As a Labor & Delivery nurse of 14 years, I often cared for women who experienced pregnancy loss. In many of those cases, they had made the painful choice to terminate a very wanted pregnancy because of a medical problem. Pregnancy termination for medical indications is a very complex issue that leaves women and their families confused by their feelings and unable to find support for their situations. If they are offered any type of support immediately after the termination, it is usually in the form of a pregnancy loss support group. However, a woman who has opted to terminate her pregnancy will typically feel uncomfortable with the notion of sharing her story with women whose babies have died of natural causes. In the unlikely event they seek out a typical post-abortion program, it is not always a comfortable fit and may not be effective. The biggest need for these women is dealing with the loss that occurred days ago, versus dealing with the shame and guilt of women who experienced abortion months or even years ago. They may not be prepared to even acknowledge that what just occurred was a late term abortion. The last option is paid professional counseling, which may or may not be covered by insurance, if they even have insurance. Therefore, they are left to suffer in silence, wondering how to relate to their loss and deal with their feelings.
Most women who terminate for medical indications do so because their babies have been diagnosed with serious, usually life threatening, conditions. These women feel that they have to choose "the lesser of two evils." The first choice is to terminate a very wanted pregnancy. They have bonded with their babies and are often in the process of picking names and preparing a nursery. The second choice is to wait for the inevitable — the death of their babies in utero or the lifelong suffering and possible death of a child. They cannot fathom the third option, which is to let nature take its course. They face tremendous pressure from a medical community constantly dealing with wrongful birth lawsuits, as well as families who don't want to see them or their babies suffer any more than necessary. They also face the possibility of huge future financial obstacles related to a child with medical issues and special needs.
Some women are urged to terminate because of their own medical conditions, such as newly diagnosed cancer. They face losing their own lives as well as their babies' lives, possibly leaving behind other children. Usually they are being urged to make a decision quickly, as many states have laws restricting pregnancy termination in the third trimester. Typically, they are into the later weeks of the second trimester when they receive the diagnosis. Therefore, they make the choice to terminate their cherished pregnancy. They are fully aware of what is about to happen. They schedule either a late-term abortion appointment at a clinic or a labor induction at a local hospital. They may be planning a funeral for a baby that still is moving around inside them. They struggle with what to tell coworkers, friends, and family members about their soon-to-be non-pregnant state. They grieve from the time of their diagnosis to the time that the termination is completed. They believe that the hard part has passed once the process is over and that the grieving will stop. Then they go home and the grieving begins anew.
Three years ago, I accepted the position of Nurse Manager at Women's Resource Center of Jacksonville, Florida. As I became involved with post-abortion ministry, I felt a strong desire to minister to women who chose pregnancy termination for medical reasons. As CPC workers, we understand that these women have experienced abortion regardless of how it is phrased, when it occurred, or why it happened. We know the value that God places on life from the moment of conception. However, we also know that these situations do not take Him by surprise and that He desires to heal the hearts and save the souls of those suffering as a result.
I hope you will consider reaching out to these hurting women. There really is not much help available to them. Following are recommended steps to attract and minister to this unique group of post-abortive individuals and their families.
Step One: Prayerfully consider starting a perinatal hospice ministry if one does not already exist in your area. Perinatal hospice provides support and information to families who have received an adverse diagnosis during pregnancy. Pregnant women and their families may find the help necessary to carry the pregnancy to its natural end given the support of a perinatal hospice program. Be aware that some clients may need reassurance that we wish to help them explore their options and support them through a difficult pregnancy if they choose, not to pressure them out of a termination decision. A recent client of our center stated, "Organizations should be aware that the client would probably have fears of contacting them because of the assumption that the organization would try to talk her out of the termination or judge her." She recommended that when marketing to potential clients we relate that our organizations will talk with them about their diagnosis and the decision to be made and, if possible, have trained medical staff available to talk to them about their difficult decision.
For general information, visit www.perinatalhospice.org. You may also wish to consider training available specifically to CPCs through Truth Link Now. You can review courses available at www.tlrescuenow.com.
Step Two: Resolve in your mind that the loss of a baby, not the act of abortion, will be the primary focus of support. Decide what materials you will use. Again, typical post- abortion materials will likely alienate, not support, your clients. One resource that I have found highly effective is Threads of Hope, Pieces of Joy, a pregnancy loss Bible study authored by Teale Fackler and Gwen Kik. The study focuses on all of the stages of grief, specific to any kind of pregnancy loss, allowing clients to discuss their experiences and how those experiences affected them emotionally, physically, and spiritually. One chapter deals with the issue of guilt, which is a natural gateway into discussion of the feelings associated with making the choice to terminate pregnancy. It is available free of charge at www.scribd.com. Another option is to put together your own materials, using the various stages of grieving as a springboard for discussion at each session.
Step Three: Develop a list of perinatal loss resources such as websites, books, and memorials for the unborn in your area. Have these available at the first visit with your client. You may want to offer a book such as I'll Hold You in Heaven by Jack Hayford, in the event that she does not return to your facility after the first visit.
Step Four: Consider the room or area that you will use to meet with clients. Are there pamphlets, posters, or other media about abortion conspicuously located about the room? Though we are not trying to hide our position on the sanctity of human life, we want to consider the feelings of our clients in these situations. They already fear, and may have experienced, condemnation by others. Also, keep in mind that they prefer termination rather than abortion when discussing their circumstances. We want them to know that we plan to extend mercy and grace, no different than our Savior, Jesus Christ, does for us every single day.
Step Five: Determine who will provide these services. The most likely candidates will be those who currently offer post-abortion support services at your facility. Again, make sure that these people reframe their thought processes to focus on the overwhelming feelings associated with the loss, such as debilitating depression and crushing sadness versus the normally occurring feelings of guilt and shame that surround abortions performed for non-medical reasons.
Step Six: Notify local Ob/Gyn and Perinatology offices, hospital chaplains, and social workers of your program. They can refer women to your facility upon discharge from their care.
Step Seven: Strive to make the first visit a comfortable and inviting experience for your clients. The first visit should be a time to let the client simply tell her story and express her feelings. Provide reassurance that her feelings are valid, the circumstances are difficult, and she is not alone in her experience. Ensure that she does not exhibit signs that require immediate medical care (suicidal thoughts or inability to care for self or others, for example). Just being able to tell her story and having her feelings validated will be an immediate source of relief. Discuss with her what she would like to accomplish during her period of support services at your facility, making a list of goals that she would like to work towards. Then invite her and her husband/partner, if desired, back for further support sessions.
Step Eight: Allow your clients to evaluate your services at each visit. You may use current exit surveys, or you may find that they need to be revised to fit the situation. Evaluations will help you make continuous improvements to your program as well as provide testimonials to help you market the program.
Tricia McCool specialized as a labor and delivery nurse for 16 years. She currently serves as Nurse Manager at Women's Resource Center, Jacksonville, Florida. She can be reached at firstname.lastname@example.org.