3-Step decision-making guide for women and pregnant people

Introduction

MSI Australia offers non-directive, Pro-Choice pregnancy options counselling to women and pregnant people. Our qualified counsellors are trained to provide a confidential, and evidence-based service. We have experience in areas such as; relationships/couples counselling, trauma including family violence and sexual assault, homelessness, care coordination and service navigation, advocacy, sexual and reproductive health, and perinatal and infant mental health.
Our counselling team is based in Melbourne, Victoria; providing sessions to people in all States and Territories, using telephone or video. Interpreter services are available. We operate 9am-5pm, Monday–Friday excluding Public Holidays.

We acknowledge your unique story. We respect your bodily autonomy regardless of your age, gender, sexuality, relationship status, race, ethnicity, citizenship status and religion. This Guide is intended to help you organise your thoughts and feelings about either continuing with your pregnancy (which would mean to either parent, place a child in care or kinship care, or legally relinquish guardianship through a formal adoption) or proceeding with a termination of pregnancy (also known as abortion). Deciding under time pressure about these important issues can be straight forward for some people and exceedingly difficult for others.

We hope this Guide gives you a structure to sort through your feelings and thoughts. There are no right or wrong answers when it comes to making a choice that’s best for you. Please remember as the pregnant person, you will be most impacted regardless of the decision you make.

We understand you may need to consider other people’s feelings and opinions when working out what to do. If you are feeling pressured by someone to make a decision in one way or another, please know that this is not ok. The pressure may be subtle or obvious, and may come from different people including family members, a partner, a friend, an employer, or a medical or religious organisation. It may be part of other controlling and unlawful behaviours you are experiencing. If, because of this pressure, you feel unable or unsafe to make a decision that is best for you, we see this as a form of abuse called reproductive coercion. Support is available for you, and details can be found at the end of this Guide.

What are my Pregnancy Options?

The following are working definitions of your five Pregnancy Options:

1: Parenting – Continuing with the pregnancy and choosing to parent is the option chosen by around half of women and pregnant people considering their pregnancy options (Southern Tier Women’s Health Services, 2020). You may choose to parent with a partner or parent on your own. Depending on your circumstances there may be legal, and guardianship matters to consider, as well as child support arrangements. Various online and in-person services are available to support new parents and their infants.

2: Adoption – Adoption is a permanent legal arrangement where the birth parents or parent transfer parental rights and responsibilities over to the adoptive parents (Department of Families, Fairness and Housing – Victoria State Government, 2021). This process involves signing a legal agreement, which authorises another party to take on the legal guardianship of a child (Family Planning NSW, 2019).
In many cases, arrangements are made to specify the frequency and type of contact between the child and their biological parent(s), with the primary consideration being the child’s best interests. For more information in Victoria, please go to www.justice.vic.gov.au/your-rights/adoption

3­: Care – Out of Home/foster care is when your child is cared for by unrelated others including by funded organisations. There are different types of out of home/foster care. Foster care options include Temporary Foster Care and Permanent Care (Southern Tier Women’s Health Services, 2020). Reasons why children are placed in care are varied, and contact with biological parents is respected and encouraged where this is in the child’s best interests.

4: Kinship Care – Kinship care is the arrangement in which a child or young person is cared for by a family member or someone with a familial type relationship. There are times when a biological parent is unable to raise their child. In some communities, it is common and important for a child to be raised by extended family or community members.

5: Termination of pregnancy (also known as abortion) – There are two types of abortion: Medical Abortion (which involves the use of prescribed medication to end a pregnancy) and Surgical Abortion (a safe day-surgery procedure which involves the removal of the pregnancy, most often performed in the first trimester up to 14 weeks gestation). Please contact MSI Australia on 1300 003 707 for information on State and Territory gestational limits, and pathways to care.

Personal Considerations

This section considers the unique factors influencing your decision-making, such as your personal values and beliefs, future plans and your health and/or mental health issues.

Values and beliefs

It can be helpful to identify your values and beliefs around parenting, care/kinship care, adoption and termination of pregnancy. Values are the fundamental principles we believe in that guide our actions. How are your views on pregnancy options related to your values? Which values are non-negotiable when you think about the following?

You may like to add to this list:

• How do I feel about parenting at this stage in my life?
• Am I ready to raise a child now (with a partner or on my own)?
• Are my circumstances different to what I thought they would be when I imagined myself being pregnant? If there is a difference, does it matter?
• Is it important for me to be in a stable, committed relationship? What are my attitudes toward sole parenting?
• If I decide to adopt, who are the people in my life that would be most supportive? Who would disagree with my decision? What would I need from them?
• Is terminating a pregnancy an act of self-care?
• How would placing my child with a relative impact me? Would I want to be involved in the child’s life?
• Do I feel comfortable with the decision to terminate?
• How do I usually cope with significant life changes/adjustments?

Below is some space to write notes about your values and beliefs, or you could write some notes on your phone:

Goals and future plans

When making any significant decision, it’s important to consider any longer-term impacts.

The following questions may help you envision how a decision to continue a pregnancy (parent, adopt, care or kinship care), or terminate a pregnancy, might affect your future.

• Where do I see myself in 3 years, 5 years? In 10 years?
• What goals/dreams do I have for myself? (Personal growth, having my own family, career, travel, marriage?)
• How would the various pregnancy options help/hinder my ability to achieve these goals?
• Could I give up my goals or put these on hold? Why or why not?
• What activities and interests are important to me? How would continuing with the pregnancy affect my ability to engage in these activities? How would terminating the pregnancy affect my ability to engage in these activities?
• How would my life be different if I went through with the pregnancy?
• If I had an abortion, would I still be able to achieve my career/study goals?

Below is some space to write notes about your values and beliefs, or you could write some notes on your phone:

Physical and mental health

Another personal consideration may be your physical or mental health. Below are some questions to help you to explore this further.

• Would continuing the pregnancy impact my physical health? How would I manage sleep disruption or changes to my fitness?
• Do I have underlying health issues that would be affected by this decision?
• Will I be able to have another pregnancy?
• Am I too young/old to have a child now?
• How would continuing with the pregnancy impact my mental health? How would I manage any anxiety or depression?
• Will memories of previous trauma recur if I have a termination?
• (If applicable) How did I cope with prior pregnancies or births?
• Am I in the right headspace to raise a (another) child?
• Will my safety be at risk from someone I know, if I decide to relinquish guardianship of a child?

Below is some space to write notes about your values and beliefs, or you could write some notes on your phone:

Other considerations

This section will guide you to explore some of the external factors that may influence your decision-making. Issues you may be concerned with include responses from your significant others and managing a range of relationship dynamics (including with family/friends/existing children), finances, employment and housing.

Relationships/partners, children, family

Some women and pregnant people include their partners, family members, and/or children’s needs in their decision-making process. Consider if these needs would still be there if you were not pregnant. Here are some of the questions people sometimes ask:

• Am I ok with changes to my relationships, income and lifestyle if it were for the right reason?
• How well do we know each other, especially in relation to parenting/adoption/kinship care?
• My partner says it’s my choice, but is s/he really ok with me choosing what’s best for me?
• How do I feel about parenting in a shared custody/residency agreement with my ex?
• Whether or not I am in a relationship, could we parent a child?
• Which option will give me quality time for the kids I already have?
• Do I have a friendship group to support me through this process? If not, who could I speak to?
• Will my parents think that I have brought shame on the family because I’m pregnant and unmarried?
• My Aunts are supportive, so should I continue with a pregnancy?
• We’ve wanted a child for so long, why am I feeling so upset/angry/scared about being pregnant?

Finances/employment/housing

When making a decision about which pregnancy option, it can be helpful to think about your financial, housing, and employment stability. Some questions you might ask yourself as you consider these factors include:

• Would I be able to support a child financially alone (or with my partner)?
• Am I (are we) able to provide stable housing for a child?
• Does continuing with the pregnancy mean losing my job/independence?
• Would I be able to take time off work, or if I quit my job, could I find another one?
• Would it be possible to raise a child and further my study/career at the same time?
• How would I cope with less paid work?
• Do I qualify for government assistance?
• Would I be okay financially if I adopt/place the child in care or with my family?
• Do I have a support system which allows me to continue in a paid job?
• This area doesn’t have childcare options, should I move closer to family?
• How much does an abortion cost? Do I need financial assistance?

Religious reasons

You may have religious beliefs that guide your actions. You may also be feel conflicted if you are leaning toward a decision which goes against your religious beliefs. Religious beliefs can and do influence pregnant people’s understanding of their reproductive choices. Here are some points to consider. What comes up for you when you reflect on these?

• I am from a religious family, but I consider myself a non-believer
• A loving God would support me regardless of my decision
• My religion is against sex before marriage, let alone abortion
• My parents would be ashamed if I were to terminate the pregnancy
• My community will disown me
• I deserve God’s punishment
• I cannot destroy a sentient being
• My minister/ my friends at church will treat me differently
• I’m not sure if I can forgive myself
• I was on contraception; it doesn’t make me a bad person. This is no different.
• I am comfortable with my lifestyle regardless of my religious upbringing.

Culture

Cultural norms about intimacy, relationships, pregnancy, sex and sexuality, body image and parenting are present early in our lives and can influence our thinking and behaviour. Cultural context is important when making choices about healthcare, however there may be medical considerations to weigh up when pregnant. Having an independent source of information is vital.

My Story, My Decision

You are the expert on your life, and your story should be what you want it to be. We understand you are under time pressure so here are some key questions.

• What is your gut telling you?
• When have you trusted yourself in the past to make decisions that are right for you?
• Are you allowed to put your needs first? If not, why not?
• Whose point of view do you think is most important right now?

Small Steps Forward

Whatever decision you make, it should fit as much as possible with your values, beliefs, abilities and your unique situation. It’s common to think about ‘pros and cons’. Realistically though, making a decision like this is not clear cut. Aim to make a decision that works for you better than the others or, is one that you can learn to be at peace with.

Now you have considered everything, write down the decisions you might make for Step 1 (Continuing with the pregnancy) and Step 2 (Having a termination of pregnancy).

Step 1 – Continue with pregnancy

Do I want to parent, adopt, or place my child in care or kinship care?

Parent:                          
Adopt:                          
Care:                          
Kinship Care:                          

Step 2 – Termination of pregnancy

Do I want a termination of pregnancy (an abortion)?                          

Step 3 – Bringing my story together

The way I’m leaning about my pregnancy options:

Parenting – The idea of continuing the pregnancy and becoming a parent now makes me feel                           because                          , and these thoughts come to mind as I consider this option:                          .

Adoption – The idea of continuing the pregnancy and placing the child for adoption makes me feel                           because                          , and these thoughts come to mind as I consider this option:                          .

Care – The idea of continuing the pregnancy and placing the child with caregivers outside family makes me feel                           because                          , and these thoughts come to mind as I consider this option:                          .

Kinship Care – The idea of continuing the pregnancy and placing the child with extended family and community members makes me feel                           because                          , and these thoughts come to mind as I consider this option:                          .

Termination – The idea of having an abortion makes me feel                           because                          , and these thoughts come to mind as I consider this option:                          .

Frequently asked questions

Q: What if I change my mind at the clinic?

A: We understand the experience can be overwhelming. If you have any doubts, please talk to the nurse at the clinic who will listen to your concerns without judgement. At MSI Australia we respect your decision and will be guided by what you. If you remain unsure, the nurse and doctor will advise you that the appointment cannot proceed.

Q: Could I feel regret after I make a decision?

A: The decision you make, although right for you, may leave you with some worries, sadness, anger or regret. Difficult feelings are survivable. Feelings are not facts. Try to remember that you’re making an informed choice that’s best for you in a time-pressured situation. Post procedure counselling service is also available through MSI Australia.

Q: Can I bring a support person to my appointment?

A: A support person may be permitted to enter the clinic at the discretion of the Nurse Unit Manager (NUM). It depends on the clinic due to space restrictions and various Covid-19/safety requirements across States and Territories. A support person must stay in the waiting room unless otherwise approved by the NUM.

Q: At the clinic can I access the MSI Australia counselling service?

A: You can let the nurse know that you would like counselling support. Due to the likelihood people will be feeling emotional and stressed at the clinic, we cannot offer decision-based counselling on the day of the procedure. We prefer that you have at least 24-48hrs to consider all your pregnancy options.

The nurse will book a Counselling Intake appointment for you. This appointment is to better understand what type of counselling will meet your needs. The Counselling Intake Officer will schedule the actual counselling appointment according to your and the counsellor availability.

Unfortunately we cannot provide crisis support for acute mental health deterioration. If this is needed, the Clinic staff will work with you to help you access the nearest service for specialist care.

Support services

• Ring 000 if you believe your life is under immediate threat.
• If you are in distress and need crisis support, contact Lifeline on 131 114. Lifeline offers a 24 hour, 7 days a week telephone counselling service, online chat for crisis support, suicide prevention and mental health support services. Further information is also available at: www.lifeline.org.au
• If you are an Aboriginal or Torres Strait Islander person wishing to access cultural support, please call 13 YARN (13 92 76) to speak with community.
• If you are unsafe or worried about your safety, please contact 1800 RESPECT (24hr) on 1800 737 732. 1800 RESPECT provides a range of help and support options for people experiencing domestic, family or sexual violence. They offer online and telephone counselling services for all people in Australia, including people for whom English is a second language. Further information is available at: www.1800respect.org.au
• If you are experiencing housing, financial or food insecurity, domestic or family violence, or would like to be connected to community services including legal assistance or physical/mental health services, please visit askizzy.org.au – you can select the type of assistance you are seeking and input your postcode to locate a range of support services in your local area.
• PANDA – Perinatal Anxiety & Depression Australia – supports the mental health of parents and families during pregnancy. The Helpline, 1300 726 306, operates Monday to Saturday and is staffed by trained and experienced counsellors and volunteers.