unplanned pregnancy - a hopeful response in general...
TRANSCRIPT
Unplanned Pregnancy - a hopeful response in General Practice
Dr Joseph and Mrs Cushla Hassan Rzeszów, Poland 2019
AMDG
• Ad maiorem Dei gloriam inque hominumsalutem.
• Te kororia nui o te Atua me te whakaoranga o te tangata.
• Dla większej chwaly Bożej I zbawienialudzkości.
• “For the greater glory of God and the salvation of humanity .”
(St Ignatius of Loyola)
New Zealand
Kaiteriteri
The New Zealand Context
• Population 4.9 million
• Multicultural – 74% European, 15% Māori, 12% Asian, 7% Pacific Islanders (some dual ethnicities)
• Nominally Christian 55.6% (34.7% “no religion”) but effectively very secular
• Prosperous country with an efficient health system
Challenges for General Practice in Unplanned Pregnancy
• Abortion legal under certain conditions (but effectively little barrier to abortion)
• 15 minute consultations• Unplanned pregnancy frequently leads to referral to
Gynaecology and Termination of Pregnancy• Emphasis on early and efficient access to abortion• Women seldom accept counselling prior• Government exploring how to decriminalize abortion
allowing abortion on demand up to full term• Number of abortions in NZ 13285 in 2017 (1)
A Catholic GP’s story
• Number 12 in family of 14
• Met Cushla and married at Medical School
• “Pro-life” but lacking preparedness and courage when facing abortion/contraception
• Unhappy with usual care and outcomes
A better way to practice?
• Encouraged to use fresh eyes, more compassionate, human and holistic response
• ? practice GP according to my conscience
• ? true choice to women with unplanned pregnancy
• What can we offer for women who have been through abortion and are struggling?
• HOPE - women, their families and our colleagues
St Luke’s Health Centre
• Christian Health Centre established in 2001
• New culture of support among health professionals – pro-life
• Pray together seeking God’s will and His help
• Seek life-giving alternatives
• A haven for the development of “Crisis Pregnancy Support”
St Luke’s Health Centre
Maria
• Late 20s, parenting alone, married/divorced
• 3 children
• Immigrant, English second language
• Presents acutely, without appointment to see Practice Nurse
• Pregnancy Test positive.
• “I need to get rid of it!” Suffering.
• How would you respond?
CPS – a new approach
• Hapai Taumaha Hapūtanga - Crisis Pregnancy Support (CPS)
• Health professionals meet women
• Backed by help from the community
• Fears - “did women want this?”, “would we see too many adverse outcomes?”
• Encouragement– 10 women offered in first year, 9 accepted, all continued – wonderful outcomes
Maria (cont.)
• Explained - I cannot refer for abortion but she can seek that service elsewhere, I will not charge
• Offered CPS service – accepted
• many hours in consultations
• Her main concerns - Shame, loss of custody of her children
• She believed she would go to hell
• I phoned her lawyer
• She chose to continue the pregnancy, married
What this case illustrates
• The expressed wish for an abortion does not always mean this is actually the preferred option, if we allow enough time for a woman to consider her situation fully
• The crisis pregnancy consultation is too complex to fit into a standard GP consultation
• With this degree of internal conflict adverse effects for this woman would be predicted if she had an abortion
• This would not be obvious from the initial consultation - only after many sessions with her
What is Crisis Pregnancy Support?
• A free service, established 2002, staffed initially by voluntary health professionals, working within a General Practice.
• Offers practical, emotional and holistic support for women who are distressed by unplanned pregnancy.
• Our purpose is to provide support for women who want to explore alternatives to abortion.
• We also offer support for post-abortion grief
• Supported by prayer group and charitable trust
Hapai Taumaha Hapūtanga - Crisis Pregnancy Support
• Team of 6 Care Coordinators (all health professionals, who attend regular peer support)
• Manager, administrator
• Māori and Youth Advisors
• Support of 30 community volunteers (police checked)
• Medical Advisor
• Charitable Trust
Prerequisites of this service
• Professional standards (confidentiality, client autonomy, Code of patient rights, peer-reviewed, continuous quality improvement)
• Appropriate
• Sustained, reliable, safe care
• Those who make first contact should be trained health professionals – Care Coordinators
Why in General Practice?
• Within healthcare system – accepted by colleagues
• Works easily for patient – accessible, receptionist, waiting room, telephone
• Anonymity
• GP team available for advice and support
What we are
and
What we are not
What we are…
• We support our local health professionals by offering them choice and a hope-filled pathway.
• Role includes: Developing a therapeutic relationship with patient, listening, discerning ,assessment, advocacy, evaluation, practical support, linking to community, coordinating care. Helping meet unmet needs.
…what we are not
• We do not take over the Medical care of a client
• The Care Coordinator’s role is not primarily a counselling role (though they should be health professionals, e.g. nurses)
• We are not a telephone counselling service –we are clinic based
What can Crisis Pregnancy Support Provide?
• Face to face consultation with a Care Coordinator –WINDOW OF TIME
• Understanding of the difficulties and responding to these from a practical point of view. Meeting unmet needs.
• A free service and some funding support for women in hardship
• Linking with other health professionals and support agencies including GP’s, midwives, Māori Support Agencies, Government Welfare Agencies, Child Protection Agency, St Vincent de Paul, Anglican Care, etc.
Vision Statement
Our aim is that any woman who faces an unplanned pregnancy has access to reliable, sustained care and support so that choosing to continue her pregnancy is a viable option.
Care is also provided for women who grieve from pregnancy loss, such as a termination of pregnancy
Percentage who continue pregnancy (Data from series of 217 to 2019)
63%8%
26%
3%
Yes
No
Unknown
N/A
Proportional Referral Source
0 0,05 0,1 0,15 0,2 0,25 0,3 0,35
INP (Family Planning)
GP/PN
?
Self
PCS
Midwife
Family
School Counsellor
Lawyer
Social Worker
Friend
St Vincent dePaul
Church
Alcohol/Drug
Youth Worker
House 44
Presb Support
Police Probabation
EGAR
Serie1
Serie2
Ethnicity
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
NZ European
Maori
Pacific Island
Asian
UK
Australian
Latin American
other
Serie1
Client Feedback
• At first I was extremely nervous
• I didn’t know what to expect
• I became very comfortable and able to confide
• It wasn’t so bad and I slowly started to open up
• I didn’t feel judged or pressured and the support was great
Feedback continued
• You made me feel all wasn’t lost
• It worked in well with my family doctor.
• I fell into a big black hole each time after I had my babies.This time I still sat beside the big black hole but I never went in
• What you are doing here is what woman like me need
• Thank you and God bless you
How St Luke’s has developed
• Natural Family Planning – Billings Ovulation Method
• Teaching undergraduates and GP Registrars
• Providing training/seminars to health workers In Nelson and other regions on request
• Supporting CPS development in other regions
• Services are valued by our local community, primary healthcare services and hospital health agencies
Future
1. Publish our data
1. Research:
• Factors contributing to crisis pregnancy
• Defining “Best practice” in providing services for women facing unplanned pregnancy
• Focus on long term outcomes
Future (cont.)
3. Develop similar services in other centres.
4. Shift focus from “access to abortion”
(a “medicalised response”)
to
“Providing comprehensive and holistic care for women facing unplanned pregnancy”
(a community response)
Summary
• We have identified that there is a need for services, led by professionals within the healthcare system, for women facing unplanned pregnancy and those facing post-abortion distress.
Summary (cont.)
• These services should be free and have professional standards like any other health service
• We have found that these services require voluntary work from health professionals and from community members.
Summary (cont.)
• Crisis Pregnancy Support, Nelson provides a high standard of service to women and has achieved a high degree of trust and acceptability by women, their health professionals and local health services.
Summary (cont.)
• The unplanned pregnancy is not primarily a medical problem and there is no “cure”. It is a community issue and the solutions lie within the community. The role of healthcare workers is in leadership, ensuring professional standards and in coordination of care.
Websites
• https://www.crisispregnancysupport.org.nz
• https://stlukeshealth.co.nz
• https://www.billingslife.org.nz
Email contacts
References
1. Abortion Supervisory Committee Report 2018