Melissa Chadwick Nurse Educator Unplanned pregnancy choices
Melissa Chadwick
Nurse Educator
Unplanned pregnancy choices
© Family Planning Victoria
Aims for today….
• Pregnancy testing
• Options
• Health professional's role
• Resources and referral
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Significant public health issue
Worldwide:
estimated 40% pregnancies
Australia:
limited studies
estimated 50% pregnancies
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Tim and Lisa
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Reasons
Often at least one method of contraception used
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History first
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Pregnancy test
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Pregnancy test outcome: negative
Consider: possible false negative
other possible reasons period late
Discuss contraceptive options
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Pregnancy test outcome: positive
Consider possible false positive
Calculate dates
Ultrasound?
Response?
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Your role
Provide safe space
• Non-judgemental
• Supportive, not directive
• Validate woman’s thoughts and feelings
“You are making the decision
that is right for you at this time”
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Your role
Provide factual, non-biased information for all options
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Unplanned pregnancy options
• Continue pregnancy and parent
• Continue pregnancy and adopt
• Abortion/termination of pregnancy
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Continue pregnancy and parent
• Commence ante-natal care
• Local GP
• Health information
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Adoption
Legal process whereby all rights and responsibilities are permanentlytransferred from birth parents to adoptive parents.
Managed: Department of Health and Human Services (DHHS) or approved non-government organisations
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Adoption law Victoria
State and territory based legislation
• Adoption Act 1984
• Adoption Regulations 2008
• Adoption Amendment Act 2015
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Adoption in Australia 2016 - 2017
http://www.aihw.gov.au/adoptions/
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Abortion/termination of pregnancy
Public and private providers
Medical and surgical options
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Abortion/termination law Victoria
• State and territory based legislation • Abortion Law reform Act October 2008
• Be aware of provider limitations
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Medical or surgical abortion?
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www.drmarie.org.au/services/abortion/medical-and-surgical-abortion-difference
Medical abortion Surgical abortion
High success rate1 (93–98%) High success rate1 (95–100%)
Only used in early pregnancy (law varies state/territory)
Can be used to later gestation (law varies state/territory)
Usually happens at home Done at a centre
Surgical instruments not used Surgical instruments used on cervix and uterus
No anaesthetic Analgesic may be used to manage pain
Anaesthetic usually needed
Medications cause process similar to miscarriage A clinician performs the procedure
Termination of pregnancy usually occurs 4–6hrs (<24hrs) after the second medication
Termination is completed in 5-10 minutes although there may be recovery time
Pain can be mild to severeBleeding may be heavy or prolonged
Pain and bleeding are usually less
May be difficult to conceal Can usually conceal
Requires a follow-up visit to the centre Takes one visit but time in the centre is longer
Need to return post TOP for IUD IUD or Implant can be inserted at time of STOP
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Considerations for women
• School, work, activities
• Social situation
• Support person
• Access to emergency services
• Personal choice
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Where to go?
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What will I do?
Majority do not wish to speak to a counsellor
Decision can be complex
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Pregnancy options session
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Decision making activities
• https://www.thewomens.org.au/
• https://thewomens.r.worldssl.net/images/uploads/fact-sheets/unplanned-preg-info-your-feelings-values.pdf
• https://thewomens.r.worldssl.net/images/uploads/fact-sheets/unplanned-preg-info-pros-cons.pdf
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Further information
• Family Planning Victoria: www.fpv.org.au
• Better Health Channel: www.betterhealth.vic.gov.au
• The Royal Women's Hospital: www.thewomens.org.au
• Department Health and Human Services: www.dhs.vic.gov.au/for-individuals/children,-families-and-young-people/adoption-and-permanent-care
• Children by Choice: www.childrenbychoice.org.au
• Dr Marie: www.drmarie.org.au
• Non-directive pregnancy counselling: www.psychology.org.au/FindAPsychologist/www.aasw.asn.au/find-a-social-worker/search/
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STI screen
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Here come’s Sarah
• Don’t assume
• Ask why
• Sexual history
• Do a pregnancy test
• Calculate dates
• Factual, non-biased information on all options
• Contraception and STI screen
• Referral
Observe, listen, support, do not direct
© Family Planning Victoria
References• Aruda, M., Waddicor, K., Frese, L., Cole, J., Burke, P. (2010). Early Pregnancy in Adolescents: Diagnosis, Assessment, Options counselling, and Referral. Journal of Pediatric
Health Care; Vol 24 No1. Jan/Feb.
• Australian Institute of Family Studies (2012). Australian Government, viewed 24 February 2012 <http://www.aifs.gov.au/nch/pubs/sheets/rs3/rs3.html>
• Baron, C., Cameron, S., Johnstone, A. (2015) Do women seeking termination of pregnancy need pre-abortion counselling? Family Planning and Reproductive Health Care; 41: 181-185.
• Children by Choice (2012). http://www.childrenbychoice.org.au. Viewed 24 August 2015.
• Department of Health and Aging (2012). http://www.health.gov.au/maternityservicesreview. Australian Government. Viewed 24 February 2012.
• Kjelsvik, M and Ghengedal, E. (2011). First-time women’s experience of decision making process related pregnancy – a phenomenological study. Scandinavian Journal of Caring Sciences; 25; 169-175
• Marie Stopes International. Real Choices: Women, contraception and unplanned pregnancy. (2008). http://www.drmarie.org.au/wp-content/uploads/2015/02/Real-Choices-Key-Findings.pdf?83ca66
• Marie Stopes International. What women want: when faced with an unplanned pregnancy. (2006). http://www.mariestopes.org.au/wp-content/uploads/2014/07/KeyFindings.pdf
• Nettlemann M., Brewer J., and Ayoola, A. (2009). Why women risk unplanned pregnancy. The Journal of Family Practice; 58:4.
• Ong, J., Temple-Smith M., Wong, WCW., McNamee, K., and Fairley, C. (2012). Contraception matters: indicators of poor usage of contraception in sexually active women attending family planning clinics in Victoria. BMC Public Health; 12: 1108.
• Rosenthal, D., Rowe, H., Mallett, S., Hardiman, A., and Kirkman, M. (2009). Understanding Women’s Experiences of Unplanned Pregnancy and Abortion, Final Report. Key Centre for Women’s Health in Society, Melbourne School of Population Health, The University of Melbourne: Melbourne, Australia.
• Victorian Law Reform Commission March (2008). Law of Abortion: Final Report. http://www.lawreform.vic.gov.au/