Pregnancy and Abortion Counselling

214 Pages·1996·1.52 MB·English

by  Joanna Brien

Pregnancy and abortion counselling
Every year approximately 180,000 women undergo abortions. Making the decision to
terminate a pregnancy is both difficult and painful. Written for professionals who
provide counselling, support and information to women faced with this decision
Pregnancy and Abortion Counselling covers the key elements which make up good
practice.
Using many case examples, the authors examine the wider issues that contribute to
an unwanted pregnancy and the client’s decision about termination. They provide
information on how to answer questions regarding methods of abortion and the
development of the foetus, and give advice on how to structure sessions to meet the
particular needs of each client. Guidance is given on dealing with special situations,
such as a client who is depressed, HIV positive or pregnant following abuse. In cases
of abortion for foetal abnormalities, the authors examine the various methods of
screening and types of foetal abnormality that can be detected. A chapter devoted to
counselling after abortion focuses on the client’s experience of loss and the
consequences of her decision.
Current legislation relating to contraception and abortion is outlined and set
against the moral and ethical debate which practitioners as well as their patients must
confront. The book gives special attention to the experience of professionals working
in the field, how they cope with the pressures and gain benefit from supervision.
Joanna Brien is Senior Counsellor, London Brook Advisory Centres. Ida
Fairbairn is Doctor and Counsellor, Brandon Centre, London.
Pregnancy and abortion
counselling
Joanna Brien and Ida Fairbairn
London and New York
First published 1996
by Routledge
11 New Fetter Lane, London EC4P 4EE
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection
of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
Simultaneously published in the USA and Canada
by Routledge 29 West 35th Street, New York, NY 10001
© 1996 Joanna Brien and Ida Fairbairn
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage and retrieval system, without permission in
writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalogue record for this book has been requested
ISBN 0-203-36012-5 Master e-book ISBN
ISBN 0-203-37268-9 (Adobe eReader Format)
ISBN 0-415-12278-3 (hbk)
ISBN 0-415-12010-1 (pbk)
Contents
List of figures and tables v
Preface vi
Acknowledgements ix
1 Why do women get pregnant when contraception is available? 1
2 The changes that occur when a woman is pregnant 23
3 Abortion: the historical, legal and social context 37
4 Counselling: definitions and constraints 53
5 Counselling: the relationship and practical issues 77
6 Special situations 101
7 Termination for foetal abnormality 125
8 Counselling after abortion 141
9 The effects of abortion work 167
Bibliography 189
Index 197
Figures and tables
FIGURES
5.1 Four basic emotions 88
5.2 Family tree 89
TABLES
1.1 Risk of pregnancy in any one-year period 3
2.1 Physically debilitating and painful changes during pregnancy 25
2.2 Physically and emotionally draining, and embarrassing/annoying changes 26
during pregnancy
3.1 Percentage agreeing that abortion should be allowed by law under certain 40
circumstances
3.2 Abortion rate in 1994 (per 1,000 women) 44
3.3 Abortion statistics by gestation and marital status for England and Wales in 44
1994
3.4 Abortion statistics by parity and age in 1994 45
3.5 Grounds for abortion (legal reasons for approval) in 1994 45
3.6 Women from other countries having abortions in England in 1994 46
3.7 Legal abortions: age, residents, purchaser and rates per 1,000 women in 47
1994
5.1 Checklist 97
5.2 Adoption (by age) in England and Wales in 1977 and 1991 99
Preface
This book came into being through chance. We met at the 1993 British Association
of Counselling Annual Training Conference and realized that we had much in
common when we both attended the same three workshops out of a choice of ninety.
On the train journey back from Cardiff to London, fortuitously much delayed, we
ended up sitting next to each other and shared our thoughts and feelings about our
jobs and involvement with unwanted pregnancy.
Joanna had worked as a senior counsellor for fifteen years and, as well as
counselling young people, was much concerned with improving practice, supervision
and support for counsellors at London Brook. London Brook is a non-statutory
voluntary organization for young people:
The objectives of London Brook Advisory Centres (LBAC) are the prevention
and mitigation of the suffering caused by unwanted pregnancy, by educating
young persons in matters of sex and contraception and developing among them
a sense of responsibility in regard to sexual behaviour.
(London Brook: 1995)
At present there are seventeen centres spread throughout the capital. Venues vary
from standard clinic sites to clinics held in a college, youth centres, a day centre for
the homeless and a genito-urinary clinic. Over 15,000 young people visited London
Brook last year.
Ida had been working with young people for a much shorter time. She had worked
as a doctor at the Brandon Centre for two years. The Brandon Centre (formerly the
London Youth Advisory Centre) is a well-established community-based clinic
located in a large Victorian house in Kentish Town in London. Another voluntary,
non-statutory agency, it is altogether a much smaller organization than Brook (570
people had appointments at the centre last year). It offers a complimentary service to
young people with an emphasis given to individual psychotherapeutic work. The
Brandon Centre service extends to a wide range of adolescent problems:
The principal objective of the Brandon Centre is to maintain and develop an
accessible and flexible professional service in response to the psychological,
medical, sexual and social problems of young people aged 12–25 years. It aims
vii
to relieve distress, mobilise personal resources and facilitate growth in
adolescents towards responsibility and self-fulfilment. Furthermore, it aims to
prevent or alleviate suffering caused by unwanted pregnancy and by mental ill
health, psychological disturbance and maladaption in adult and future family
relationships.
(Brandon Centre: 1995)
Ida was very aware of the lack of any training courses or written material that could
have helped her as she started counselling young women who were unhappily
pregnant.
This book was planned and conceived in the joint recognition of the need for
support, information and guidelines to good practice for all those involved in
pregnancy counselling. Although we have enjoyed the support and collaboration of
our colleagues at London Brook and the Brandon Centre, we want to point out that this
book represents our personal views, not those of the organizations.
It is written with several aims. Its starting point is the wish to educate helpers and
increase their awareness of the issues involved in this widespread and important area
of counselling work. We also hope that its publication will draw attention to the need
for women to receive good pre- and, if necessary, post-abortion counselling. It is
written in the knowledge that there is little material directed at those undertaking this
work, that there are as yet no detailed written guidelines as to what pregnancy
counselling is or how it should be carried out, and very little in the way of specific
training. Counselling women who are unhappily pregnant is skilful work but often
the work is unacknowledged. Silence and secrecy are often features of a woman’s
request for help and this isolates them from support. Pregnancy counsellors involved
with women seeking abortion parallel this silence. We want to explore and examine
the work we do openly; in doing so we can then support others’ counselling work.
We are constantly aware that an abortion is the destruction of a potential child and
have not tried to gloss over this issue or deny that this is the case. The personal
anguish for clients is often great. We hold a strong personal belief that women have
to make their own informed decision and that this can often be more easily achieved
in a safe environment provided by a counsellor.
The book is written for established pregnancy counsellors who may value the
opportunity to reflect on the complexity of their work, for all those embarking on this
work and for the many health professionals who are so often at the front line. We
hope that it will be useful to general practitioners and hospital doctors, nurses, both
hospital-based and in the community, family planning staff, social workers, youth
and community workers, and counsellors. We realize that some areas of the book
will be of more interest to some disciplines than others but hope that readers will be
able to dip into the book to find what may be particularly pertinent to them.
However, by seeing all the ramifications of the issues around unwanted pregnancy, we
also hope that there may be opportunities for learning and for understanding each
other’s roles.
viii
Throughout the book we have chosen to refer to the counsellor as ‘she’ rather than
‘he’, simply in order to avoid clumsy constructions such as ‘he/she’, ‘his/ her’. What
we have to say is of course equally applicable to counsellors of either sex.
The case examples we use to illustrate the points we make in the book are
fictional, but are based on our joint experience as counsellors. They represent the sort
of situations anyone working in the field will commonly meet.
The first three chapters set the scene, they explore factors that influence the
decisions women take and that may make decision-making complex and difficult.
The first chapter explores the range of pressures on individuals that cause
pregnancies to be perceived as unwanted. Although ways of protecting against
pregnancy are relatively safe and effective, the use of contraception is affected by
conscious and unconscious factors and the chapter also aims to help workers become
aware of such contradictions.
Pregnancy itself hampers decision-making. This is explored in Chapter 2.
Chapter 3 provides statistics and information about trends, the law and methods of
abortion.
The middle chapters contain the working bulk of the book. Pregnancy counselling
is defined, and attention paid to who should receive and who should provide this
counselling. Issues surrounding good practice are fully explored. We also consider
the emotional aftermath of abortion and the various special situations that warrant
extra care, such as work with young people. In a separate chapter we focus on
termination for foetal abnormality as opposed to ‘social’ terminations and examine
the similarities and differences.
The final chapter concentrates on the effects of this work on those who are
providing counselling and medical or nursing attention. We are aware from personal
communications, a questionnaire and workshops of the impact this work has on the
professionals involved. Indeed it was our own experience of this impact that led to
this book being created. We hope that you will find it helpful.
Acknowledgements
We would like to take the opportunity to thank all the people who have contributed to
the writing of this book. We owe a great debt to our colleagues and friends at The
Brandon Centre and London Brook. We are grateful to our families who put up with
our engrossment in this project with as much patience as possible.
We appreciate the many people who wrote to us or responded to our
questionnaires, attended our workshop and generally took time to discuss their work.
We would particularly like to thank Gillian Ballance, Jonie Dimavicius from
SATFA, Tania Glynn from The Red Admiral Project, Ruth Kaleb from Post Abortion
Counselling Service, Chris Kell, Robert Kirkwood, Lyn Margerison from The
Kennedy Galton Centre, Dr Linden Ruckert and Dr G.Zolese. The librarians at St
Albans City Hospital and Hill End were also most helpful in finding papers.
Above all we would like to thank the young people who use the centres in which
we work.