QUICK GUIDE: COMMUNICATION DURING THE PROCEDURE
If the clinician does not do the abortion counseling or consent
Depending on how your services are set up, a counselor may conduct pre-abortion counseling instead of the clinician, making rapport building even more important. It helps to use an accepting tone and start with open-ended questions while sitting at the patient’s eye level. You might check in saying, “I know you have spoken to the counselor. What questions do you still have for me?” Look for emotional cues, and try to create a safe space for them to express emotions, perhaps saying “all your emotions are welcome here.”
Approach to Communication
Honesty and transparency are vital to adequately inform an individual about what to expect during a potentially painful procedure and to create an environment of trust. During the procedure, the use of neutral terms and avoidance of triggering language may decrease pain perception during procedures (Dalton 2014, Ott 2012), but has not specifically been studied in uterine aspiration. Many clinicians prefer to use language describing what they are doing next rather than what a person may feel. Others describe symptoms the person may experience but avoid 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 additional tips for communication. Also ask about terms people use for their body parts and mirror their language by using those terms (Wesp 2016).
| Approach to Communication | Instead of |
|---|---|
| Sitting at patient’s eye level during introductions | Looking down at someone during introductions |
| Your pregnancy is 8 weeks along | Your baby is 8 weeks old |
| Place your feet in the footrests | 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 like an open book or butterfly stretch or frog legs | Open or spread your legs |
| Your cervix looks healthy and normal. | Your cervix / uterus looks/feels good |
| You may feel some cool wet cotton | I am cleaning your cervix (implying it is dirty) |
| This is the local medicine for your cervix. You may feel a cramp or numbness | You are going to feel a poke/prick/stick with the injection |
| I will place the IUD or implant. | I will insert the IUD or implant. |
When is it appropriate to defer an abortion?
Some people feel a new or increased sense of uncertainty right before the procedure begins. This may mark heightened anxiety, or perhaps the reality of being in the procedure room is making the person reconsider their decision.
Trust your instincts in deciding how to proceed. They can be offered supportive counseling and more time to think. It is ok to pause prior to initiating the procedure and ask for a clear statement of their intent before proceeding. For example: “It’s not clear that you are ready to go on with the procedure today. If you are not sure, it is OK to postpone. Do you need some more time?” or “Are you feeling comfortable and sure about proceeding?”
For many people, 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.
Some people may realize they need more effective pain management once the procedure has started. If a person asks to stop the procedure once it has started, and doing so does not pose a life-threatening emergency, STOP. Engage in shared decision making with the person to determine how and if it is safe to continue (at a different pace, with added pain management, by changing to a medication abortion or referring to another facility for more optimal pain management).