The scenario:
A 21-year-old patient (she/her) presents to your health center after a positive home urine pregnancy test last week. Based on a sure last menstrual period (LMP), the patient currently has an estimated gestational duration of 6 weeks. When you ask how she’s feeling about being pregnant, she pauses and says, “Honestly? I don’t know. I think I could see myself going either way. I just don’t know what the right thing to do is.”
She has a 3-year-old at home, a job she’s not sure allows for more time off, and a partner she describes as “supportive but not pushing me either way.” She denies urgent safety concerns and has no significant medical history.
What is high-quality pregnancy options counseling?
Person-centered pregnancy options counseling is defined by ACOG as providing “information regarding management options in continuing a pregnancy or not, and seeks to understand a patient’s values, beliefs, preferences, concerns, and ambivalence regarding pregnancy.” The ambivalence the patient in this scenario expressed about their current pregnancy is a normal and common response, not a clinical problem to be solved. This patient is not asking you to tell them what to do or resolve their uncertainty. Your role is to make space for it while ensuring she has accurate information about all pregnancy options she wants to hear about, understands her options, and has a path to follow-up care for whatever she chooses.
Providers have an ethical responsibility to offer truly non-judgmental pregnancy options counseling, avoid making assumptions about how a patient may feel about their pregnancy, and avoid directive statements about what they should or shouldn’t do.
I want to make sure you have everything you need to feel clear about this decision, and that means I’m here to give you real information about all the pregnancy options you are interested in, not to steer you in any direction. There’s no right answer here.
What patients need to know in pregnancy options counseling
Ambivalent patients often don’t know what they don’t know, and filling in factual gaps, such as gestational dating, what the next steps actually involve, and the timeline for decision-making, can help clarify their own feelings without pressure.
Start by establishing gestational dating. Understanding current gestational duration affects the practical landscape for every option: timeline for abortion access, early prenatal care scheduling, and patient understanding of where they are in the pregnancy.
Present options neutrally and specifically. Unbiased language avoids implying that one option is easier, better, or “right”. The decision is between seeking an abortion and continuing the pregnancy, and if continuing the pregnancy, either parenting or making an adoption plan. For patients who want to hear about how to access abortion care, AbortionFinder.org has essential information on gestational limits, travel, cost, and availability. For patients continuing pregnancy, provide a referral to a local provider offering prenatal care.
Ask about what matters to them right now. Open-ended questions and a pause to listen to what they are considering work better than checklists.
What feels most important to you as you’re thinking this through?
or
Is there anything that’s making you lean one way?
Check in on support. Do they have people she can talk to? Do they want to involve their partner in a follow-up visit? Are they interested in connecting with emotional support resources to inform decision-making?
Don’t rush to close. It is okay for patients to leave undecided with a clear next step.
You don’t have to have this figured out today. Let’s make sure you have what you need to keep thinking about it, and we can plan to talk again soon.
What about her worry that she might regret her decision?
Patients who are ambivalent sometimes voice fear of future regret about any direction. For those considering abortion, this concern is often amplified by abortion stigma. The evidence on post-abortion decision regret is now robust and consistent.
In the Turnaway Study, 95% of participants who received an abortion reported that it was the right decision one week afterward, and that finding remained consistent at each follow-up through five years. A 2020 follow-up study found that, despite claims that abortion is inherently stressful and causes emergent negative emotions and regret, participants reported high levels of decision rightness and relief across the study period.
Collectively, these studies show that the overwhelming majority of people who have abortions feel relieved afterward and believe it was the right decision for them. Importantly, the research also shows that negative emotions, when they do occur, are most associated with perceived community stigma, not the abortion itself. Patients who feel supported and unhurried in their decision-making fare better emotionally regardless of the option they choose.
It makes sense to think about that since it’s hard to know how we might feel in the future about anything. What the research shows is that more than 95 out of 100 people who have abortions feel it was the right decision for them, even years later.
Key Points
- Ambivalence in early pregnancy is common, normal, and not a reason to delay high-quality clinical care.
- The provider’s role is to offer accurate information about all pregnancy options without judgment, connect patients with the resources they need, and support their decision-making process.
- Patients who make this decision on their own terms, with accurate information and without pressure, fare better emotionally, whatever they decide.
Clinical Tools
- ACOG. Pregnancy Options Counseling. ACOG Clinical Guidance. July 2026.
- Rocca CH, Kimport K, Roberts SCM, et al. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study. PLOS ONE. 2015;10(7):e0128832.
- Rocca CH, Samari G, Foster DG, Gould H, Kimport K. Emotions and Decision Rightness over Five Years Following an Abortion: An Examination of Decision Difficulty and Abortion Stigma. Social Science & Medicine. 2020;248:112704.
- Foster DG. The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having — or Being Denied — an Abortion. Scribner, 2020. (ANSIRH summary: https://www.ansirh.org/research/ongoing/turnaway-study)