QUICK GUIDE: COMMUNICATION DURING THE PROCEDURE
If the provider 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 provider. This can make establishing rapport even more important, and can be assisted by sitting at the patient’s eye level, using an accepting tone, and starting with open-ended questions. You might check in with the patient, such as “I know you have spoken to the counselor. I wanted to see what questions you may still have for me.” Look for emotional cues, and try to create a safe space for them to express their emotions, perhaps saying “all your emotions are welcome 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), but 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 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 tips. Consider asking about terms people use for their body parts and mirror their language by using those terms (Wesp 2016).
| Approach to Communication | Instead of |
|---|---|
| Introduction sitting at patient’s eye level | Introduction looking down at patient |
| 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. | 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 numbing medicine. You may feel numbness or a cramp. | You are going to feel a poke/prick/stick with the injection. |
| We’re over halfway through. | It will be a few more minutes. |
| I will place 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 anxiety, or it may be that the reality of being in the procedure room is making the patient reconsider their decision.
It is usually not appropriate to try to facilitate a decision-making process while the patient is sitting, undressed, on the table. Trust your instincts In deciding how to proceed. The patient 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 the patient’s 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 as sure as you can be that you’d like to proceed?”
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.