Thursday, December 30, 2010

What I hear you saying is...

Part of the pre-abortion process at my clinic is counseling. Clients talk with a counselor one-on-one to review their medical histories, discuss the details of the procedure, ask questions about the aftercare instructions, and work thorough any lingering doubts or concerns they have. Some clients latch onto this idea and want to use it as an in-depth therapy session for things that really should be handled by a professional, while other clients roll their eyes at the idea and assume that counseling is yet another law with which the clinic must comply, a law created with the assumption that women don’t understand what an abortion is or that every human was once a fetus.

But the majority of the clients welcome the opportunity to talk with someone whose job it is to listen and to be pro-choice. I value it because it gives clinic staff a chance to develop a rapport with a client. (Not to mention the chance to debunk myths about having to slice someone stem to stern to perform an abortion.)

I actually took the counseling portion of the program for granted until I learned that some very compassionate, professional clinics don’t offer counseling to their clients. It could be a trick to save time (clients always complain about how long the process takes) or minimize cost (we ARE in a recession), and it could simply be what has worked and continues to work for individual clinics.

So, readers, I’m curious: If you’re an Abortioneer, does your clinic offer counseling? If you’re a friend of the Abortioneers, would you opt for counseling, given the choice? And if you’ve been a patient, did you have a counseling session? What have your experiences been?


  1. I work for an abortion clinic in Ohio and we do offer counseling, although it's just from a patient advocate, not an actual social worker or counselor. We go over medical history, the procedures in detail, what to expect afterward and I usually touch a bit on emotions, but only if they feel comfortable talking about it. When they are filling out their paper work we have them fill out a "Feeling Sheet." The questions on there are pretty simple, like "Are you being forced?" "Do you want to talk about your feelings?" "Are you afraid you'll regret your decision?" but that was we can get a good sense of how they are feeling. I'm glad we walk them through the procedure though, and answer all of their questions. I don't remember any of that when I had my procedure, I just remember watching a video and being terrified.

  2. I've worked at two abortion clinics in two states, both of which have mandated counseling (I'm pretty sure it's state law in both places). As a counselor I love and value my position deeply, and I know that I have made a difference in many women's lives in that role. At the same time I don't know if I think counseling should be a legal requirement. It should absolutely be an option, probably even encouraged, but I definitely don't think all of my patients need it or benefit from it. Beyond the informed consent piece, at least - certainly everyone needs to know about risks and aftercare instructions, as with any medical procedure. But I DON'T think women need to hear about the ins and outs of the actual procedure unless they want to; no other type of surgery/procedure requires that level of knowledge on the patient's part. I've had patients strongly object to hearing the details of the procedure, and I hate that I have to tell them anyway. If they're sure they need an abortion, the details of the procedure really don't matter.

    With regard to the decision part of the counseling (as in, where it's my job to make sure the patient is confident in her decision and is not being pressured or coerced into it) I have counseled many women who understandably don't want to talk about their personal circumstances with a total stranger. I'm pretty uncomfortable at times with the fact that they are subject to my assessment of their decision. I understand why legally it's important to make sure the patient is confident in her decision, and that it is actually her decision. But I don't know if I should have the right to turn someone away, as I have before, for what I see as ambivalence or coercion when the patient objects. It's often a really tough question. If the patient states that her boyfriend is making her have the abortion and she doesn't want it, but she needs to do it because he will abandon her and her three children without any support if she doesn't, are we really helping her by refusing to provide the abortion? Or what if she refuses to use the terminology I need to hear - repeatedly telling me that NO, she's NOT confident this is the right decision for her and she doesn't think more time would help her to feel more sure, but she's adamant that she has to have it done now anyway. I love and adore my job when I form really good connections with patients and am privileged enough to hear their personal stories and I can help them to feel empowered about their decision. But sometimes I agonize over the power I have. I don't know if that kind of power would be appropriate in an ideally pro-choice system.

  3. Our clinic has a screening process where we talk about feelings, debunk myths and everything else you mentioned above, however because we aren't licensed counselors we do not call it a counseling session.

  4. I had an abortion in 2001 when I was finishing my freshman year of college. I was pressured/forced into the decision by my mother and boyfriend.

    We had gone to an adoption agency first. After hearing what the lady said, he stood up and yelled, "You will either have this baby or have an abortion, but I will not sign any papers."

    When I told my mom, she threatened to kick me out if I went through with the pregnancy (to either have the baby or to live there until giving the baby up for adoption). My boyfriend had just gotten out of a 2 year prison sentence so he was living at his parents home. I really didn't have anywhere to go.

    I felt as if I had no choice. When we went to the abortion facility/Dr. office, no one gave me any type of counseling. The only thing I was told was that I'd be put to sleep using Ketamine and that freaked me out because I knew what a K-hole was and didn't really care for them! When the lady did the ultrasound, I asked if the baby had a heartbeat yet. She said, "no, they don't get heart beats until later." but when I got pregnant the second time and read a pregnancy book I learned that a baby DOES gets a heart beat earlier! And when I had twins I had an ultrasound at an earlier week and saw now I feel like I was lied to. (I was a little over 8 weeks when I had my abortion)

    When the nurse came in to put me to sleep I started crying hysterically. She asked if I was sure about my decision, and I said no. She then told me she'd give me a few minutes to get myself together. Again, no one offered me any type of counseling and/or help.

    So, for me I think counseling is a good thing. After the birth of my twins, I ended up with a large hernia that needed to be repaired. It was to big to do laparoscopically so the Dr. would have to make an incision from ribs to below belly button (or I could pay a little more and go hip to hip and get a tummy tuck too). I had to go in two days before surgery and I was upset. I was scared because I had a 2 year old at home and 3 month old twins. The doctor sat with me, explained the procedure, and told me that I should cancel the procedure and reschedule it when I feel confident in my choice of how it should be done. That's what I did. I NEEDED to do the surgery, it had to be done, but him sitting there and not telling me to get myself together and just do it was the more appropriate way to go.

    I believe we have free will in life. And if a woman wants an abortion, then she's going to find a way to get one no matter if it is legal or not. And while I know some women might be the ones coming up with the decision on their own and/or sure of their decision to abort, there are some of us who are not.

    Carie Lea- I love the idea of a feeling sheet! Because sometimes it will help a person really realize what they are feeling and that it may be normal or that yeah, they aren't sure.

    Lily- I was just curious if the times you had to turn the women away, did you give them any information about adoption, or shelters, or governmental programs that are offered?

    Because I wish someone had done that to me. My choice would be to give the baby up for adoption. I wish someone (hell, even the adoption agency lady) had told me about the other options out there instead of just saying nothing.

    I regret my abortion and suffered from it for many years. I was one of those women who had the "choice" part taken from her since I was pressured/forced into it by my mom and boyfriend. So for women like me, PLEASE offer the counseling. Even if 100 women walk through your door and roll their eyes at it, for the sake of a woman like me- send me away! But just send me away with information on programs and other options!! Thanks. :-)

  5. Allison – Thanks so much for sharing your story. I’m so sorry you were coerced into such an important, intensely personal decision and that the clinic didn’t seem to be looking out for your emotional well-being. I hope you’ve been able to heal and find peace and support. Have you ever called Exhale? (1-866-439–4253) If you still feel like unbiased support/counseling might be helpful, they're fantastic and would welcome your call even years later.

    To answer your question far too verbosely, it really depends. I think of patients I turn away as falling into two categories: those who come to agree that they should not have the abortion that day, and those who disagree with my assessment and resist being turned away. For the former, we generally come to the decision mutually and whatever resources I give them depend on their situation. Sometimes they just need more time to think, or feel that they will eventually choose abortion but aren’t ready yet. In that case we usually reschedule the appointment with the understanding that they can cancel at any time, or we make an appointment for options counseling. Resources I like to offer include a pamphlet called “Thinking About Abortion” and a little booklet called “What If I’m Pregnant?” that’s like a guide for thinking through different options and the decision-making process. I also like to give a card that lists some helpful resources, like the numbers for Exhale and Backline and the URL for the Pregnancy Options Workbook.

    I do offer information about prenatal care/having a healthy pregnancy, plus referrals for prenatal care if they don’t have a doctor, and I always encourage patients to start prenatal care ASAP if they decide to continue the pregnancy. If she doesn’t have insurance, I give information about a state health insurance program for pregnant women. Sometimes I give referrals for parenting education classes or teen parenting resources. Finally, I do offer information and referrals for adoption, but most patients decline them. Adoption is an important option to have and it’s definitely the right one for some women, but at least in my experience, the vast majority of women are deciding between parenting and abortion and don’t feel that adoption would be a viable option for them.

    (As an aside, usually I give these types of resources during pregnancy test visits, not abortion counseling sessions. The vast majority of abortion patients are really very clear in their decision and turning someone away is rare.)

    The latter category of patients are much tougher, those who insist on being seen when my judgment is that they shouldn’t be. As I’ve gotten more experienced it happens less often, which is partly because I’ve begun to question whether I should have the right to turn someone away who insists on being seen – don’t they know best for themselves, and doesn’t their insistence mean that they ARE sure? But mostly I think it’s because I’ve gotten better at asking the right questions and really figuring out where a patient is coming from, so as to better determine whether she’s truly ambivalent/coerced or whether she is actually reasonably certain but has complicating factors/emotions that make it hard to tell (like the examples in my first comment above). If I decide I have to turn someone away, I always try my best to make it a mutual decision and get the patient to agree that she should postpone the abortion at least. If she ultimately disagrees, though, unfortunately that tends to mean she then views me as a barrier, not an ally, and we lose any trust or rapport we might have had. Since she’s insisting she needs the abortion and doesn’t understand why we won’t see her that day, usually we just end up rescheduling the appointment. Generally she doesn’t want information or referrals for other options. Sometimes we even refer her to another clinic if it ends hostilely and she doesn’t want to come back to us. But again, this all happens very, very rarely.

    Sorry for how long-winded that got! This is my favorite topic in the world. :)

  6. Allison, Lily, carrie-lea, snail-trail -- thank you all for sharing your experiences with us and each other! Please do keep talking amongst yourselves about it and know that we're appreciating it :)

    Allison, that sounds like a really stressful abortion experience, and I'm so sorry to hear that you weren't offered counseling. Who on earth could fault you for having a hard time under the circumstances? Outsiders are quick to conclude that trauma means abortion hurts women, when what we already know is that being stuck between a rock and a hard place can hurt women, and approaches that minimize the importance of the decision (and of being able to make one's own decision) can hurt women. Your perspective and advice to us are extremely valuable and taken to heart, so thank you for being willing to share with us.


This is not a debate forum -- there are hundreds of other sites for that. This is a safe space for abortion care providers and one that respects the full spectrum of reproductive choices; comments that are not in that spirit will either wind up in the spam filter or languish in the moderation queue.