Options counseling for unintended pregnancy
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Options Counseling for Unintended Pregnancy. Overview of presentation. Background on unintended pregnancy Overview of knowledge, skills and attitudes needed to provide care to women with unintended pregnancy Professional issues. Background on Unintended Pregnancy.

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Options Counseling for Unintended Pregnancy

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Options counseling for unintended pregnancy

Options Counseling for Unintended Pregnancy


Overview of presentation

Overview of presentation

  • Background on unintended pregnancy

  • Overview of knowledge, skills and attitudes needed to provide care to women with unintended pregnancy

    • Professional issues


Background on unintended pregnancy

Background on Unintended Pregnancy

Each year in the United States:

48% of pregnancies are unintended:

Approximately half are carried to term or end in miscarriage

Approximately half are terminated

Women with unintended pregnancies are from all races, ethnicities, classes, and religions.


Options counseling for unintended pregnancy

Sexual and Reproductive Health:

Comparison Between Sweden, France, Canada, Great Britain, U.S.


Why do women experience unintended pregnancies

Why do women experience unintended pregnancies?

Access issues:

Contraceptives unavailable/difficult to obtain/expensive

Don’t know about or can’t access emergency contraception

Lack of understanding of reproduction/fertility

Sexual assault/abuse/coercion

Religion and/or partner opposition to contraception

Emotional/psychological reasons

Contraceptive failures


Prevention is important applying a public health model

Prevention is important: Applying a Public Health Model

  • Primary Prevention

    • Preconception care

    • Contraception

    • Emergency contraception

  • Secondary Prevention

    • Pregnancy diagnostics

    • Early pregnancy loss, ectopic pregnancy screening

    • Pregnancy options counseling

    • Early abortion care, adoption, referral for prenatal care

  • Tertiary Prevention

    • Late term unintended pregnancy support

    • Pregnancy termination


Primary prevention

Primary Prevention

  • Preconception care

    • See CDC Reproductive Life Planning

  • Contraception

  • Emergency contraception

    • OTC and prescription

    • Emerging research suggests overweight & obese women may have decreased efficacy with oral EC.

    • Copper IUDs very effective


When primary prevention is unsuccessful

When primary prevention is unsuccessful

  • Secondary Prevention

    • Unintended pregnancy has occurred

    • Pregnancy options counseling


What skills do nurses aprns need to provide care to women with unintended pregnancy

What skills do nurses/APRNs need to provide care to women with unintended pregnancy?

Attitude, skills and knowledge


Attitude needed by rn aprns to provide options counseling

Attitude needed by RN/ APRNs to provide options counseling

  • Inform and educate self on:

    • Providing care in a sensitive, respectful manner, acknowledging the need for privacy and confidentiality.

    • Using language that is sensitive and respectful.


Skills needed by rn aprns to provide options counseling

Skills needed by RN/APRNs to provide options counseling

Providing non-judgmental, non-directive counseling using specific counseling techniques.

Addressing issues of ambivalence.

Supporting the woman in her decision-making.

Assuring that the informed-consent process includes appropriate, accurate information about the potential benefits and risks of abortion, adoption and continuing the pregnancy.

Providing resources or referrals to

quality providers.


Options counseling for unintended pregnancy

Skill: Provide options counseling using non-judgmental, non-directive counseling techniques to promote effective communication:

  • Asking questions

  • Reflecting

  • Normalizing

  • Examining consequences

  • Reframing


Skill counseling

Skill: Counseling

  • If the woman appears too overwhelmed to respond to the news of an unintended pregnancy, give her time to absorb the news

  • Assist the woman to identify support systems and access risks

  • Discuss a timetable for decision-making


Skill informed consent

Skill: Informed consent

  • Principles of informed consent:

    • Client must have appropriate information to make an informed decision

    • Decision-making is not coerced or manipulated

    • Client is capable of understanding information and making

      a decision


Knowledge needed by rn aprns to provide options counseling

Knowledge needed by RN/APRNs to provide options counseling

Inform and educate self about:

  • Providing the full range of pregnancy options.

  • Counseling on prenatal, adoption or abortion care.

  • Assisting women with selecting an acceptable contraceptive method.


Knowledge needed by rn aprns to provide options

Knowledge needed by RN/APRNs to provide options

What are a woman’s options?  

Continue pregnancy and:

parent

make an adoption plan

Terminate pregnancy through:

medication abortion

aspiration abortion


Counseling continuing the pregnancy

Counseling: Continuing the pregnancy

  • Provide education about the effects of alcohol, drug use, smoking, toxins and medications on a developing pregnancy. Review current medication use.

  • Screen for any personal or family history of genetic diseases that may require a consult with a genetic specialist.

  • Provide a prescription for prenatal vitamins (which include folic acid 1mg).

  • Provide referrals for prenatal care.

    • Is woman interested in midwifery care?

    • If financial resources are limited, is she eligible for Medicaid, WIC, or other programs?


Early pregnancy health concerns for any woman with an unintended pregnancy

Early pregnancy health concerns for any woman with an unintended pregnancy

  • Does the woman have any immediate social concerns?

  • Does the woman need nursing support or medical management for nausea of pregnancy?

  • Screen for domestic violence.

  • Screen for abdominal/pelvic pain with vaginal bleeding. If present, refer the woman for an immediate workup for a possible ectopic pregnancy.


Counseling choosing adoption

Counseling: Choosing adoption

  • Applies skill in nondirective counseling

  • Knowledge of different types of adoption:

    • Open, closed, familial adoption, state adoption or foster care

  • Management of or referral for adoption services


Positive adoption language

Positive Adoption Language

POSITIVE

NEGATIVE

Giving your child away

Putting your child “up” for adoption

Keeping the child

“Real” or “natural” mother/father/parents

Keeping the child

  • Planning an adoption for your child

  • Choosing an adoptive family for your child

  • Birthmother, birthfather, birthparent

  • Deciding to parent the child

Adapted from Open Adoption & Family Services www.openadopt.org


Counseling choosing an abortion knowledge

Counseling: Choosing an abortionKnowledge

88% are done in the first 12 weeks of pregnancy

95% performed in outpatient setting

Actual procedure takes less than 5-10 minutes in most cases

Local anesthesia used; may opt for conscious sedation or general anesthesia

In outpatient settings, average cost $468


Method of abortion medication

Method of Abortion: Medication

Advantages:

  • May offer more privacy

  • Can occur in comfort of home

  • Avoids instrumentation procedure

    Considerations:

  • Two medications: mifepristone administered in the office & misoprostol self administered at home.

  • Takes 4-6 hours (on average, maybe longer) to complete abortion at home.

  • If unsuccessful, requires f/u aspiration intervention.

  • Currently used for abortions up to 9 weeks gestation.


Method of abortion vacuum aspiration

Method of Abortion: Vacuum Aspiration

Advantages:

  • Procedure complete within minutes during one visit

  • High success rate

  • Can be performed into second trimester

    Considerations:

  • Involves instrumentation procedure

  • Similar cost to medication option

  • Can be performed with manual vacuum or electric vacuum aspiration


Aspiration abortion procedures

Aspiration abortion procedures

Methods and timing:

Vacuum aspiration

Up to 14-15 weeks

Dilation and evacuation

15-23 weeks

Induction or instillation

Used <1% of procedures, usually between 20-23 weeks


Summary suggested steps in pregnancy options counseling

Summary: Suggested steps in pregnancy options counseling

Explore how the woman is feeling about the positive test result.

If she is unsure of her plans, help her to consider her alternatives. Many women will know what they want to do.

Help her to identify support systems.

If she is not ready to make a decision, discuss a timetable for decision-making after estimating gestational age by LMP and/or clinical exam and/or ultrasound to determine gestational age.

Refer or provide her with appropriate information about abortion or adoption services.


Professional responsibilities

Professional responsibilities

  • Engage in self reflection and values clarification about the intersection of personal beliefs and professional responsibilities.

  • Uphold the woman's autonomy and right to care.

  • The ANA Code of Ethics offers an ethical framework for approaching nursing care.


Additional resources

Additional resources

www.roeresources.org

Thank you to Grayson Dempsey of Backline for the ppt. slides on adoption.

PPT updated Feb. 2014


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