Unplanned pregnancy Dr Alison Creagh Plan Attitudes & values - PowerPoint PPT Presentation

Unplanned pregnancy Dr Alison Creagh

Plan • Attitudes & values • The legislation – WA & other States • Non directive discussions • Legal issues and abortion • Medical issues and abortion • Adoption • Questions

Our attitudes and values

Ethics • “Do no harm” • At SRHWA, we often see patients harmed by health care professionals • Feeling judged • Advised to have unnecessary ultrasounds • Unnecessary delays • Referred for counselling to directive counselling services • Prevention of harm: Dr Smith does not provide • Notice on website or in referrals for waiting room eg. abortion

Pregnancy options • Continue pregnancy and keep child • Antenatal care as usual • Continue pregnancy and offer for adoption • Antenatal care as usual, plus • Early contact with DCP: https://www.dcp.wa.gov.au/FosteringandAdoption/Pages/Pregnant AndConsideringAdoption.aspx • Abortion

Making decisions • Often (but not always) a few days required to absorb news and to consider options • We can help with non directive discussions • Providing wanted information • Ask the woman/couple what they see as pros and cons of each choice • Assess pressures to make a particular decision • eg. ask “does anyone else have a strong view about what you should do?” • Provide information about gestation and time left before a decision needs to be made • Refer to counsellor if ambivalent

Counselling • Dept of Health funding for unplanned pregnancy counselling: • SRHWA – telephone counselling an option • Relationships Australia • Other counselling services MAY be appropriate 

Abortion law in WA • Two different doctors must be involved • The referring doctor • The performing doctor

WA law Referring doctor must: • Inform the patient about • the possible risks of TOP • the possible risks of continuing the pregnancy • The availability of counselling before or after a termination if she wishes it • If a dependent minor, or pregnancy is over 20 weeks, additional requirements

Dependent Minors • A dependent minor is under 16 years of age and supported by a custodial parent. • Informed consent from the minor should be obtained, and • A custodial parent/guardian must be informed that an abortion is being considered, and provided with an opportunity to participate in counselling and consultations between the woman and her doctor. OR...

Dependent Minors • A dependent minor may apply to the Children’s Court for an order that the custodial parent NOT be consulted • It is up to the Magistrate to decide whether the parents’ participation is required or not • An order once given cannot be challenged or appealed against • If the Magistrate feels that an order is not justified, the parent must be involved

Minors: court practicalities • Client presents to local Children’s Court, (Perth: 160 Pier St, 9am-4pm), and sees The Managing Registrar or The Presiding Magistrate. • Cases will be heard within 3/7. • Recommend: • Legal Aid 1300 650 579 • Aboriginal Legal Service 1800 019 900 • or a support person to assist

Abortion over 20 weeks • Over 20 weeks gestation, the performance of an abortion is not justified unless the woman or the foetus has a severe medical condition that justifies the procedure • 2 medical practitioners who are members of a panel of 6 appointed by the Minister for the purposes of this section must agree that the procedure is justified. • The abortion is performed in an approved facility ( ie KEMH)

Over 20 weeks - practicalities • Refer to Social Work Dept KEMH • Valda Duffield 9340 2222 • Panel agrees only for life threatening conditions • Alternatively, women can go to Victoria • Very costly • Only available up to 24 weeks

Laws in other States & Territories • Legal in Vic, SA, NT, ACT and Tas with specific conditions • In Criminal Code in NSW and Qld, but case law says abortion can be done if risks to woman justify it • Specific information on Children by Choice website http://www.childrenbychoice.org.au/

What the consultation might include • Certainty of decision • Support or pressures from others • Mental health or domestic violence issues? • Assessing contraindications or medical risks • Gestation estimate • STI risk assessment • Past and future contraception

Abortion method options - medical • Mifepristone, then misoprostol 24-48 hours later • Available up to 9 weeks • Most effective at earliest gestations • Main contraindications • Ectopic pregnancy • IUD in situ • Severe disease requiring corticosteroid Rx • Chronic adrenal failure • Haemorrhagic disorders or using anticoagulants

Medical abortion • What to expect • Side effects from misoprostol N&V, diarrhoea, fever/chills • generally mild and short-lived • • Bleeding and cramping usually within 1 – 4 hours • cramping ranges from mild to severe • decrease once pregnancy expelled • average duration of bleeding10-16 days • • Passage of tissue

Medical abortion • Requires a capable adult at home • Women given analgesia and 24 hour phone number if any concerns • Followup at 2 weeks to ensure abortion is complete • Overall very low risk of complications • Infection, heavy bleeding • Incomplete expulsion requiring further misoprostol or surgical intervention

Abortion options - surgical • Least risks prior to 12 weeks gestation, can be performed up to legal limit of 20 weeks • Low risk of complications < 12 weeks • Infection, heavy bleeding, perforation • Usually done under sedation, sometimes “vocal local” • Can have implants and IUDs inserted during procedure

Where can abortions be done? • Nanyara, Rivervale • 9277 6070 www.nanyaraclinic.com • Dr Marie, Midland • 1800 003 707 www.drmarie.org.au • Some private gynaes • KEMH only if medical necessity • However, financial assistance available if patient can’t pay – contact Family Services Coordinator

Adoption • Arranged through Department for Child Protection • Very few women giving birth in WA relinquish their children for adoption • All adoptions in WA have been open (identity of birth family, adoptive family and child available to all) since 1995 • More information available on Dept website: https://www.dcp.wa.gov.au/FosteringandAdoption /Pages/PregnantAndConsideringAdoption.aspx

Training in abortion care • Unplanned Pregnancy Counselling course • Three day course, held each year at SRHWA • MS2Step - online for medical abortion https://www.ms2step.com.au/ • For extra training options, contact Medical Educator at SRHWA alison.creagh@srhwa.com.au

Resources • Children by Choice • Information on abortion for patients • Limited support for patients in financial difficulty • Summaries of law in each State http://www.childrenbychoice.org.au/ • Family Services Coordinator, KEMH • 9340 2222 Nikki Ranshaw Mon-Fri 0800-1630 • Information book • http://kemh.health.wa.gov.au/services/termination_of_pregnancy/ docs/wnhs0459.pdf

Questions?