February 2021

by Dr. Laura Lewis

Sherie was 18 years old when she came to see me at the clinic on a Friday morning. She presented with a cold but admitted that she might be pregnant. Without me asking many questions, Sherie’s words spilled out, “I can’t go through another abortion…It was the worst decision I ever made…I felt like I had no other choice…I think about my child every day.” Her sorrow was palpable, and I wondered why she was willing to share such raw emotions with a physician she just met. But then I realized the poster on my office wall, featuring our local pregnancy care centre, provided an open door for Sherie to speak of her fears and feelings.

For over twenty years, I worked as a family physician. During that time, I met many young women experiencing an unexpected pregnancy, many overwhelmed and pressured by their circumstances and fears. What they needed was information and support to be empowered to make their own well-informed pregnancy decision because every decision before them – whether to parent, place for adoption, or have an abortion – was a life-impacting one.

It took me years to understand and recognize the hidden challenges of an unexpected pregnancy and respond with sensitivity and awareness; to ensure that I created a safe environment to listen, ask questions, and understand the underlying pressures confronting my patients.

I share these lessons and practical tips in the Pregnancy Care Canada booklet Unexpected Pregnancy, designed for health care professionals. This short booklet supports front-line professionals as they assist patients in a pregnancy decision. I also share this booklet for those who wish they had found space and safety in their physician’s office when making their own pregnancy decision. I want you to know that I believe we can do better as a medical profession. It may be one small step, but as Lao Tzu says, “The journey of a thousand miles begins with one step.”

Below are some excerpts from the booklet. If you would like to read the booklet in full, there is a link provided at the bottom of the page.

To my fellow physicians,

If I were to go back and sit across from a woman with an unexpected pregnancy, I know that I would ask more questions. I now realize that years ago I had very little understanding about the challenges my patients were dealing with. As a result, in my attempt to work efficiently and balance the demands of my family practice, I didn’t ask some key questions that might have helped my patients make a well-informed decision – a decision without underlying uncertainty, and a decision they would not regret down the road.

As physicians, we have the opportunity, influence, and duty to help our patients make well-informed decisions about their health care issues, and that includes unexpected pregnancies.

My hope is that this booklet will assist physicians to better help their patients decide well, mitigating the unnecessary emotional and mental health consequences noted in women who choose abortion with ambivalence.

Health care professionals have the opportunity, influence, and duty to help their patients make well-informed decisions about health care issues, including unexpected pregnancies. At times, the most significant problem is not the pregnancy itself but the additional circumstances surrounding it. Circumstances that may include financial instability, concern about single parenthood, a lack of readiness/maturity to parent, relationship problems, or pressure from others who may significantly influence her pregnancy decision.

As noted by the playwright Eugène Ionesco,

 “It is not the answer that enlightens, but the question.”

Sharing in the belief that it is often in questions that we find clarity, we have compiled a list of 9 key questions to consider. These questions will help identify the other circumstances and concerns that need to be supported, cared for, and discussed.

1. Have you talked about your pregnancy situation or decision with the important people in your life?
2. Do you understand all your options for your unexpected pregnancy? Have you thoroughly considered each one?
3. Have you given yourself adequate time to think about your decision?
4. Is anyone pressuring you to make a specific decision?
5. Have you considered your beliefs and attitudes about abortion, adoption, and parenting?
6. Do you have a spiritual or religious worldview that impacts your decision?
7. Are you aware of the supports and resources available in your community?
8. Are you aware of pregnancy milestones and the stage of development of your pregnancy?
9. Do you have any uncertainty about your decision?

Using questions as a starting point allows us to step outside of our own perspectives and worldviews and permit the listener to reflect and receive information. The value of a question-based approach is particularly beneficial when discussing a topic such as abortion.

In these discussions, a health care professional must be aware of his or her personal biases and assumptions to ensure patients receive all the necessary information required to make an informed pregnancy decision. We trust this booklet will be a valuable tool for physicians to support their patients in making a fully informed choice.

Adapted from an informational booklet Unexpected Pregnancy: Practical tools to help your patients make a well-informed decision.

You can access the booklet here.