Pregnancy Options Counseling
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Transcript Pregnancy Options Counseling
PRCH © 2007
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Pregnancy and Options
Counseling and
Adolescents
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Outline
Adolescent sexuality and pregnancy
data
Goals of effective pregnancy options
counseling
Pregnancy options
Options counseling in practice
Cases
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Objectives
By the end of this presentation,
participants will be able to:
Identify
3 elements of effective options
counseling relating to adolescents
Describe
the healthcare provider’s role
in the process of options counseling
Discuss
the important issues regarding
each pregnancy option
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Adolescent Sexuality
Most adolescents become sexually active in
teenage years
The majority of these sexual relationships:
Are consensual
Healthy expressions of human sexuality
Vary according to the adolescent’s culture
and psychological, physical, and
relationship development
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Adolescent Sexual Behaviors:
Results from the 2005 YRBS
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Have Had
Intercourse
Currently
Sexually
Active
Intercourse
Before Age
13
4 or More
Parnters
HaveBeen
Been
Have
Forced to
to
Forced
HavePRCH
Sex© 2007
Have
Sex
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Japan
Italy
Teen Pregnancy
Rates Worldwide,
2000
Netherlands
Spain
Germany
France
(per 1000)
Switzerland
Israel
Norway
Scotland
Australia
Canada
England
Latvia
Romania
United
States
0
10
20
30
40
50
60
70
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80
90
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Pregnancy Outcomes for Teenagers 15–19
Years by Race and Hispanic Origin,
Rates per 1,000 women
1990 and 2002
250
Abortion rate
200
Birth rate
150
223.8
134.2
116.3
100
75.4
169.1
131.5
98.8
65.0
50
0
1990 2002
All Races
1990 2002
White
1990 2000
Black
1990 2002
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Hispanic
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Adolescent Attitudes Toward
Pregnancy
82% of teen pregnancies are
unintended
1 in 3 teenage girls has positive and/or
ambivalent feelings about immediate
childbearing
22% identified their pregnancies as
neither mistimed nor unwanted
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Adolescents, Sexual Assault,
and Pregnancy
Violent crimes are more common among
adolescents than other age groups
Among adolescents ages 12–17 years,
5.3% of rapes cause pregnancy
Adolescents may be unaware of or have
limited access to emergency
contraception
May not be using any long-term
contraceptive method at the time of the
assault
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Implications of Teen
Pregnancy
Many teen mothers:
Are less likely to graduate from high
school
Are more likely to have symptoms of
depression
Lack resources to foster children’s
development
Have a higher risk of repeat births
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Implications of Teen
Pregnancy
Many teen fathers are more likely to have:
Poor academic performance
Higher school drop-out rates
Limited financial resources
Decreased income capacity
Difficulties staying involved in children’s
lives
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Implications of Teen
Pregnancy
Many babies born to teen mothers are at
higher risk of
Being born prematurely and of having a
low birth weight
Physical neglect and abuse
Poor school performance
Substance abuse
Being teenage parents themselves
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Pregnancy
Options
Counseling
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Goal of Pregnancy Options
Counseling
To
provide a careful process of
evaluation and decision-making
based on young women’s
Personal
circumstances
Psychosocial
development
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Effective Pregnancy Options
Counseling
Reduces anxiety so that the pregnant teen 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
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Effective Pregnancy Options
Counseling
Helps her
Make a decision that is right for her
Accept responsibility for her
decision
Act on her decision, with referrals as
needed
Mobilize resources, including family
and medical care
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Practitioner Should Be Aware of:
Local support services
Necessity of early prenatal care and
follow up
Developmental issues that may impact her
decision
Importance of completing high school
State laws regarding parental notification
and consent for termination
Increased safety of early abortion
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Key Point
If the healthcare provider does not feel
comfortable providing unbiased,
accurate information regarding
pregnancy options, he/she should
refer the patient to someone who
does.
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Pregnancy Options
Continuation
of
Pregnancy (47.7%)
Adoption (2%)
Parenthood (45.5%)
Pregnancy Termination
(33.4%)
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Continuation of Pregnancy:
Adoption and Raising a Baby
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Health Needs of Pregnant
Teens
Special understanding
Access to psychological counseling
Education about
Nutrition
Infections
Substance abuse
Complications of pregnancy
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Health Needs of Pregnant
Teens
Less
likely to seek early medical
care
Increased
risk for medical
complications, including:
Anemia
Low
birth weight
Pre-term delivery Neonatal
admission
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Pregnant Teens’ 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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Adoption
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
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Changes 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
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State Statutes Surrounding
Adoption: As of June 2006
40 states and DC allow minors to place their
children for adoption
28 states and DC explicitly allow consent
12 states make no distinction between minor and
adult parents
10 states require adult involvement in process
5 states require legal representation for minors
4 states require parental consent
1 state requires parental notification
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Pregnancy Termination
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Abortion Rates: 15-19 Year Olds
per 1,000
50
45
40
35
30
25
20
15
10
5
0
88
89
90
91
92
93
94
95
96
97
98
99 2000 2001 2002
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Adolescents and Abortion
Reasons most often given by teens
for choosing to have an abortion are
Concern
about how having a baby
would change their lives
Feeling
that they are not mature
enough to have a child
Financial
problems
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Parental Involvement in Minors’
Abortions
61%
of minors who have
abortions do so with at least one
parent’s knowledge
45%
voluntarily inform parents of
intentions to have an abortion
Majority
of parents support their
daughters’ decisions
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Mandatory Counseling and
Waiting Periods for Abortion:
As of June 2006
32 states require counseling before an
abortion
22 are mandated to provide state-developed
abortion-related materials
6 require that counseling be provided in
person, 18 hours in advance of the procedure
24 require mandatory waiting periods (usually
24 hours) between the counseling and the
procedure
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Mandatory Parental Involvement in
Minors’ Abortions: As of June 2006
34 states require some parental
involvement
22
require parental consent; 2 require
both parents to consent
13 require parental notification; 1
requires that both parents be notified
1 state requires both parental consent
and notification
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Mandatory Parental Involvement in
Minors’ Abortions: As of June 2006
All of the 34 states that require parental
involvement have an alternative process
for minors seeking an abortion
All 34 states include a judicial bypass
procedure
6 states also permit a minor to obtain an
abortion if a grandparent or other adult
relative is involved in the decision
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Judicial Bypass
Minor petitions court to waive the
notification/consent requirement
Judge decides if:
Minor is mature and sufficiently well
informed
Abortion without informing parents is
in her best interest
Notification could lead to physical,
sexual, or emotional abuse
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Mandatory Parental Involvement in
Minors’ Abortions: As of June 2006
Most states that require parental
involvement make exceptions under
certain circumstances
28 permit a minor to obtain an abortion
in a medical emergency
12 permit a minor to obtain an abortion
in cases of abuse, assault, incest, or
neglect
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Pregnancy Termination
Options
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Medication 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
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Medication Abortion
Pros
Avoids surgical
procedure and
sedation (in most
cases)
Some women feel
more in control
Sometimes more
culturally acceptable
because noninvasive
Cons
Requires patient
compliance
Necessitates 2–3
office/clinic visits
This option is
appropriate for
early pregnancy
only
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First Trimester Aspiration
Abortion
Manual Vacuum Aspiration
Abortion option through 12 weeks of pregnancy
Requires a vacuum syringe that creates suction
Actual procedure takes less than 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)
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
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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
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Surgical Abortion
Pros
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
Cons
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
Counseling in Practice
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What To Do
Ask open-ended questions
Reflect: “I am hearing you say that you…”
Validate: “Many young 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
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What 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 DECISION
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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?
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C: Confirm Pregnancy Results
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?
Abstinence?
Condom use?
Disappointment: Refer for further
counseling regarding parenting plans.
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C: Confirm Pregnancy Results
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?
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I: Identify Personal 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
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S: Assess Support
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 adult
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I: Address Immediate Concerns
Continuing Pregnancy
Access to prenatal care
Medicaid enrollment
Finishing school
Finances
Housing
Co-parent
Adoption
Open v. closed
Social service
organizations
Parenting
Abortion
Types of abortion
Access to
abortion in your
state
Timing
Cost
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O: Offer a Timeline
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?
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N: Next Steps
Provide the patient with written
resources and necessary referrals
Discuss future contraceptive options
Write an advanced prescription for
EC
Ask if she has any more questions
Schedule follow-up visit
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Case 1:
A 15-year-old, African American Muslim woman
misses a period. She comes to your office with
an “earache.” When you question her further
you learn she suspects she is pregnant and this
is confirmed. She asks you to not tell her
mother and is confused over what to do.
Would you tell her mother and are you
required to under your state’s law?
What further counseling steps would you
take?
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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)?
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Case 3:
A 16-year-old pregnant woman comes to your
office. She tells you that she thinks she may have
been raped while unconscious at a party she
attended several weekends ago. The young
woman tells you that prior to this incident, she has
never had sexual intercourse before. She states
that she does not want to be a mother right now
yet she does not know if she could have an
abortion. The young woman is obviously
frightened.
How do you proceed with the counseling?
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Please Complete Your
Evaluations Now
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