PREGNANCY OPTIONS COUNSELING TECHNIQUES

^{Adapted from: Perrucci A. Options Counseling 2012.}

When providing pregnancy test results, it is important to hold space for the range of reactions a person may have. Some people will be surprised while others will have taken a test at home and are seeking confirmation. Some may feel a spectrum of emotion, including sadness, happiness, guilt, or conflict. Others may feel no emotion related to their pregnancy. It is also important to avoid assuming that an abortion itself will be a sad experience, even if a patient shows sadness. Some people may be sad about their life circumstances leading to them having an abortion, and ultimately feel relief (Rocca 2015). In fact, relief is the most common emotion one week and five years post-abortion, and the overwhelming majority continue to feel it was the right decision for them (Rocca 2020).

Our role when providing options counseling is to listen and provide appropriate decision support about the pregnancy, as needed (Perucci 2012). When providing positive results:

• Be explicit: “Your pregnancy test came back positive, which means you are pregnant.”
• Allow some time for the person 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.

Although we may use language like “choice” or “decision”, a person’s pregnancy outcome may not be experienced as a choice at all, but the only mechanism of upholding dignity, bodily autonomy, or safety. For some the decision to have an abortion is also clear. They won’t need options counseling; we can help them with planning the next steps.

The following framework may assist in your counseling conversation (Perucci 2012).

Helpful considerations for patients who are undecided

For patients who are less sure, provide basic information including when they need to decide in order to have a medication or aspiration abortion, ask questions in a non-directive manner, and provide reassurance. These conversations can take time, so providers and staff may have to be creative on how to manage this within the constraints of a busy clinic.

In counseling, consider the following statements:

• Some people feel conflicting emotions, and that is completely normal.
• What aspects of this are challenging for you?
  • On a scale of 1 to 10, 1 being sure that continuing the pregnancy is the best decision, and 10 being that abortion is the best decision, where are you now?
• I recognize that you are trying to make the best decision for you and your family, given the circumstances.
• You are in charge of this decision. Nothing happens today, unless you want it to.
• Sometimes neither decision feels good, and that’s okay.

Another exercise for people who are unsure regarding their pregnancy is to invite them to imagine their life, now and in a few years, and how it might be different depending on the outcome of this pregnancy. “What is your picture of the next year or five years of your life? How would each outcome change, affect, or support your goals?”

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 people about abortion. You truly cannot know the answer to the person’s dilemma; instead, explore what this conflict means for them. People 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 higher power(s), 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 person’s beliefs and options for spiritual reconciliation and healing. It may also 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.

Additional resources:

• Catholics for Choice
• Religious Coalition for Reproductive Choice
• Faith Aloud

Maguire, DC. Sacred Choices: A Right to Contraception & Abortion in 10 World Religions. Minneapolis, Fortress Press, 2001