For most, an unintended pregnancy triggers a host of mixed emotions. A patient facing an unplanned pregnancy may feel uncertain, fearful and overwhelmed by thoughts of the future. Pregnancy counseling offers a safe, supportive forum for a pregnant patient to meet with a compassionate clinician in order to discuss the various options available and guide them toward their preferred outcome.
In order to help patients make an informed choice on how to proceed with their pregnancy, clinicians must be prepared to help the patient examine their feelings and arrive at a decision that best reflects their beliefs and ideals. To do this, pregnancy counselors need to adopt a mindful, sympathetic approach to their support procedures. This can be very important to make sure that the patient stays healthy during the pregnancy.
Previsit for Unplanned Pregnancy
Pregnancy counselors should be a generous adviser to patients unexpectedly confronted with several possible choices, including parenting, abortion and adoption options. Prior to the initial visit with a patient, pregnancy counselors must prepare to lend an impartial, responsive ear.
Examine Personal Values
Patients will likely be arriving at the office apprehensive or unsettled. Unplanned pregnancies force a patient to not only confront their values head on, but they also create an urgent awareness of the effects the pregnancy would have on their future goals, their families and their health. Scheduling an appointment with a pregnancy counselor is a prudent, brave step that should be met with encouragement.
Counselors should consider that patients need to be wholly educated on the many therapies available to them. Counselor values may reflect a moral bias that may lead to partiality in advice. If after examining their values a counselor will be unable to provide impartial counseling, it is appropriate for a counselor to remove themselves and refer the patient to another provider or resource.
Keep in mind that an unplanned pregnancy does not always mean an unwanted pregnancy. There are many emotions involved in an unwanted pregnancy, but not all are disconcerting. Maintaining as neutral a support approach as possible will allow a patient to make choices that resonate with their understanding of the benefits and tolls of every option they have.
Provide Careful Referrals
Should a counselor need to refer a patient to another colleague or practice, it’s vital that it is done with caution. Some external resources are largely unsympathetic, provide inaccurate information or utilize pressure tactics to sway a pregnant patient toward a particular choice. Often referrals do more to intensify the already substantial stress a patient is experiencing.
Many facilities can also place further strain on patients with hefty financial fees and economic burdens. Pregnancy is a time-sensitive, pressing circumstance, and outside facilities with little immediate availability, or those that would require a patient to travel a great distance, are not always practical referrals.
Adhere to Medical Standards
Patients deserve to receive the most accurate, pertinent information possible. No matter what a patient’s socioeconomic, marital or legal status, they are entitled to counseling that enables them to consider all their options, regardless of counselor perceptions. A counselor’s job is to treat patients with abundant emotional and physical respect.
Counselors should act with a patient’s best interests in mind. Patients should be able to practice autonomy. When discussing options, counselors should prepare to empower patients to both refuse and choose their own outcomes. It is merely the responsibility of clinicians to inform patients of all information available in order to assist them in arriving at a decision.
Prepare for an Open Discussion
With numerous patients seeking the same services, it is common to fall into clinical, sterile patterns of communication with each appointment. Remember, it is likely a patient’s first time seeking pregnancy counseling. It is safe to assume that pregnant patients seeking assistance are presumably feeling vulnerable, and even desperate.
Practicing empathy and active listening work to create a much needed sense of trust and safety for patients. Patients from all walks of life will come through the door, each with a different set of circumstances. An earnest, responsive counselor seeks to make no assumptions, and demonstrates a willingness to help patients feel heard, self-assured and respected.
Initial Counseling for Pregnancy
From answering patient questions to providing detailed options, counselors have an important responsibility to lessen some of the overwhelm a patient may be experiencing. In order to skillfully assist a patient in deciding what is best for themselves and their situation, clinicians who are prepared with thorough, thoughtful medical information and suggestions will better be able to provide patients with the support and knowledge they need.
Explore Their Circumstances
Through a series of questions, counselors can not only establish rapport with their patients, but they can also get a clearer picture of where they’re coming from. Should they choose to respond, counselors should note:
- Patient’s age
- Patient feelings about the unplanned pregnancy
- Patient’s marital status
Previous pregnancies - Presence or absence of patient’s partner and family support
- Patient thoughts about parenting, abortion and adoption
Asking open ended questions helps. Rather than use congratulatory, leading or assumptive statements, clinicians should speak to the patient as neutrally as possible. For example, rather than asking if the patient is married, counselors should simply inquire objectively about their marital or relationship status. Remain curious about their feelings, and refrain from using any language that makes implications or references to how things “should” be for a family or pregnancy.
Options Counseling for Unplanned Pregnancy
After establishing a patient’s background and current state of affairs, it’s time to offer comprehensive education about their options. If a patient has an idea of what they’d like to do next, it’s a good idea to ask them if they’d like to hear about alternatives. For this reason, coming to every appointment prepared to prepare patients for all routes is crucial.
Adoption
Most patients with unintended pregnancies choose to remain pregnant and go on to have a live birth. Some of these patients choose to transfer legal parental rights to a family seeking to adopt a baby. Pregnant patients have many routes to adoption, and should be educated on what to expect, the state’s adoption laws, where to seek medical care and what level of involvement they can expect from an adoptive family should they choose this route.
The patient may have worries about what the child will think of them, or concerns about whether the child will feel abandoned or hurt by their decision to place them for adoption. Adoption is a permanent decision, one with complicated emotions. Assure patients that children who are placed for adoption will know that their birth parents made the choice out of love and care.
Some patients may desire a great deal of involvement in the placement process, while others may not be interested in that responsibility. There are many adoption options that allow birth parents to choose adoptive families, and patients should be provided with whatever resources they request to explore all that is available to them.
While counselors will not be able to spell out exactly what an adoption experience could be like for them, patients should be made aware of both types of adoption. Both open and closed adoptions are desirable for their own reasons. Would-be birth parents should be briefed as to what information they will and will not have access to in each situation. They should know that there may be social workers, counselors and lawyers to help facilitate a smooth adoption.
Pregnancy is physically taxing, and patients will likely be worried about the toll the experience and the childbirth process could take on their body. Assure them that they will have access to the medical care they need, and, if necessary, leave them with the names of obstetricians in their area. It’s important that a patient who chooses to continue with pregnancy starts prenatal care as soon as necessary.
Abortion
Some patients will choose to deliberately terminate their unplanned pregnancy. Inform pregnant patients that they have access to safe abortion options, including in-clinic and at-home methods. The decision to terminate a pregnancy is never taken lightly, and both feelings of guilt and relief are common. Validate the patient’s emotions in any event. Millions of people have had safe, successful abortions, all with varying emotional and physical reactions.
It’s important to present abortion options as completely as possible. If a patient seeks an abortion, they must be informed that it’s a time-sensitive choice. Different states have different policies on abortion. Some states allow abortions to be performed the same day as an intake appointment, while others mandate a waiting period. As well, some states require mandatory in-clinic counseling to inform the patient of other available options, possible side effects and descriptions of procedures. For many, these requirements can be distressing. Patients should be assured that they can seek mental health counseling that will help them work through any complicated feelings that may arise.
Patients that choose abortion may also feel peaceful about their decision. The decision to terminate a pregnancy is personal, and each patient has their own unique reasons for pursuing abortion. Counselors should be ready to hear from a patient regarding their considerations about their future, health, religious beliefs, outside pressure, and available support systems.
Patients may also not wish to share personal details, and will only desire referrals to clinics and providers to take their next steps. Whatever their situation, clinicians should check in with patients to determine their certainty and provide suggestions to help a patient navigate the process ahead.
Parenting
If a patient facing an unwanted pregnancy chooses to complete their pregnancy and become a parent to the child, whether becoming a parent for the first time or not, they should be counseled regarding prenatal care. Continuing with a pregnancy involves a great deal of life changes. Many of these changes are physical, while others are emotional. Pregnancy affects everyone differently. Counselors may not be able to provide in detail every possible pregnancy complication, but they can provide basic guidelines for what the next several months of a patient’s life will bring.
If a patient is choosing single parenthood, clinicians should have available several basic resources to assist pregnant patients with their pregnancy and future parenthood. Like any of the other options for an unplanned pregnancy, choosing to have and raise a child comes with a variety of complex feelings. Patients may feel an obligation to carry their pregnancy to term. They may experience pressure or apprehension. They may also seem hopeful. Demonstrate acceptance for any and all reactions.
Patients should know that there are more options than ever for them when it comes to parenthood. They may express concerns about financial implications, the impact a child would have on their ambitions and career, the way a child may change their relationship with their partner or other children and whether they are able to parent in the ways they hope. Clinicians should provide patients with practical resources and information to soothe these anxieties.
Contraceptive Counseling
Considering the profound and often overwhelming emotions surrounding an unplanned pregnancy, patients should take measures to prevent future unplanned pregnancies. Regardless of which option a patient chooses, it may be a good time to discuss contraceptive options. Keeping patients healthy through STI prevention may be an appropriate topic as well.
For patients who choose adoption or parenting paths, the conversation may be better had with providers later on. Patients who choose abortion, of course, will need to consider their options sooner. In any case, come prepared with a list of potential birth control options and plan to answer any questions about both long and short term contraceptive methods.
Even when a patient exhibits a history of dubious sexual practices, maintain an empowering and approving demeanor when discussing contraception. Stress the importance of pregnancy prevention and the risks of STIs through unprotected sex. If a patient doesn’t seem receptive to these discussions, it’s important to leave them with the knowledge that they can and should plan appropriately for the future in order to prevent any unintended pregnancies or illness in the future.
Conclusion
Above all, counselors should be there to explore any misunderstandings, provide details on all the options available and set up a plan with the patient for their pregnancy. Sometimes counselors will need to navigate difficult waters with a patient. Many times patients are unsupported by family or in situations where domestic violence or abuse is present. Including social resources in the counseling process will help patients feel more equipped to handle all aspects of the road ahead.
No pregnant patient needs to feel alone. Clinicians have an important and powerful obligation to counsel patients with unintended pregnancies in ways that respect the patient’s medical history, personal wishes and fears. Patients need compassion and support to help them arrive at a decision that aligns with their values and goals. Only when counselors fully understand their critical role in that decision making process can they practice fully empathetic and knowledgeable consultation.