8.6 Pregnancy Diagnosis and Counseling

Part II: Guidelines for Client Services and Clinic Management

  1. Pregnancy Options Counseling:
    1. 1. Counseling Content: Unplanned Pregnancy and a Positive Test Result:
    2. 2. Counseling Content: Planned Pregnancy and a Positive Test Result:
    3. 3. Counseling Content: Unplanned Pregnancy and a Negative Test Result:
    4. 4. Counseling Content: Planned Pregnancy and a Negative Test Result:

Pregnancy testing is one of the most common reasons for a first visit to a family planning clinic. It is important to use this opportunity as an entry point for providing education and counseling about family planning and reproductive health. Personnel involved in pregnancy diagnosis and counseling should have knowledge of:

  • Pregnancy testing procedures
  • Preconception education
  • Prenatal care and delivery
  • Infant care, foster care and adoption
  • Pregnancy termination
  • Availability of referral services
  • Methods of contraception
  • Federal, state and local requirements
  • Non-directive counseling skills and techniques
  • Required documentation

The client's response to counseling should be documented in the medical record.

All family planning delegate agencies must provide pregnancy diagnosis and counseling to all clients in need of this service. However, if a pregnant woman is seeking proof of pregnancy simply for evidence of eligibility for other public services, agencies should seek support from sources of funds other than Family Planning grants.

Pregnancy cannot be accurately diagnosed and staged through lab tests alone. Pregnancy diagnosis consists of:

  • Informed consent;
  • History;
  • Pregnancy testing; and
  • Physical assessment, including a pelvic examination, when appropriate.
    • If the medical evaluation cannot be performed in conjunction with the pregnancy test, the client must be counseled as to the importance of receiving a physical assessment as soon as possible, preferably within 14 days.
    • If the pregnancy test is negative but the physical examination and history are indicative of probable pregnancy, the client must be encouraged to schedule a repeat pregnancy test within an appropriate time frame. Prescriptive methods of contraception should not be given if a pregnancy is suspected.
    • For clients with a negative pregnancy diagnosis, the cause of the delayed menses should be investigated. If ectopic pregnancy is suspected, the client must be referred for immediate diagnosis and treatment. Clients with a history of PID (due to Chlamydia and other STDs) are at high risk for ectopic pregnancies. Follow-up with these clients must occur and must be documented in the medical record.

Pregnancy Options Counseling:

Family planning clinics must offer pregnant clients the opportunity to be provided with information and counseling regarding each of the following options:

  • Prenatal care and delivery;
  • Infant care, foster care and adoption; and
  • Pregnancy termination

All pregnancy options must be named. All materials provided to clients on the pregnancy options should be balanced. A referral sheet that provides 2-3 referrals for each pregnancy option is highly recommended. If requested to provide information and counseling, family planning counselors must provide neutral, factual information and non-directive counseling on each of the options and referral upon request, except with respect to any option(s) about which the pregnant client indicates she does not wish to receive information and counseling.

1. Counseling Content: Unplanned Pregnancy and a Positive Test Result:

Clients with an unplanned pregnancy may be unsure about their pregnancy options. Provide them with the following information to assist them in making an informed choice:

a. Prenatal Care and Parenting:

Provide clients considering the choice of carrying their pregnancy to term and parenting with information about good health practices during early pregnancy, and stress the medical, social and financial aspects of prenatal care and parenting, such as:

  • the need for early and ongoing prenatal care;
  • the importance of proper nutrition and exercise;
  • the significant benefits of knowing her HIV status early in the pregnancy;
  • the negative impact of smoking, drugs, and/or alcohol consumption, lead and other toxic chemicals/substances and exposure to x-rays;
  • the need to check with her physician before taking any medications or over the counter products;
  • the financial aspects of pregnancy and parenthood; and
  • her relationship with the father of the baby.

When a prenatal referral is appropriate, encourage the client to schedule an appointment within two weeks of the pregnancy diagnosis. If appropriate, refer the client to other services, such as screening for Medicaid eligibility and/or Women, Infants and Children and Family Case Management (WIC/FCM), at the time of the pregnancy diagnosis.

b. Prenatal Care and Infant Care, Foster Care and Adoption:

When clients are considering the choice of this option, additional counseling may be required. In such cases, refer the client for prenatal care and counseling services. Along with these referrals and the counseling outlined above in Prenatal Care and Parenting, other important medical, social or financial areas for discussion include:

  • discussion of the different types of adoption that are available;
  • birthparent rights, termination of parental rights and finalization of adoption;
  • discussion of the procedural aspects of licensed adoption agencies, such as placement directly after birth with adoptive parents, foster care until after termination of parental rights, availability of housing for the birthmother, and input by birthparents in the matching process;
  • legal, medical or other costs.

c. Pregnancy Termination:

Provide clients requesting information about pregnancy termination with medical, social and financial information about this option, such as:

  • the timetables for medical and surgical terminations;
  • general information about medical and surgical termination procedures. The client will receive in-depth, extensive counseling from the abortion provider;
  • safety/risks of the procedure;
  • the cost of the procedure;
  • the importance of the follow-up examination following the procedure; including obtaining an effective contraceptive method.

Referrals for medical or surgical pregnancy termination may be given to clients upon request. Termination referrals should be made relative to the client's LMP. It is important to note that Title X family planning clinics may provide referral information such as the name, address, telephone number, and fees for abortion providers. A Title X family planning clinic may NOT provide services that directly help a client secure pregnancy termination services such as to negotiate a reduced fee, make an appointment for the client or provide transportation to the procedure.

If the client with an unintended pregnancy is in need of additional information/counseling to make a pregnancy options choice, the client must be referred to other community based social service or medical facility that will provide her with the additional assistance and counseling to make an informed decision.

2. Counseling Content: Planned Pregnancy and a Positive Test Result:

Counseling information will deal with the importance of early prenatal care, proper nutrition, and the cessation of smoking and drug/alcohol intake. Referral should be made to an appropriate prenatal care provider. Prenatal vitamins may be given to the client at the time of this visit. See also the previous section on Prenatal Care and Parenting above.

3. Counseling Content: Unplanned Pregnancy and a Negative Test Result:

No options counseling is indicated. However, clients who are found not to be pregnant and not seeking pregnancy should be provided with counseling about their feelings about the test results. Counselors should define the limitations of the pregnancy test and stress the need for a follow-up appointment if menses does not occur within two weeks. Also, preconception health, contraception information, contraceptives, and/or prophylactic emergency contraception should be discussed and/or dispensed. A follow up family planning clinic appointment should be scheduled at the time of the pregnancy test visit. If not, document referral to the chosen provider in the client record.

4. Counseling Content: Planned Pregnancy and a Negative Test Result:

No options counseling is indicated. Preconception health messages should be reviewed. Provide counseling on fertility awareness, fertility determination and infertility and provide a referral for infertility services, if indicated.

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