Pregnancy Counseling

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pregnancy counseling

A service provided to women with crisis pregnancies. Counseling may be offered by social workers at adoption agencies, counselors at family planning clinics, pregnancy centers or schools or other individuals.

The woman with a CRISIS PREGNANCY may need assistance in resolving her immediate needs, for example, verification that she actually is pregnant, location of a place to stay (if needed) and initiation of medical care. She may be eligible for public assistance, such as Temporary Aid to Needy Families (TANF), food stamps and Medicaid.

She may also be uncertain as to whether or not she should continue her pregnancy and may feel compelled to abort her baby because she is fearful of what her parents, friends and others will think when she becomes visibly pregnant.

Often she may have vague and erroneous ideas about adoption that need to be clarified after her immediate needs are met. Should she consider adoption or parenting (presuming she continues the pregnancy), she needs someone who can fully explore both options with her. The agency social worker is usually the best qualified person to provide this service. Whoever provides her counseling should be sure to include the adoption option as one possible choice, whether the woman appears interested or not.

In his study of counselors, Edmund Mech found that many counselors never discussed adoption with pregnant teenager because they were convinced teens were completely uninterested. On the contrary, when Mech surveyed pregnant teens, he found the majority were interested in learning more about adoption. Yet this omission causes a problem for the teenagers (or woman) who is interested: if she brings the subject up herself, will the counselor think she is a "bad" person? By not approaching the topic of adoption, the counselor implicitly conveys the idea that adoption is not acceptable-or at least not acceptable in this person's case.

In addition, a failure to discuss adoption shortchanges the woman who might consider it if she understood what it entailed.

Jerome Smith and Franklin Miroff describe feelings the birthmother faces as she makes her decision about whether to parent or make an adoption plan in their book You're Our Child: The Adoption Experience.

According to the authors, the birthmother may tell herself that an infertile couple will adopt her baby, and without her, they would be unable to adopt. If she is religious, she may see herself as "God's instrument." She may also try to think of the baby as the adoptive couple's child rather than her child. By such thinking, she defends herself against maternal attachment, thereby reducing the sense of anticipatory loss.

She will also swing back and forth between deciding to parent or to delegate parenting to others more prepared for it. Smith and Miroff explain the ambivalence of the woman (or girl) as a "head-heart" response.

Smith and Miroff believe counseling is critically important and state, "A warm, supportive, nonjudgmental atmosphere will allow the woman to think through her situation and discuss the practical aspects of her planning free from coercion."

They add, "In assisting the woman in decision-making, the counselor must help her to separate fact from fantasy, help her to see the realities involved with raising a child alone and with relinquishing a child she may never see again."

Most birthmothers say they have some future plan for themselves after placement; for example, they plan to return to high school or college or they expect to resume their job or career. A study by Jane Bose and Michael Resnick revealed the teenagers who made an adoption plan had much higher educational aspirations than did the teenagers who chose parenting. (See TEENAGE PARENTS.)

Women who refuse to make future plans and who have no idea what will happen to them after the baby is born are far more likely to change their mind about placing the child for adoption, either just before or after the baby is born and before consent is signed, than is a woman with a plan for her future.

Stages of Counseling

In a paper on pregnancy counseling, former vice president of the NATIONAL COUNCIL FOR ADOPTION Mary Beth Style discussed stages of the counseling process, including assessment, decision making, making an "action plan," mourning and acceptance and integration of the adoption experience.

According to Style, it is the initial assessment that requires the most skill on the part of the pregnancy counselor. It is at this point when the counselor must learn about the woman or teenager, her family and her relationships and also evaluate at what intellectual and emotional levels she is. In addition, if possible, the counselor will actually involve the birthfather and the family of the birthmother (and sometimes the family of the birthfather as well), not only to help the social worker with assessment but to involve people who are intimately connected to the crisis at hand and who can help the pregnant woman with resolution, whatever her ultimate decision is.

Style says it is dangerous to concentrate on the outcome (parenting or adoption) at this point because there are many other issues that more urgently need to be discussed (although the woman should be assured that the agency can assist with adoption, should that option be chosen).

During the decision-making phase of counseling, the pregnant woman begins evaluating the pros and cons of parenting and adoption as she explores each option and considers her own unique case.

When she is in the "action plan" stage, she is ready to formulate a plan; however, she cannot make a plan unless the counselor has fully explained both adoption and parenting to her. Says Style, "If the client knew everything she needed and wanted, chances are she would not be in the counselor's office . .?. She may not know the possible repercussions of any of her choices on herself, her baby or the adoptive family unless the social worker leads her through a thoughtful decision-making process after outlining all possible options and supports available to her."

The last stage of counseling is grief counseling. Some counselors may try to shorten this phase because it is painful; however, this well-meaning action could result in even more pain because it inhibits the resolution of the loss. (See LOSS.)

As she resolves the pain associated with the loss, the birthmother can accept that adoption was the best choice for herself and her child, particularly if she feels she was not pressured to make an adoption plan but personally believed it was the best decision. Counselors should be careful not to make adoption a scapegoat if the birthmother complains of problems and should instead seek out what the problem is, whether it be family problems, "unresolved problems of pregnancy" or other problems.


Edmund V. Mech, Orientations of Pregnancy Counselors Toward Adoption, U.S. Department of Health and Human Services, Office of Population Affairs, 1984.

Mary Beth Style, M.S.W., "Pregnancy Counseling: Traditional and Experimental Practices," paper revised and published by the National Council For Adoption, 1999.

Find more information on pregnancy counseling

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