23 February 2012

A day in the life of a pregnancy options counsellor

By Cath Sutton, BPAS London East.

For the best part of fifteen years I have worked as a counsellor for BPAS. Despite the length of time and the hours I’ve spent talking to the women I can confidently say there is only one constant, and that is that no day is ever the same.

Every single woman we see has a unique set of circumstances. She will feel a certain way about these and will require different things from the staff she sees during her visit.

Any woman with an unplanned pregnancy who comes to us will have a consultation. She will see a counsellor first, always alone, where we explore how she’s feeling about the pregnancy, if she’s made a decision and what support she has in place.

If she’s clear that she wants to have the abortion, we make sure she is aware of all the procedure options and we can answer any non-medical questions she has about them. She will complete a medical assessment and then one of the counsellors can make her an appointment at the clinic.

If the woman is ambivalent, she has the opportunity to discuss her decision in more depth and from there …. well, there is no definite ‘from there’. It could involve more time, more counselling, more information. Whatever the woman needs to make the best and most informed decision, we try and provide it.

It’s hard for those who don’t work in the clinic to understand how much support and understanding some women need. In the outside world everyone has an opinion about abortion, and it’s generally expressed in emotive and judgemental ways. Even women who believe strongly in their right to choose are often anxious that their reasons for having the abortion aren’t good enough and that they will be punished for choosing to end the pregnancy at some point in the future.

There are no generic situations. We see women of all ages, of every colour and from every cultural and religious background. We can make no assumptions about any woman who sits before us in the counselling room. However a woman presents herself, or whatever her social background, there is no way of telling what she will need from us during her visit.

The most effective way of illustrating this is to talk you through a day. Yesterday, in fact. I arrive at work, I check the diary, catch up with my colleagues and then I call my first client from the waiting room. She is a woman in her thirties. She is clear about her decision – she and her husband have two children, and they cannot afford a third. She is very sad though and is anxious about telling anyone, in case they don’t fully understand their situation and judge her for being careless.

This woman cannot share all her sadness and anxieties with her husband, who is already worried about his job situation and is dealing with an elderly mother. But she can tell me; although the actual decision to end the pregnancy has been made we can talk about how she can look after herself – something she didn’t feel she had the right to do.

My next client is a 17-year-old student, very clear that she wants the abortion. She is keen to complete her education and the idea of starting a family now is anathema. But she is very worried about whether to have a medical or surgical abortion – she needs me to describe in detail how the procedures work and what is involved.

Because we work in close conjunction with our clinics, I can tell this woman exactly what will happen from her arrival to discharge. I know that this has helped her, because she told me it had.

My third client is ambivalent. The pregnancy was planned, but as soon as she actually became pregnant her partner of over two years got cold feet and wants to end the relationship. She couldn’t cope as a single parent but baulks at asking her parents for support, as they would find it difficult to accept her continuing the pregnancy outside marriage. They are deeply religious and they would, she thinks, be very disappointed in her if they realised what had happened.

This woman is a Christian herself and is struggling with the concept of abortion. She is trying to work out if she can reconcile her beliefs with her fear of being able to cope as a single parent and, simultaneously, the possible estrangement with her family if she continued. We discuss adoption briefly but she knows this ‘would kill her’ – the idea of not caring for the child having gone through the pregnancy and birth – isn’t one she can contemplate.

Many women feel the same about adoption or fostering – it would be too hard. But it would be wrong to dismiss this as an option, even if it only serves to concentrate the woman’s focus on either abortion or becoming a parent. She decides in the end that she needs more time, so she leaves with our telephone number and the assurance she can return if she needs to talk more.

I then call through another very straightforward client – she is positive about her choice. She wants to travel and doesn’t want to start a family, she is grateful there is somewhere she can have the abortion done safely. She is keen to talk about contraception, so the nurses and I do just that.

I then see a woman for post-abortion counselling. She had the procedure a week or so ago and is finding it difficult to cope. It becomes apparent that the relationship she was in had ended and that she was in the process of re-evaluating her career when she found out she was pregnant. Although it was a hard decision, she felt that that having the abortion was the right choice at the time, but she is now dealing with loss of the pregnancy, the loss of her partner, and the fear of staring a new job.

I spend the next hour or so booking women into the clinic for the procedure – I make sure they have all the relevant information and iron out any problems before they leave. One of the women I book is very tearful; she tells me she was so anxious and worried before she arrived but she feels everyone has treated her well and was friendly and helpful - something she wasn’t expecting (or something she feels she didn’t deserve, perhaps). Abortion care is not just about the woman’s decision, it’s also about her self-respect.

I want to emphasise that we are not saints – some days are difficult and frustrating, we can’t always help women, and we cannot undo the series of events that have lead them to BPAS in the first place. We cannot, in short, make the decision disappear and absolve them of this responsibility. But what we can do is see every woman as an individual and treat her accordingly. Listen to what she has to say and find the best way forward. We can give her the chance to talk to staff who believe that abortion is a choice. 

It isn’t enough for us to just to provide her with the means to an end but to ensure that she doesn’t feel demeaned by herself or others for choosing to have an abortion. On a good day, like yesterday, I feel I’ve gone some way to achieving this.