If the provider does not do the abortion counseling/consenting
Depending on how your services are set up, a counselor may conduct pre-abortion counseling instead of the provider. This can make establishing rapport even more important, and can be assisted by sitting at a patient’s level, using an accepting tone, and starting with open-ended questions. You might check in with patient: “I know you have spoken to the counselor. I wanted to see what questions you may still have for me.” Or consider using teach back: “Tell me what you have already learned about breathing and relaxation.” Look for emotional cues, and try to create a safe space for them to express their emotions, perhaps saying “all your emotions are safe here.”
Approach to Communication
The use of gentle, neutral language and avoidance of words associated with pain has been shown in some but not all studies to decrease pain perception during procedures such as administration of local anesthesia (Dalton 2014, Ott 2012, Varelmann 2010). This has not specifically been studied in uterine aspiration. Many providers prefer to use language describing what they are doing next rather than what the patient may feel. Others describe symptoms the patient may experience but choose their words carefully, with particular attention to avoiding descriptions of pain or sexual references. For example, “You may feel a cramp,” as opposed to “You are going to feel a poke/prick/stick”. Below are some tips for language during the procedure.
|Approach to Communication||Instead of|
|Introduction sitting at patient’s level||Introduction looking down at patient|
|Your pregnancy is 8 weeks along.||Your baby is 8 weeks old.|
|Place your feet in the foot holders.||Place your feet in the stirrups.|
|There is room for you to move down further on the exam table.||Move your bottom down the bed until you feel like you’re going to fall off.|
|Allow your knees to fall to the sides.||Open or spread your legs.|
|Your cervix looks healthy and normal.||Your cervix / uterus looks/feels good.|
|You may feel some cool wet cotton to swab away your
natural cervical mucous.
|I am cleaning your cervix (implying the cervix is dirty).|
| If…then statements such as If you want the
procedure to go as quickly as possible, then hold as still as you can.
|You have to hold still.|
|This is the numbing medicine. You may feel a cramp,
or spreading numbness.
|You are going to feel a poke/prick/stick with the injection.|
|We’re over halfway through; doing great.||It will be a few more minutes.|
|I will place / introduce the IUD or implant.||I will insert the IUD or implant.|
When is it appropriate to defer an abortion?
Some patients feel a new sense of uncertainty immediately before the procedure begins. This may be another way a patient communicates heightened fear, or it may be that the reality of being in the procedure room is making the patient reconsider their decision.
It is not appropriate to try to facilitate a decision-making process while the patient is sitting, undressed, on the table. They should be offered supportive counseling and more time to think.
In deciding how to proceed, it is appropriate to trust your instincts. Some patients, who may be having difficulty accepting their decision, recant in an effort to make the provider or the agency “responsible.” In such a case, the provider must ask for a clear statement of the patient’s intent before proceeding. For example:
“I’m not sure if you are ready to go on with the procedure today. If you are not sure, we can postpone.
Do you need some more time?”
For many patients, this last moment is what they need; when faced with the possibility of not going forward, they see this option is less appealing, and know they want to proceed. For others, it gives them a chance to think more about what they truly want.