Crisis Pregnancy in Ireland
There are a wide variety of reasons which will impel a woman to define her pregnancy as a crisis pregnancy, and to consider terminating that pregnancy.
In some cases, she will have experienced contraceptive failure. In other cases, she and her partner may not have planned to have sex, and will not have used contraception. In other cases, a pregnancy may become a crisis due to the diagnosis of a serious foetal abnormality, or due to other changes in the woman’s personal, family or health circumstances, or relationship issues.
Crisis pregnancy counselling in Well Woman is delivered within the parameters of the 1995 Information Act (the Regulation of Information (Services Outside the State for Termination of Pregnancies) Act, 1995).
This means that a Well Woman Counsellor will discuss a woman’s 3 options – abortion, adoption and parenting – in a counselling session. Our approach is client-centred, with the counsellor’s role being to listen, support and challenge the woman. If requested, we will give information on abortion service providers outside the State.
Partners, close friends or family members are welcome to attend along with women coming for crisis pregnancy counselling, and all women are encouraged to return for follow-up session/s, if needed.
Reproductive Rights in Ireland
All women have the right within the Irish Constitution to receive information on abortion. They also have the right to travel outside this State to access abortion services legally available in other jurisdictions.
To support these rights, crisis pregnancy counselling is available, free of charge, in Well Woman’s three Dublin clinics. All our counsellors are fully-qualified professional counsellors, with many years of experience in the therapeutic field, and all are accredited by the Irish Association for Counselling and Psychotherapy.
Abortion is not available in Ireland, except in cases where there is ‘a real and substantial’ risk to the life of the woman, including the risk of suicide. The risk to her life does not have to be immediate or imminent. Accessing abortion services in these circumstances can be complex.
A pregnant woman’s health, or the long-term quality of her life, is not considered to be grounds for legal abortion.
This note aims to offer broad guidance to women on crisis pregnancy, and on what happens when a pregnancy represents a risk to her life, reflecting the Protection of Life during Pregnancy Act, 2013.
The Protection of Life during Pregnancy Act and the Dublin Well Woman Centre:
Where there is an immediate risk to a woman’s life
In the unlikely event of it becoming apparent during a counselling session, or if a woman indicates it during the session, that there is an immediate risk to her life, she should be referred to the A & E Department of the nearest hospital. If necessary, the Well Woman counsellor, or a Receptionist, will organise an ambulance, and appropriate clinic staff (doctors or nurses) may be informed (with the woman’s consent).
Where there is a risk to a woman’s life that it neither immediate nor imminent
If it becomes apparent during a counselling session, or if a woman indicates it during the session, that she may require an abortion because her life is at risk, but the risk is not immediate or imminent, then the following procedures are followed:
As with all crisis pregnancy counselling sessions, the counsellor will provide information on all the options available to her:
Option 1: Obtaining an abortion in Ireland
The counsellor will discuss the Protection of Life during Pregnancy Act, 2013, referring to:
- The referral process
- The decision-making process
- Timescales involved
- The appeals process
- Eligibility for abortion under this legislation
If the woman expresses a wish to use the Act provisions in order to secure an abortion in Ireland on the basis of a risk to her life, the counsellor will then make a referral to a medical practitioner, in most cases the woman’s GP.
For this to happen, it will be necessary to establish:
- If the woman has a GP
- If she is comfortable with her GP being aware of her decision to seek a termination
- If it is appropriate to refer her back to her GP
- Whether the GP is likely to support her decision to seek a termination, and to refer her to an appropriate practitioner for assessment, under the Act’s provisions
If she does NOT have a GP, or if for any reason she does not wish us to refer her to her GP, then the counsellor should refer her to another medical practitioner (which may include a Well Woman doctor).
Option 2: An abortion outside the State
At this stage, the counsellor will also ensure the woman is aware that the process of obtaining a legal abortion in Ireland is very difficult and time-consuming, and that she may not succeed in meeting the assessment criteria. For this reason, the woman will also be provided with information on abortion services available outside the State.
The format of a regular crisis pregnancy counselling session will be followed, including discussion of abortion, adoption and parenting. The counsellor will underline to the woman that, even if she goes through the Act process, she may still opt to travel outside the State to terminate her pregnancy. As with all crisis pregnancy counselling clients, she will be encouraged to return to Well Woman for counselling information and support, should she choose to do so.
The counsellor will also ensure that the woman is aware of post-abortion support available through Well Woman, notably a medical check-up, or counselling.
Where the risk to a woman’s life is linked to suicidal ideation or intent
If, during the crisis pregnancy counselling session, the woman discloses suicidal ideation or intent which are of concern to the counsellor, the counsellor will first explore with the client her support systems, reality testing and coping strategies.
Based on this discussion, the counsellor will assess the risk of suicide and, if the counsellor considers that there is an immediate risk to the woman’s life, the woman will be referred to the A & E Department of the nearest hospital.
The counsellor may also discuss the provisions of the Protection of Life during Pregnancy Act with the woman, highlighting in particular:
- The eligibility criteria for accessing an abortion in Ireland
- The referral process
- The decision-making process
- The timescale involved
- The appeals process
If the woman decides she wishes to seek an abortion in Ireland on the grounds that she is suicidal, the counsellor will make an urgent referral to her GP.
As in the case of Option 1 (seeking an abortion in Ireland on the grounds of immediate or serious medical risk to her health), it will be necessary for the counsellor to tease out with the woman whether or not she has a GP, and if it is appropriate to refer her to that GP.
In such cases, information on abortion services available outside the State will also be provided to the woman.
If she is not happy to have her GP informed, then the counsellor will make a referral on the grounds detailed under Option 1.
How does a pregnant woman establish that she is entitled to a legal abortion?
A pregnant woman who fears that her pregnancy involves a risk to her life can attend her GP and request a referral for certification that she is entitled to an abortion. A Well Woman counsellor can support a woman in requesting a referral from a GP.
If it is an emergency situation, the woman can present at the Accident & Emergency Department of her nearest hospital.
If a GP considers a pregnant woman’s life to be at risk from suicide, s/he should refer the woman urgently to a local consultant psychiatrist, or a consultant obstetrician, or through the appropriate emergency pathway depending on her condition and how critical her situation is.
The decision-making process
To certify non-emergency physical risk to life: two doctors must examine the pregnant woman and must jointly certify that there is a risk to the woman’s life. At least one of the two doctors must be a specialist in obstetrics and gynaecology. The other doctor must be registered under a relevant specialty, for example, if the woman has cancer, one doctor must be a cancer specialist. The two doctors must consult with the woman’s GP, if she consents.
To certify risk of suicide, three doctors, of whom one must be an obstetrician and two of whom must be psychiatrists, must examine the woman. One of the psychiatrists must have provided mental health services to women in relation to pregnancy, childbirth or post-delivery before but he/she does not need to be a perinatal psychiatrist. All three must jointly certify that there is a risk to the woman’s life. The three doctors must consult with the woman’s GP, if she consents.
In cases of medical emergency, one medical practitioner can certify that the termination is necessary to save the woman’s life, but the risk must be immediate.
Seeking an abortion in Ireland under the legislation is complex, particularly if the risk to life is not imminent, if the risk is of suicide, or if the pregnancy is at an advanced stage of gestation.
Well Woman counsellors will ensure that the woman is aware that:
- Seeking certification of risk to life will involve a number of examinations by a number of different medical specialists who, if she consents, will consult with her GP
- There is no minimum time between presenting with a possible risk to life and having a legal abortion
- The outcome is uncertain
- Seeking certification may result in refusal of abortion
- If the gestation stage is advanced, even in cases where the risk to life has been certified, an early delivery and NOT an abortion will be carried out.
- In cases of conscientious objection, even where the risk to life has been certified, healthcare practitioners may refuse to carry out an abortion
Wherever possible, any woman considering seeking an abortion In Ireland under the 2013 legislation will also be provided with information on abortion service providers outside the State.
Recording of Information
Detailed notes are taken by Well Woman counsellors of all crisis pregnancy counselling sessions. In cases where the woman wishes to seek a termination within the provisions of the Protection of Life during Pregnancy Act, and where a referral is made by the counsellor, the following information will be recorded in the counselling notes:
- Details of any external referrals made, eg to her GP, or psychiatric services, or a social worker, or another NGO
- Details of any internal referrals made, eg to the Head of Counselling Services, or the Medical Director, or another Well Woman doctor or counsellor
The information in this briefing note is of a condensed and generalised nature only, and will change from time to time. Nor should it be considered as a substitute for the detailed protocols, policies and procedures which govern every aspect of delivering Well Woman’s counselling and medical services.
While the Well Woman Centre takes all reasonable care in researching, compiling and publishing this guideline, we do not assume legal or medical or any liability howsoever arising for any inaccuracy, error or mis-statement of whatsoever nature contained herein.
The information accessible herein is entirely at the risk of the user. The Well Woman Centre shall not be liable, directly or indirectly or in any manner whatsoever to the user or any other third party or any person for any damage resulting from the use of the information contained or implied herein.
The Well Woman Centre hereby formally disclaims liability in respect of all of the matters referred to in this guideline. By proceeding, you are accepting this disclaimer.