CHAPTER 4 - COUNSELLING
Counselling focuses on an immediate,
identifiable single problem area. The counselling session deals with
the feelings, facts and circumstances that relate to that
problemarea: the unwanted pregnancy.
Empathise and reflect feelings; question without judging and
affirm the normalcy of the woman's ambivalence
Abortion counselling covers options counselling and pre-procedure
counselling. In some countries informed consent has to be obtained as
well.
If a woman decides to terminate her pregnancy practically always
there will be a competition of rational arguments in favour of
termination and emotional arguments to preserve the pregnancy.
Help the woman to recognise this conflict .
A counsellor has the task to discuss this dilemma with the
patient so that she can make up her mind and make a well balanced
choice. Discuss also the impact of childbearing. The patient should
be told that she is at liberty to leave the clinic at any moment if
she wants to reconsider her decision. Indeed it happens occasionally
that a patient at the last moment, already on the operation table,
suddenly decides that she does not want the termination done. It is
very important in this situation to differentiate ambivalence from
fear for the intervention and consider sedation. Although it disturbs
the clinic routine and is bad for the doctor's temper the woman
should feel free to leave the clinic unrebuked. Best is to send her
back to the counsellor who should tell her that she may always come
back if she wants to talk with her.
Why is it that a woman gets an unwanted pregnancy while she has
easy access to contraception? A few patterns can be recognised. The
list is by no means complete.
1.The young girl who is not yet prepared. The social pressure of
friends or schoolmates may induce her to take part in sexual
intercourse for fear of being an outcast. Wise parents foresee this
and explain this to the girl giving her the choice to accept
contraception. But not all parents are wise.
2.The woman has no male acquaintances and no sexual intercourse,
so she does not practise contraception. Pregnancy may occur after an
unforeseen meeting. See the discussion of the MAP in
Chapter 6 .
3.The woman denies sexual desire because of some psychological or
religious sexual inhibition and therefore, of course, does not
practise contraception. This group of women provide the most fervent
anti abortion activists. They consider abortion as an opportunity to
avoid punishment for those women who are less restricted. When they
have the misfortune to become pregnant they form the most difficult
type of patient. The secret desire to become pregnant may cause an
unrealistic fear for contraception, for instance that it causes
cancer. This fear leads to neglecting contraception or 'forgetting'
the pill. In certain cultures reproduction is seen as a form of self
expression. The woman wants to show that she can become pregnant, the
man that he can impregnate a woman. Since the pregnancy is undesired
for practical reasons this can lead to repeated abortions.
4.Genuine failure of a more or less adequate contraceptive
method.
5. Forced sexuality, 6.rape, 7.incest.
An abortion clinic should develop its own standards of
counselling. Counselling should take place in a friendly relaxed way,
before the procedure and afterwards again. It is important to listen
actively, not only to the content, but also to the tone and the
choice of words. The counsellor should be prepared to be present
during the procedure if the patient wishes. Never force your well
meant advises on the patient. If she does not want to be counselled
her wish should be respected. She may want to solve her own problems.
Before the procedure try to get an impression if the woman wants
the termination and if she has any doubts about her decision. Assess
the need for additional counseling or extra reflecion time. The
situation classified above under the numbers 1,2,6 and 7 will
generally cause no problems. Try to find out if she comes of her own
free will or if she is forced.