Post on 15-Dec-2015
PRCH © 2006 1
Pregnancy and Options Counseling and
Values Clarification
PRCH © 20062
OutlineOutline Sexuality and pregnancy data
Goals of effective pregnancy options counseling
Pregnancy options
Options counseling in practice
Values Clarification
PRCH © 20063
ObjectivesObjectives By the end of this presentation,
participants will be able to: Identify 3 elements of effective options
counseling relating
Describe the health care provider’s role in the process of options counseling
Discuss the important issues regarding each pregnancy option
Clarify their own feelings around abortion provision and counseling
PRCH © 20064
Pregnancy in the United StatesPregnancy in the United States
More than six million women become More than six million women become pregnant annually pregnant annually
Slightly fewer than two-thirds of these Slightly fewer than two-thirds of these pregnancies result in live birthspregnancies result in live births
20% result in abortions20% result in abortions
The remainder end in miscarriageThe remainder end in miscarriage
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Pregnancy Outcomes for Teenagers 15–19 Pregnancy Outcomes for Teenagers 15–19 Years by Race and Hispanic Origin, Years by Race and Hispanic Origin,
1990 and 20021990 and 2002
0
50
100
150
200
250
1990 2002 1990 2002 1990 2000 1990 2002
Abortion rate
Birth rate
All Races White Black Hispanic
116.3
75.4 98.865.0
223.8
134.2 169.1131.5
Rates per 1,000 women
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Unwanted PregnancyUnwanted Pregnancy
About half of all pregnancies are About half of all pregnancies are unintendedunintended
42% of unintended pregnancies are 42% of unintended pregnancies are terminated by abortionterminated by abortion
Approximately 1/3 of American Approximately 1/3 of American women will have an abortion in their women will have an abortion in their lifetimelifetime
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Legal abortion rate per 1,000 Legal abortion rate per 1,000 women aged 15-44 women aged 15-44
Pennsylvania vs the United StatesPennsylvania vs the United States
05
101520253035404550
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
US
PA
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Women Who Have AbortionsWomen Who Have Abortions
60% are already mothers60% are already mothers More than half intend to have children in the More than half intend to have children in the
futurefuture Nearly 8 in 10 women report religious Nearly 8 in 10 women report religious
affiliationaffiliation 1/3 of women aged 18-44 live in a county 1/3 of women aged 18-44 live in a county
with no abortion providerwith no abortion provider 1 in 4 women have to travel at least 50 1 in 4 women have to travel at least 50
milesmiles
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PennsylvaniaPennsylvania
In 2000, there were 73 abortion providers In 2000, there were 73 abortion providers in Pennsylvaniain Pennsylvania
This represents a 20% increase from This represents a 20% increase from 1996, when there were 61 abortion 1996, when there were 61 abortion providersproviders
The increase in Pennsylvania may have The increase in Pennsylvania may have resulted from the use of state health resulted from the use of state health department data to identify hospitals that department data to identify hospitals that performed small numbers of abortions performed small numbers of abortions
PRCH © 200610
Legal Abortions by Age in PALegal Abortions by Age in PA
0
10
20
30
40
50
60
PA% US%
Ages Up to 19
Ages 20-29
Ages 30-39
Ages 40 andAbove
Unknown
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Access in PennsylvaniaAccess in Pennsylvania
In 2000, 75% of Pennsylvania counties In 2000, 75% of Pennsylvania counties had no abortion providerhad no abortion provider
39% of Pennsylvania women lived in these 39% of Pennsylvania women lived in these countiescounties
In Pennsylvania, 7 metropolitan areas lack In Pennsylvania, 7 metropolitan areas lack an abortion provider: Altoona; Erie; an abortion provider: Altoona; Erie; Johnstown; Lancaster; Scranton-Wilkes-Johnstown; Lancaster; Scranton-Wilkes-Barre-Hazleton; Sharon; Williamsport Barre-Hazleton; Sharon; Williamsport
PRCH © 200612
Abortions in Philadelphia by AgeAbortions in Philadelphia by Age20042004
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Under15
15-19 20-24 25-29 30-34 35-39 40-44 45 &over
Philadelphia
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Pregnancy Pregnancy Options Options
CounselingCounseling
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Effective Pregnancy Options Effective Pregnancy Options CounselingCounseling
Reduces anxiety so that the woman can concentrate on the decisions she has to make
Creates a safe environment in which she can discuss her hopes and fears about her decision
Imparts knowledge and facts about various options and their implications
Clarifies her choices and her feelings about them
Takes into account her cognitive and psychosocial development (if adolescent)
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Effective Pregnancy Options Effective Pregnancy Options CounselingCounseling
Helps herMake a decision that is right for herAccept responsibility for her
decisionAct on her decision, with referrals as
neededMobilize resources including family
and medical care
PRCH © 200616
Practitioner Should Be Aware Of:Practitioner Should Be Aware Of:
Local support services Necessity of early prenatal care and
follow up Financial issues that may impact her
decision
Increased safety of early abortion
State laws regarding parental notification and consent for termination (for teens)
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Pregnancy OptionsPregnancy Options
Continuation of Pregnancy (47.7%) Adoption (2%) Parenthood (45.5%)
Pregnancy Termination (33.4%)
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Continuation of Pregnancy: Continuation of Pregnancy: Adoption and Raising a BabyAdoption and Raising a Baby
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Pregnant Womens’ NeedsPregnant Womens’ Needs Referral for prenatal care including
nutrition counseling and prenatal vitamins Assistance in obtaining Medicaid/CHIP Referral for parenting classes Smoking cessation classes and/or
alcohol/drugs counseling Development of support and parenting
plan
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AdoptionAdoption Closed Adoption: Records about birth
parents are sealed Open Adoption: Birth parents choose
adoptive parents and maintain some level of contact
Adoption Arrangements Private adoption agency Individual county adoption services Non-profit adoption agencies Attorneys
PRCH © 200621
Changes in Adoption NormsChanges in Adoption Norms
The percentage of infants placed for adoption has decreased in the last 4 decades From 8.7% in 1972 to 2% in 1988.
>3% of Caucasian unmarried women place their children for adoption
>2% of African American unmarried women place their children for adoption
PRCH © 200622
Pregnancy TerminationPregnancy Termination
PRCH © 200623
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Abortion Rates: 15-19 Year Oldsper 1,000
0
5
10
15
20
25
30
35
40
45
50
88 89 90 91 92 93 94 95 96 97 98 99 2000 20012002
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Pregnancy Termination Pregnancy Termination OptionsOptions
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Medication AbortionMedication Abortion An abortion option for the first 49–63
days of pregnancy Requires 2–3 visits to office/clinic Most common regimen consists of:
An oral dose of mifepristone which blocks the receptors of progesterone
Followed by a dose of misoprostol which causes the uterus to contract and empty
PRCH © 200627
Medication Abortion Pros
Avoids surgical procedure and sedation (in most cases)
Some women feel more in control
Sometimes more culturally acceptable because non-invasive
Cons Requires patient
compliance Necessitates 2–3
office/clinic visits This option is
appropriate for early pregnancy only
PRCH © 200628
First Trimester Aspiration First Trimester Aspiration AbortionAbortion
Manual Vacuum Aspiration Abortion option through 12 weeks of pregnancy Requires a vacuum syringe that creates suction Actual procedure takes under 5 minutes
Electric Vacuum Aspiration Performed up to 12 weeks of pregnancy A suction catheter removes products of conception Takes between 5 and 10 minutes after the cervix
has been dilated
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Second Trimester Options (12–24 Wks)Second Trimester Options (12–24 Wks)
Dilation and Evacuation (D & E) Performed under general or local anesthetic
between 13 and 20 weeks Requires 2 visits to hospital/clinic for dilation
and removal of the fetus Currently the most common method used in the
second trimester Dilation and Extraction (D & X)
D & X procedures are extremely rare Requires 2 visits to hospital or clinic for dilation
and removal of the fetus
PRCH © 200630
Second Trimester Options (12–24 Wks)
Labor-Induction Abortion Methods Involves laboring and delivering a stillborn
fetus Intra-amniotic hypertonic solutions, such as
urea or saline Prostaglandin inductions (e.g., prostaglandin
E2 suppositories) Uncommon method of abortion
Woman may choose labor induction because it preserves the fetus intact
May be useful in confirming fetal anomalies
PRCH © 200631
Surgical Abortion Pros Cons During 1st trimester:
Can be completed in one visit
Procedure itself takes between 5–10 minutes
2nd trimester procedure possible
Performed under local anesthesia
Can be performed under sedation
Some women find process invasive
Procedure takes place in hospital or clinic (rather than at home)
External locus of control*
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Pregnancy Options Pregnancy Options Counseling in PracticeCounseling in Practice
PRCH © 200633
What To DoWhat To Do Ask open-ended questions Reflect: “I am hearing you say that you…” Validate: “Many women feel…” Give the patient control: “Which would you
prefer?” Pay attention to non-verbal cues Communicate acceptance: Tone, eye
contact Use silence: Let her finish
PRCH © 200634
What To AvoidWhat To Avoid
False reassurances: “You’ll be fine.” Over-identification: “I know how you
feel.” Medical jargon: “Have you had
previous terminations?” Loaded and/or judgmental statements Giving advice: “I think you should…”
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Utilizing Utilizing DECISIONDECISION
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D: Determine Reason for Visit What can I help you with today? Why do you think you may be
pregnant? When was your last period? Have you ever been pregnant before?
What were the outcome(s)? Are you currently using any form of
contraception?
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E: Evaluate Feelings What do you hope will be the results of
this test? Have you ever wanted to get pregnant? How do you feel about the sexual
encounter that brought you here today? Do you have any friends who are
pregnant or who have had a baby?How do you feel about that?
PRCH © 200638
Give results and remain silent allowing patient to initiate response
IF TEST IS NEGATIVE: How do you feel about the result?
If she is relieved: What are some ways that you can prevent pregnancy in the future? Contraception? Condom use? Disappointment: Refer for further
counseling regarding parenting plans.
Abstinence?
C: Confirm Pregnancy Results
PRCH © 200639
IF THE TEST IS POSITIVE:IF THE TEST IS POSITIVE: How do you feel about this result? What does a positive pregnancy test
mean to you? Clarify facts regarding gestational
timeline, trimesters, due date What do you think you want to do? What other information do you need to
make your decision?
C: Confirm Pregnancy Results
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I: II: Identifydentify Personal CircumstancesPersonal Circumstances
Place pregnancy in perspective of her life What is your picture of the next year of
your life? Five years? How does this pregnancy affect this?
How do your personal/spiritual/ religious beliefs affect your decision process?
Validate fears and conflicting emotions
PRCH © 200641
Who in your life can help you in a supportive way?
What is your relationship with the man that you are pregnant by?
Do you have a current partner? How would s/he feel about you being
pregnant? Discuss if and when to involve
another adults
S: Assess Support
PRCH © 200642
I: Address Immediate Concerns Continuing Pregnancy
Access to prenatal care Medicaid enrollment Finishing school
Adoption Open vs. closed Social service
organizations
Parenting Finances Housing Co-parent
Abortion Types of abortion Access to
abortion in your state
Timing Cost
PRCH © 200643
How much time do you need to make this decision?
If you decide to continue the pregnancy: By what date will you make an
appointment for prenatal care? If you decide to have an abortion:
By what date will you schedule an appointment?
O:O: OfferOffer a Timeline a Timeline
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N:N: NNext Stepsext Steps Provide the patient with written
resources and necessary referrals Discuss future contraceptive
options Write an advanced prescription
for EC Ask if she has anymore questions Schedule follow-up visit
PRCH © 200645
Values ClarificationValues Clarification
PRCH © 200646
Key PointKey Point If the health care provider does not
feel comfortable providing unbiased, accurate information regarding pregnancy options, he/she should refer the patient to someone who does.
PRCH © 200647
Values ClarificationValues Clarification
If 1 in 4 pregnant women will choose an If 1 in 4 pregnant women will choose an abortionabortion How can she trust you won’t judge her?How can she trust you won’t judge her?
There is nothing that is “not judgmental” There is nothing that is “not judgmental” The goal: The goal: identify identify personal beliefs & reflex personal beliefs & reflex
reactionsreactions Then: Then: distinguish these from professional distinguish these from professional
role in the provision of carerole in the provision of care
PRCH © 200648
Everyone stand upEveryone stand up We all do things that we “know better” not to We all do things that we “know better” not to
do even though we know the consequencesdo even though we know the consequences Sit down if you smokeSit down if you smoke
Sit down if you ever eat too muchSit down if you ever eat too much
Sit down if you cross in between carsSit down if you cross in between cars
Sit down if you work too hardSit down if you work too hard
Sit down if you do not maintain the recommended Sit down if you do not maintain the recommended 30min cardio 3 days a week30min cardio 3 days a week
PRCH © 200649
Everyone stand againEveryone stand again
Move to the side of the room that is most Move to the side of the room that is most appropriate for you:appropriate for you: I love chocolate cakeI love chocolate cake
There are good reasons a minor should involve her There are good reasons a minor should involve her parents in an abortion decisionparents in an abortion decision
It is better to have an abortion at 8 weeks rather than It is better to have an abortion at 8 weeks rather than 18 weeks18 weeks
A woman having her 4A woman having her 4thth abortion is just as justified as abortion is just as justified as a woman having her 1a woman having her 1stst
PRCH © 200650
Case 1:Case 1:Ruth is 34 years old, married with 3 Ruth is 34 years old, married with 3 children.children.
She had just ended a month long affair and She had just ended a month long affair and had committed herself to her marriage when had committed herself to her marriage when she discovered she was pregnant. she discovered she was pregnant.
She is unsure with which man she became She is unsure with which man she became pregnant. Her husband is very loving and pregnant. Her husband is very loving and supportive but is unaware of his wife’s supportive but is unaware of his wife’s involvement with another man.involvement with another man.
PRCH © 200651
Case 2:Case 2:A 17-year-old Caucasian woman enters your office suspecting she is pregnant. A pregnancy test confirms her suspicions. She has already spoken to her parents about her situation. She states, “My mom told me I should have an abortion.” How do you proceed with counseling? When do you involve her mother in the discussion (if at all)?
PRCH © 200652
Case 3: Case 3: Sue is 37 years old and married. Sue is 37 years old and married. She and her husband had been trying to She and her husband had been trying to get pregnant for 3 years. get pregnant for 3 years. She just got back the results of her She just got back the results of her amniocentesis that indicate the baby has a amniocentesis that indicate the baby has a severe genetic abnormality. severe genetic abnormality. She is 16 weeks pregnant.She is 16 weeks pregnant.
PRCH © 200653
Please Complete Your Please Complete Your Evaluations NowEvaluations Now