Malady Wise

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Pregnancy Counselling

Maladywise

Initial presentation for a pregnancy test

  • Sexual + Reproductive health history

  • Once the result is known, the patient may lose focus on the consult

  • The extent of history depends on time and clinic

  • Always do test before discussing options

Questions

  • Why request a test? (UPSI, planned pregnancy, emergency contraception)

  • Symptoms of pregnancy? (Coping with symptoms, and medical issues)

  • Has a test been taken already?

  • Supports in place

  • Menstrual history (LMP, assess what is normal for patient, calculate dates)

  • Sexual contacts (risk assessment, gauge level of support biological father)

  • Contraception use (assess need for education)

  • Pregnancy hand obstetric history

  • Genetic issues

  • CST up to date

Pregnancy test discussion

  • Before testings ask what she would do if pregnant (Moral, cultural, religious beliefs)

  • Outcomes negative, positive or unclear

  • Negative test

    • Discuss may take up to 3 weeks to confirm pregnancy

    • Could do BHCG

    • False negative possible

    • Discuss contraception

    • Other reasons for missed periods

      • Breastfeeding

      • Stress

      • Weight loss, dieting, exercise, obesity

      • Drugs

      • Menopause

  • Positive test

    • How does the patient feel?

    • Calculate dates

    • Present options and information

    • Assess certainty of decision

    • Refer

    • Consider false positive

      • Misread test, faulty test

      • Recent birth, miscarriage, TOP, tumours

Unplanned pregnancy

  • Range of emotions (panic, fear, guilt, anger, empowered, blame, excitement, shame, distress, happiness)

  • Your role

    • Safe space, non-judgemental, accepting, non-influential

Who might need a pregnancy choices session

  • Women who might be ambivalent

  • Women who are unclear about the options available

  • Advocacy, referral

Options

  • Adoption

    • https://www.childrenbychoice.org.au/

  • Continuing

  • Termination

    • Private clinic

    • Public clinic

    • Family Planning Services

Legal Considerations

  • Consent of Partner in Pregnancy

    • Not required

  • Minor consent

    • Gillick definition of a mature minor

  • Mandatory reporting

    • Risk of harm

Counselling Skills

  • Reflection - restating what is said

  • Leading Statement - Tell me more about that

  • Clarification - You sound sad / angry about that

  • Summarisation - Review

  • Questioning

Decision making

  • Support person in consult - partner, family, friend

  • Talk to the woman alone as well

  • Define problem + situation

    • Unexpected, unplanned

    • Pregnancy confirmed

    • Circumstances

    • Relationship with partner

    • How long known about pregnancy

    • Estimate gestation

    • Symptoms

    • Coping?

    • Medical issues?

  • How does she feel about the pregnancy at the moment?

  • Supports

References