Options Counseling and Abortion Education by Dr. Chavi Kahn, MD, MPH
Explore comprehensive abortion care, informed consent, and pregnancy options through a supportive and unbiased approach. Understand the importance of creating a safe and stigma-free environment for patients facing pregnancy decisions. Learn to address decision conflict and ambivalence with empathy and informed guidance.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
OPTIONS COUNSELING AND ABORTION EDUCATION CHAVI KAHN, MD, MPH
MAKING THE DECISION Everyone who is facing a pregnancy decision must answer questions: Is this the right time for me to bring life into the world through my body? Is this the right time for me to be responsible for a child? For many women, no decision is greater than this one. No responsibility is as important as raising a child. No activity takes more energy, more love, more patience than having a child.
YOUR GOALS AS A HEALTHCARE PROVIDER To create a space where patients feel that it is safe to ask questions You are listening without an agenda To be the person whom patients trust You are known as someone who will give them accurate information To establish an environment free of stigma around pregnancy decisions You are modeling unbiased language
COMPREHENSIVE ABORTION CARE: COUNSELING Pregnancy options Informed Consent Abortion methods Post-abortion contraception
INFORMED CONSENT Competence The ability to reason, to understand, and to appreciate the consequences of a decision Understanding the nature and purpose of the proposed treatment, its alternatives, and the risks and benefits of each Making the decision voluntarily
PREGNANCY OPTIONS Abortion Adoption Parenting
THE ABORTION DECISION Most people are: Sure about their decision, have support, and expect to cope well. Decision conflict: Emotional conflict: feelings of sadness, guilt, or grief. Spiritual conflict: concern about God, forgiveness, or sin. Moral conflict: belief that abortion is murder. Ambivalence: Uncertainty about which way to go
DEALING WITH AMBIVALENCE Most life decisions are characterized by a normal degree of ambivalence If you are not sure that the patient is clear and confident in her decision, however, it is appropriate to provide more time for thought and supportive counseling, even if it means delaying a procedure Consider having them imagine their life now and a few years from now, and how they will feel about their decision in each circumstance
DEALING WITH SPIRITUAL OR MORAL CONFLICT Validate and normalize Seek understanding Set the stage for reframing Reframe She is a good person Her decision is moral Witness the feelings that you see and hear Normalize her feelings Learn about her feelings and their origins Reflect on what makes this the best decision for her
DEALING WITH SPIRITUAL OR MORAL CONFLICT Validate and normalize Seek understanding Set the stage for reframing Reframe It s okay to be sad or scared. That s not strange at all; a lot of women have asked me that question. Can you say more about what you re feeling? Can you put your finger on where this feeling is coming from? I can imagine that you are a good person trying to do the right thing based on what is going on in your and your family s life. What I hear is that you are making this decision because you care about the well- being of your children. You are following your family values.
POSTABORTION REACTIONS Most women feel relieved after making their decision/having their abortion There still may be feelings of sadness, anger, or guilt Studies show that if a woman feels a loved one is opposed her decision, she is more likely to have difficulty
REPRODUCTIVE COERCION Abuse and partner violence are common experiences in women s lives Abuse can take many forms Reproductive coercion is related to behavior that interferes with contraception use and pregnancy. This includes sabotage of contraceptive methods, pregnancy pressure, and pregnancy coercion: Birth control sabotage is active interference with a partner s contraceptive methods in an attempt to promote pregnancy Pregnancy pressure involves behavior intended to pressure a female partner to become pregnant when she does not wish to become pregnant. Pregnancy coercion involves coercive behavior such as threats or acts of violence if a partner does not comply with the perpetrator s wishes regarding the decision to terminate or continue a pregnancy.
PREGNANCY OPTIONS COUNSELING EXERCISES A patient presents with an unexpected positive pregnancy test during clinic or in the ED. How would you approach this? How do you feel about this result? What would it be like for you to continue a pregnancy at this time? What do you know about your options?
PREGNANCY OPTIONS COUNSELING EXERCISES When you ask a patient what questions they have, they want to know if an abortion will affect their ability to have children in the future. How would you respond? There is a lot of misinformation out there about this issue, but abortion is extremely safe and will not affect your ability to get pregnant in the future if and when you want to .
PREGNANCY OPTIONS COUNSELING EXERCISES A patient says, I feel sad. Response 1: Is that making you feel less sure about your decision? Response 2: Would you like me to give you a referral for a talk line/to talk with a social worker? Response 3: What kinds of things have you done in the past to help cope with sadness? Response 4: Can you say more about that?
PREGNANCY OPTIONS COUNSELING EXERCISES Other questions/phrases that might be helpful: A lot of patients feel that way. It is ok to cry here. I am right here with you. Is there anything that is making this particularly difficult?
COUNSELING WOMEN ON SURGICAL VERSUS MEDICATION ABORTION
FACTORS TO CONSIDER Duration of pregnancy Efficacy Safety Side effects Use of anesthesia Location Time required
OPTIONS FOR TERMINATING PREGNANCY Electric Vacuum Aspiration Dilation and Evacuation Manual Vacuum Aspiration 24-28 Weeks LMP 0 12 Methotrexate/ Misoprostol Mifepristone/Misoprostol
EFFICACY OF EARLY ABORTION OPTIONS Surgical and medication abortion are highly effective Manual vacuum aspiration 99% 0 1 2 3 4 5 6 7 8 9 10 Weeks LMP 95-88% Medication abortion (vaginal/buccal)
SAFETY OF EARLY ABORTION Surgical and medication abortion are low risk Surgical Medication Uterine or cervical injury Infection Infection Heavy bleeding Stewart FH, et al. 2004.; Danco Laboratories. 2005. FDA. 2006.; Green MF. N Engl J Med. 2005.
EXPECTATIONS Usually subside quickly MVA Medication Cramping Bleeding Nausea/vomiting Diarrhea Fever/chills Fatigue Cramping Bleeding Grimes DA, Creinin MD. Ann Intern Med. 2004. NAF. 2006.
LOCATION: WHERE EARLY ABORTION OCCURS Surgical Medication Hospital or office setting Begins in hospital/office Occurs at home NAF. 2006.
TIME REQUIRED FOR EARLY ABORTION MVA Medication Complete within 24 48 hours 2 visits to provider (evidence-based) Complete within minutes 1 visit to provider NAF. 2006.
ADVANTAGES Medication More natural More private Usually avoids surgery MVA Quicker Woman less involved More certain Stewart FH, et al. 2004. NAF. 2006.
DISADVANTAGES OF EARLY ABORTION OPTIONS Medication MVA Waiting, uncertainty Longer bleeding, cramping, nausea Additional clinic visit Invasive Less private Small risk of injury or infection Stewart FH, et al. 2004. NAF. 2006.
SECOND TRIMESTER SURGICAL ABORTION D&E Steps: The cervix is slowly and gently dilated. The physician then removes the pregnancy through the cervix and vagina with a combination of suction aspiration and grasping instruments. The abortion itself generally takes about 10-30 minutes.
SECOND TRIMESTER INDUCTION Can take several days Medication side effects Will experience labor Retained placenta/may still need surgical procedure
