for the patient to process the information.
- Use open-ended questions to start, such as “How do you feel about this result?”
- Avoid assuming how a patient will react to the result.
For many patients the decision to have an abortion is clear. They won’t need options counseling; we can help them with planning the next steps. Gauging this is important to respecting their decision. Similarly, avoid making assumptions about what emotions the patient may be experiencing or the reasons behind them. For example, avoid assuming abortion itself will be a sad experience, even if the patient shows sadness. Some people may actually be sad about their life circumstances leading to the choice to have an abortion and ultimately feel relief after completing the process (Rocca 2015).
For patients who are less sure, provide basic information in a non-directive manner.
- I want to look at this situation with you so you can come to a decision you are sure of.
- No matter whether you choose to continue or end this pregnancy, a decision eventually has to be made. Some patients feel conflicting emotions, and that is completely normal.
- Is there any part of this situation that is challenging for you?
- Is there anyone in your life who can help you in a supportive way, without judging you or pushing their opinions on you?
The following framework and examples may assist your counseling conversation.
Helpful considerations for patients who are undecided
For patients who are unsure about what decision to make regarding their pregnancy, invite them to imagine their life, now and in a few years, and how it might be different depending on the choice they make. “What is your picture of the next year or five years of your life? How would a different decision change, affect, or support your goals?”
|Continuing Pregnancy||Ending Pregnancy|
Video: Counseling for Pregnancy Ambivalence (Innovating Education). https://www.innovating-education.org/2019/05/counseling-for-pregnancy-ambivalence/.
Working through religious, spiritual, or moral conflict
People of all religious and spiritual backgrounds have abortion and you do not need any background in these matters to talk to patients about abortion. You do not have to—and truly cannot—know the answer to the patient’s dilemma; instead, explore what this conflict means for them. It may be beneficial to suggest readings including online faith-based resources below, texts, discussions with their own clergy and/or a supportive religious group, or other counseling referrals.
Patients may experience moral conflict around abortion for multiple reasons. Some may feel that life begins at conception and that abortion is an act of murder. Others may feel that a higher power (God or gods), elders, or others important in their community may not forgive them for their abortion. The counseling framework discussed above can be helpful to explore the patient’s beliefs and options for spiritual reconciliation and healing.