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:
• Notice on website or in

waiting room eg.

Dr Smith does not provide referrals for 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
• f 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
• btained, 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

• r 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?