unplanned pregnancy choices...2018/04/26 · understanding women’s experiences of unplanned...

Melissa Chadwick

Nurse Educator

Unplanned pregnancy choices

© Family Planning Victoria

Aims for today….

• Pregnancy testing

• Options

• Health professional's role

• Resources and referral


Significant public health issue

Worldwide:

estimated 40% pregnancies

Australia:

limited studies

estimated 50% pregnancies


Tim and Lisa


Reasons

Often at least one method of contraception used


History first


Pregnancy test


Pregnancy test outcome: negative

Consider: possible false negative

other possible reasons period late

Discuss contraceptive options


Pregnancy test outcome: positive

Consider possible false positive

Calculate dates

Ultrasound?

Response?


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”


Your role

Provide factual, non-biased information for all options


Unplanned pregnancy options

• Continue pregnancy and parent

• Continue pregnancy and adopt

• Abortion/termination of pregnancy


Continue pregnancy and parent

• Commence ante-natal care

• Local GP

• Health information


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


Adoption law Victoria

State and territory based legislation

• Adoption Act 1984

• Adoption Regulations 2008

• Adoption Amendment Act 2015


Adoption in Australia 2016 - 2017

http://www.aihw.gov.au/adoptions/


Abortion/termination of pregnancy

Public and private providers

Medical and surgical options


Abortion/termination law Victoria

• State and territory based legislation • Abortion Law reform Act October 2008

• Be aware of provider limitations


Medical or surgical abortion?


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


Considerations for women

• School, work, activities

• Social situation

• Support person

• Access to emergency services

• Personal choice


Where to go?


What will I do?

Majority do not wish to speak to a counsellor

Decision can be complex


Pregnancy options session


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

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-your-feelings-values.pdf

https://thewomens.r.worldssl.net/images/uploads/fact-sheets/unplanned-preg-info-pros-cons.pdf


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/

http://www.fpv.org.au/

http://www.betterhealth.vic.gov.au/

http://www.thewomens.org.au/

http://www.dhs.vic.gov.au/for-individuals/children,-families-and-young-people/adoption-and-permanent-care

http://www.childrenbychoice.org.au/

http://www.drmarie.org.au/

http://www.psychology.org.au/FindAPsychologist/

http://www.aasw.asn.au/find-a-social-worker/search/

Contraception

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCIPMhOn9hMkCFYV0pgodnLAPLQ&url=http://www.thefrisky.com/tag/withdrawal-method/&bvm=bv.106923889,d.dGY&psig=AFQjCNG2plHSEn4IZZNiVvfiCVBxDJPNNg&ust=1447214759235160


STI screen


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


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/

http://www.aifs.gov.au/nch/pubs/sheets/rs3/rs3.html

http://www.childrenbychoice.org.au/

http://www.health.gov.au/

http://www.drmarie.org.au/wp-content/uploads/2015/02/Real-Choices-Key-Findings.pdf?83ca66

http://www.mariestopes.org.au/wp-content/uploads/2014/07/KeyFindings.pdf

http://www.lawreform.vic.gov.au/

unplanned pregnancy choices...2018/04/26 · understanding women’s experiences of unplanned...

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