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Counselling before medical abortion

Counselling before medical abortion. Counsellors’s Role. Make sure that woman‘s decision to abort is firmly settled. Listen to the woman’s motivation behind her choice of the method . Ensure a proper understanding of the method.

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Counselling before medical abortion

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  1. Counselling before medical abortion MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  2. Counsellors’s Role • Make sure that woman‘s decision to abort is firmly settled. • Listen to the woman’s motivation behind her choice of the method . • Ensure a proper understanding of the method. • Make sure that women is psychologically able to take upon herself and to comply with the schedules of the appointments, in particular coming back for ultra sound and follow up visit • Be able to reach an emergency area, during the following 2 weeks, in case of problems. • Discuss any concerns at the follow up visit. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  3. Chronology Surgical Abortion Medical Abortion 8 to 14 weeks of amenorrhea Applicabilty = < 7 weeks of amernorrhea Gynecology consultation HCG Test/ultrasound and group RH Counseling - Clinical exam - Abortive pill taken (by the patient) a the clinic, after the signed consent. • Clinical exam • Surgical abortion(by surgeon) • at the clinic • 48 H later prostaglandine taken orally • (by the patient) at the clinic or at home. - Follow up visit ? • Follow up visit at the clinic • around 10 days later. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  4. Surgical abortion >= 7 weeks of amenorrhea. Wants to be taken totally in charge. Unable to take charge herself. Does not want to wait for the expultion. Women fears the bleeding associated with medical abortion. Women has a greater concern regarding potential pain of medical abortion. Medical abortion <= 7 weeks or less of amenorrhea Simple and less invasive methode. Done earlier in the gestation. Women prefers to avoid anesthesia. Terrified by surgery. Women does not want to touch their body. Wants to be involve and in control. Patient’s Decision Criteria MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  5. New Law in 2004 • In order to facilitate access to medical abortion MD practitionners who belong to a « Network », (who have been trained specifically on abortion) are allowed now to give Mifegyne at their private office The prostaglandine is taken at home, the patient come 10 days later to check through ultasound that abortion is done MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  6. Cost for patient • At Hospital total price is 259,45 . 80 % of Medical abortion cost is taken in charge by Medical Social Security, and Patient pay the remaining 20% : 51€89 • At home with private practice, total price is 200€, patients are reimboursed 80% by Social Security they pay 40€ MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  7. What is the reality of medical abortion for a woman (1/2) • The abortion starts when she takes the mifepristone (600mg) Day 1 - 80% have no clinicalsymptoms. - 15 % may start to bleed equally or more than during the normal period. - 5 % expel. Day 2 - Misoprostol 400 mg PO will induce uterine contraction leading to the expultion of ovular sac. (Pain depends on each woman’s psychological and physiological history; if the patient has dysmenorrhea she will have equal or superior than during the period) Possibility of taking oral contraceptif immediatly. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  8. What is the reality of medical abortion for a woman (2/2) Day10 Follow up visit is determinant to finalize this abortion. We may manage a throphoblast or ovular retention bay adding an other dose of misoprostol or performing a surgical abortion. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  9. What the women say (1/2) Avantages of medical abortion - Pill, no surgical intervention - Its more natural - No doctors touching my body - Conscious and self experience - Choose to come back for the misoprostol at the clinic or to stay home in their own environment MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  10. What the women say (2/2) Disadvantages of medical abortion - Not sure when abortion will take place - More blood loss - Anxious about cramps, nausea, or eventually diarrhoea MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  11. CONCLUSION (1/2) • Receive the patient in her request, • With respect • With a positive attitude, • Listen to her in the globality of her situation. • And of course, provide her with the advice’s most relevant to her choice. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

  12. CONCLUSION (2/2) • Giving her the relevant information fitted to her case, • Understand that the team is available if she needs help. • Will allow her to take responsibility for her own actions with more autonomy and confidence all along the procedure. • A patient correctly informed will be more comfortable and will improve the chances of succes of method. MOSCOW 0ctober 27-28, 2005 CHRISTIANE DER ANDREASSIAN Hopital Broussais PARIS FRANCE

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