When You Weren’t Expecting Them To Be Expecting – 4 Immediate Actions

“NO,” my boss almost yelled. “You are NOT allowed to refer any patients to Planned Parenthood. We don’t believe in that here.” Shocked, frustrated and bereft of support, I walked out of her office, wondering how this could be happening.

I had requested referral information, not permission, and my boss’ response shook me. I already felt overwhelmed with my duties as a brand new NP in a Federally Qualified Health Center, but now with one more stress to deal with. Can you burn out in your first month of practice? In that moment, I believed so.

The teenaged patient had come in and informed me that she had become pregnant, and wanted an abortion ASAP. I confirmed that she was 7 weeks, and asked if she wanted to talk about options. She declined, and said she just needed emotional support and help finding an abortion provider. Despite the lack of support from my boss, I succeeded in directing the patient to an appropriate clinic.

Not all “I just found out I’m pregnant, and it wasn’t planned” visits are this dramatic, but they are almost always charged with emotional energy on both sides of the stethoscope. The patient may feel shocked, elated, frustrated, terrified, confused or simply content.

We may be judging the pregnant woman, her partner or lover, ourselves, “the system,” society or their OB/GYN. How do we deal with those feelings and not inflict them on the patient so we can be fully present and supportive?

Action #1 – Normalize Your Feelings

Whether you are feeling frustration, anger, guilt, sadness or nothing at all, it is normal. Unexpected pregnancies are a charged topic in our society, and despite our training in “impartiality” and all that jazz, we are human beings first, and react strongly to things that affect us. It is normal to feel judgmental at such times as well. Take a deep breath and Be Kind to Yourself.

Action #2 – Don’t Guilt-Trip Yourself

As Albert Ellis, the “New York Taxi driver of psychotherapists,” said: “Stop shoulding on yourself!” Yes, maybe you could have done better, or gotten them on birth control previously. Maybe you disagree with their decision, and are angry about needing to hold yourself back as you discuss options with them. Maybe you are angry because disagree with your staff or leadership about how to handle pregnant teens. That’s okay. Take a deep breath and Be Kind To Yourself.

Action #3 – “Mind the Gap”

Between a triggering event and an emotional response, there is always a gap. Becoming mindful and aware of this gap allows for more thoughtful responses to your own feelings and the situations that “cause” them. The true cause of our emotional responses is internal rather than external. I discuss “The Gap” and how to handle it in further detail in Day 14 of the Burnout Recovery Guide. Take a deep breath and Be Kind To Yourself.

Action #4 – Take Care Of The Patient

Support her, refer her, accept her for prenatal care, listen to her, and/or take care of whatever she needs that you can provide.

Allow time afterward to manage whatever fallout has occurred for you emotionally from the situation. You may not need this if you manage unexpected pregnancies frequently, but many of us need to process it afterward, particularly if the patient was extremely distressed.

In the above case, for example, after I went home from work that day I needed to process the conflict with my supervisor. I shared the situation with nurse practitioner friends and mentors, and they confirmed that indeed “no, Samantha, you’re not crazy. Neurotic, yes, but not crazy.”

And yes, putting the patient “fourth” in this case is intentional. If you don’t manage your own emotional reactions first, you may say or do something that deeply offends the patient. They are at their most vulnerable at this point, and need us to be fully present. Managing our own emotions first allows us to be present at that level.

Also note that steps one through three take no significant amount of time. They can usually be completed within a few seconds, with a single cleansing breath. Taking care of yourself allows you to take better care of your patients.

Even if you weren’t expecting them to be expecting, you can expect strong reactions from all sides. Know how to manage yours, and you will be even more effective at helping manage theirs, and the world will be a better place for everyone involved.

Take Care of You,