Counseling for sterilization.

PIP: The standards of the Department of Health and Human Services (DHHS) regarding the provision of sterilization services fail to deal with the need for professionally trained sterilization counselors to present the medical, social, and related information in a manner that prospective patients can understand and retain. Sterilization patients require counseling by a person who is competent, experienced, warm, and supportive of their decision. A good counselor will remain non-judgmental and objective. A counseling session with a prospective sterilization patient should have the following specific objectives: help the woman understand her feelings about birth control, pregnancy, abortion, and possible relationships between sexuality and reproductive capacity; help her understand her own reproductive anatomy and physiology; help her understand the sterilization procedure and what she can expect to experience; help her project her thoughts to the future to see if she can think of any life situation in which she might want to become pregnant; and fulfill the legal requirements for obtaining informed consent. The direction and consent of any interview will be influenced by several factors, such as marital status or lifestyle of the prospective candidate. The ideal situation for postpartum sterilization would include counseling and arrangements made long before the onset of labor. Specialized counseling is also valuable when delivery is to be by cesarean section, for in these instances a last minute change of plan is not possible. If female sterilization is to be performed under local anesthesia, the patient should be prepared for the possible discomfort or actual pain that might occur. The counselor also needs to be alert to indications of a special need for in-depth discussion. Such indications include the individual who has a physical, mental, or emotional condition that would be improved by sterilization. Any evidence of coercion should be regarded as a contraindication to sterilization. Those persons depending on possible reversal of sterilization require special attention, but old restrictions on voluntary sterilization based on age and parity should be discarded. A counselor is obligated to present the arguments against successful reversal in individual cases while making it clear that reversals are increasingly successful. Good counseling does much to eliminate regret or at least reduces it to an absolute minimum.^ieng