Should prenatal care providers offer pregnancy options counseling?

Abstract

BackgroundProfessional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider.MethodsAt four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses.ResultsAt entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p < 0.001) and interested in options counseling (RRR = 5.48, p < 0.001) than those who were food secure. Most women were open to discussing with their provider if their pregnancy was planned (88%) or if they had considered abortion (81%). More than 95% stated they would be honest with their provider if asked about these topics.ConclusionsMost women are certain of their decision to continue their pregnancy at the initiation of prenatal care. However, there is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these women and ensuring unbiased, non-directive counseling on all pregnancy options.

Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions

“…We also aimed to: 1) Understand women's experiences considering and seeking abortions in a state with multiple versus few restrictive abortion policies; 2) Assess health & social service needs of women who consider but do not have abortions; and 3) Understand women's experience with and impacts of Pregnancy Resource Centers. We have previously published some findings related to each aim [5,8,[22][23][24]]. The analyses presented in this manuscript are a-priori components of the first aim.…”

“…In this mixed-methods study, quantitative and qualitative data collections were convergent and embedded (Fig 1). Study methods have been described in detail previously [5,8,22,23]. Briefly, we recruited 589 English and Spanish-speaking pregnant women 18 years and older at their first prenatal care visit at three prenatal care facilities in Southern Louisiana and one prenatal care facility in Baltimore, Maryland between June 2015 and June 2017.…”

The Health and Social Service Needs of Pregnant Women Who Consider but Do Not Have Abortions

“…Our finding that women who reported a policy barrier to abortion were more likely to report need for pregnancy options counseling, substance use treatment, and intimate partner violence counseling/ shelter is also consistent with prior research. As part of our larger study, we found that, although most women are certain of their decision to continue their pregnancy upon entering prenatal care, there is a subset who are uncertain and wish to discuss their options with their prenatal care provider (Berglas, Williams, Mark, & Roberts, 2018b). Intimate partner violence is a known reason that some women decide to terminate their pregnancy, expressing concern that they would be tied to an abusive partner and that their child would be exposed to violence (Biggs et al, 2013; * Job counseling, transportation assistance, quit smoking, dental care, and child care were asked among women in Maryland only.…”

Patient-reported experience with discussion of all options during pregnancy options counseling in the US South

“…Our finding that all options counseling was associated with better patient experience corroborates prior qualitative research that indicated patients prefer all-options counseling. For example, a study of patients entering prenatal care found that a broad majority of patients were open to discussing pregnancy options, whether or not their pregnancy was intended [36]. Another qualitative study of options counseling preferences, which included both patients in prenatal care and women seeking abortion services, found patients preferred that providers: 1) respect patient autonomy, 2) avoid assumptions about patients' desired pregnancy outcomes, and 3) consider the needs of the patient beyond her pregnancy [16].…”