This "sending her home" phenomena is one of the hardest we have to deal with and we have written about it here before. It is a judgment call to some extent and we never want to create another barrier for women seeking abortion services. When I talk to a woman that is ambivalent she usually comes to see that she is not quite ready, or that there is some unfinished business that would be better dealt with before something that cannot be undone like an abortion is done. I assure you we don't suugest that people re-schedule often; sometimes it is a deciding point for a woman. I had a young woman just yesterday like that. She was saying contradictory things like "I really want this baby." and "I loathe being pregnant." So I encouraged her to take more time if she needed it to be sure. She thought a minute and then straightened up and said, "I'm staying." It may be like flipping a coin and when the opposite of what you want comes up, you realize what you really wanted.
I think when you have talked to women--not that many fortunately-- who return to say, "if someone there had just said, 'are you sure?'" you really want to be cautious about women who just want to "get it over with because I might change my mind" or "I can't come back here again." Decisions made out of desperation really are not optimal. The bottom line is that we are not moral arbiters but we do need to pay attention to both physical and emotional health. If someone persists in "wanting it but dealing with the emotions later" I go over coping strategies very carefully, and detail all that we know about poor outcomes post abortion. Particularly if the abortion is a secret or major players have not weighed in (and this is a source of anxiety for the woman), or if the people around her are in opposition, you could expect some problems down the line.
And unlike other health care, the problems will come back on our door, not just individually but collectively. Has anyone ever stopped to wonder why 1.3 million women every year since 1973 have had abortions and yet we are on the verge of losing legal abortion? I believe that this is one of the issues that have clouded people's commitment to legal abortion. If they feel ambivalent or cannot sort out the situation that caused them to have an abortion, or feel emotionally troubled, it is not only a poor emotional outcome for many women, it is also a political nightmare.
I have experienced some incredible transformations with women who took more time after talking with us. I have learned, like lou, to trust my gut, and to share what I know with the women I talk to. The other piece is that we care about what we do too. It is our signature on the consent form that assures the doctor that she has resolved her ambivalence and is ready for the abortion. If we abdicate this thorny question and don't offer our best information and advice then we really are working at a mill.