RESPONDING TO CHALLENGING QUESTIONS

It can be challenging to respond to complex questions. Here we will review some of the most common questions that arise. General guidelines include:

• Avoid assumptions, ask clarifying questions, and validate feelings.
• Remain sensitive to both verbal and non-verbal expressions of emotion.
• Mirror the patient’s language (for example, if the person uses the term “procedure” for abortion, use the term “procedure”; or if the person uses the term “baby” to refer to the pregnancy, use that same term).
• Provide accurate information.

“What do you do with the pregnancy after the abortion?”

Examples of provider responses:

• “A lot of people ask about that.”
• “I examine the pregnancy tissue to ensure you are no longer pregnant.” Address any follow-up questions, saying the pregnancy tissue is handled like tissue from any health care procedure. Sites have different policies for handling tissue based on local, state, and hospital policies.

“Can I see it?”

Some people wish to view their POCs after an abortion. Patient-centered viewing (PCV) practices could include normalizing this desire and clarifying expectations of what will be seen/recognized at that stage of pregnancy, as well as explaining/identifying various aspects such as gestational sac, decidua, chorionic villi, and fetal parts. Many show the tissue after clearing blood and decidual tissue in a small, open container after the procedure. This practice aims to provide patients with information, a sense of closure, and the ability to make informed decisions about their abortion care. Additional staff and health center training on offering pregnancy viewing can help them connect with the reality of abortion care and practice empathy for patients (Hann 2020). The Patient Centered Pregnancy Tissue Viewing tool (available through ACN) may be helpful for health centers and clinicians to share.

“Will this hurt the baby?”

Evidence regarding the capacity for fetal pain indicates that fetal perception of pain is unlikely before 24 weeks (Lee 2005). For people having a procedural abortion before then, explaining the facts may alleviate this concern. For example, “No, this will not hurt the baby. The fetal nervous system is not developed enough to feel pain at this point in the pregnancy. Still, it may be comforting to know that any pain medication you receive will also reach the fetus.”