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Unplanned Pregnancy Counselling

Unplanned Pregnancy Counselling. Willow Women’s Clinic Vancouver Island Women’s Clinic Family Medicine Forum Ellen Wiebe MD, Heather Frayne BSW Vancouver BC 16 October 2010; 1050-1150. Objectives. To identify issues that arise for women

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Unplanned Pregnancy Counselling

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  1. Unplanned Pregnancy Counselling Willow Women’s Clinic Vancouver Island Women’s Clinic Family Medicine Forum Ellen Wiebe MD, Heather Frayne BSW Vancouver BC 16 October 2010; 1050-1150

  2. Objectives • To identify issues that arise for women • To understand and address some of the myths women have about abortion • Explain the medical and surgical abortion process • To have an organized way to address the issues • Share local and national resources for women

  3. Practitioners come with these “circles”

  4. Women come with these “circles”

  5. What is our “Duty to Care” for women? CMA Code of Ethics • 1. Consider first the well-being of the patient. • 2. Practice the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect. • 11. Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of the patient. • 17. In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, socio-economic status. • 21. Provide your patients with the information that they need to make informed decisions about their medical care, and answer their questions to the best of your ability.

  6. Brief history of abortion in Canada • Abortion, along with contraception, was decriminalized in Canada in 1969. • From 1969-1988, a woman could obtain a hospital abortion upon approval from a three-member Therapeutic Abortion Committee. • Dr. Henry Morgentaler was repeatedly charged with violating the law, fought many legal battles until finally in 1988 the Supreme Court of Canada struck down the law. • Since 1988, abortion has been regulated like any other medical procedure.

  7. How common are unplanned pregnancies? • ~50% of pregnancies are unplanned • ~50% of unplanned pregnancies end in births • ~50% “mistimed”, ~50% unwanted (and high risk) • ~50% of unplanned pregnancies end in abortions (~100,000 annually in Canada)

  8. How available are abortions in Canada? • All provinces except PEI provide abortions <12 weeks • Unplanned pregnancies are usually recognized early, and ~90% of abortions are <12 weeks • >12 weeks are available in most provinces • Most abortions occur in large urban centres in southern Canada. Many women travel to obtain care

  9. What is a medical abortion? • Methotrexate 50mg/m2 IM followed by Misoprostol PV 4+5 days later is used up to 7 weeks for ~3000 annually (~3% of abortions) • Mifepristone, used in Europe and US is not available in Canada • Medical completion of spontaneous and missed abortions is more common using misoprostol alone or M&M

  10. What is a D&C, D&E? • IV Sedation or monitored anesthetic in clinics and hospitals • Intracervical/paracervical block • Dilation usually mechanically (with dilators) till 12-15 weeks, enhanced with misoprostol after 12 weeks, and with laminaria 15-20 weeks • Suction curettage to 14/15 weeks (D&C) • Evacuation (forcep extraction) after 15 weeks (D&E)

  11. Common Patient Concerns • Will I be able to have children in the future? • How will I feel afterwards? • How risky is abortion?

  12. Will I be able to have children in the future? • Fertility returns quickly • No decrease in fertility in the women who have no major complications (1/1000)

  13. How will I feel afterwards? Most women experience great relief and a quick reduction in pregnancy symptoms. • Emotionally, there may be some mixed feelings for a few days, coupled with other issues such as the relationship and the financial, school or work realities. • Physically, it is common to have bleeding and/or cramping on and off for about 2 weeks, most noticeable 4-10 days after the procedure, and usually relieved with NSAIDs or acetaminophen. At 2 weeks, most women are emotionally and physically well.

  14. How risky is abortion? • Abortion is one of the most common surgical procedures in Canada and is very safe. 97% of women who have abortion report no complications; 2.5% have minor complications and less than 0.5% require some additional surgical procedure. In comparison, 1 out of 21 women who give birth by vaginal delivery experience obstetrical traumas, such as lacerations of the cervix, vaginal wall or sulcus, or injury to the bladder or urethra. • Canadian maternal mortality rate per year is 6.1 per 100,00 live births or 23 maternal deaths each year. There have been no recorded deaths as a result of surgical abortion performed by an accredited physician.

  15. What can you expect in an abortion clinic? • Clinics in Canada follow what is commonly referred to as the National Abortion Federation (NAF) model with patient education /counselling and informed consent • The goal of informed consent is to assure that the woman’s decision is voluntary and informed. • Patient education/counselling is a discussion of the feelings and concerns expressed by the woman which may include help with decision making and contraceptive choices, values clarification or referral to other professionals. Information and referrals concerning all pregnancy options are given. • Ambivalent women are encouraged to take more time to arrive at a clear decision and are sometimes referred to other agencies for more options counselling. An abortion clinic will not provide an abortion to a woman who does not freely choose to have one

  16. Tiffany • 18 y o starting university in a different city in one month • 26 y o boyfriend wants to get married and have the baby

  17. Tiffany’s concerns • Will I be able to have babies later? • Will it hurt? • He’s pressuring me to stay and keep it, but I want to go to university.

  18. Discussion

  19. Questions/statements for Tiffany • How do you see your life in 5 years, if you had an abortion or a baby? • How sure are you about wanting an abortion? Could you put it in percent? • What is your boyfriend saying? Are you safe? • You might be saying “no” to this pregnancy now but you are saying “yes” to some important things. • You want to create the best family you can when you are ready.

  20. Gloria • 38 y o married with two school-age children • Financial worries with family business • Church-going Christian • Husband sure they need to have the abortion but she is not sure.

  21. Gloria’s concerns • Religious guilt • How she will feel afterwards • Effect on marriage • How to make sure she never faces this again (better contraception)

  22. Discussion

  23. Questions/statements for Gloria • Is your God forgiving? • Women choose abortions with a good heart because they want to be good moms and God supports us to do the best for our families. • What would help you make peace with your decision after? • Who is your support? • If you have an abortion, how do you think that would affect your relationship?

  24. Wendy • 30 year old, 5 weeks pregnant • One previous abortion at age 20 • one month relationship • Good job, planning to start her Master’s program • Good support from family and friends • can’t stop crying

  25. Wendy’s concerns • I will never forgive my self if I have another abortion • I feel that I should have been more careful • It feels wrong to have a child without 2 parents • I’m scared

  26. Discussion

  27. Questions/statements for Wendy • Do you have the resources and support to be a single mom? • Just because you are single now doesn’t mean you will stay single. • We are biologically primed to want sex when we are ovulating.

  28. Questions for yourself Are your reactions influenced by something in her life or in yours? Have you made some assumptions that may not be stated? Do you have feelings about each situation that creates bias or inner conflict for you?

  29. Unplanned pregnancy counseling • Options: Have you considered the other options? How do you see yourself in 5 years if you have an abortion or a baby? • Issues: What about your relationship, your religion, your career, your plans to have children in the future? • Information: Do you know about medical, surgical abortions, where to go, follow-up? • Contraception: Let’s find something which does not give you side effects and will fit into your lifestyle and relationship.

  30. Unplanned pregnancy counseling • If she chooses birth, is it “mistimed” or “unwanted”? • Look carefully at risk factors in “unwanted”: • Less pre-natal care • Less preparation • Poor outcome for health and behavior in child

  31. Summary and resources • 1 800 772 9100 • North America, 3 languages • for patients seeking counselling and care • 1 877 257 0012 • for patients seeking referral to a NAF accredited clinic • 1 888 875 3163 • For BC women only, Pregnancy Options Service, for referrals • Local Sexual Health Centres (Canadian Federation of Sexual Health- formerly Planned Parenthood) • www.cfsh.ca

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