Now is the chance: patient-provider communication about unplanned pregnancy during the first prenatal visit.

Rebecca Meiksin ORCID logo; Judy C Chang; Tina Bhargava; Robert Arnold; Diane Dado; Richard Frankel; Keri L Rodriguez; Bruce Ling; Susan Zickmund; (2010) Now is the chance: patient-provider communication about unplanned pregnancy during the first prenatal visit. Patient education and counseling, 81 (3). pp. 462-467. ISSN 0738-3991 DOI: 10.1016/j.pec.2010.09.002
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OBJECTIVE: Unplanned pregnancy is associated with psychosocial stress, post-partum depression, and future unplanned pregnancies. Our study describes how topics related to unplanned pregnancy were addressed with patients during the first prenatal visit. METHODS: We audio-recorded and transcribed initial prenatal visits between 48 patients and 16 providers from a clinic serving racially diverse, lower-socio-economic patients. We conducted a fine-grained thematic analysis of cases in which the patient's pregnancy was unplanned. RESULTS: Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits for unplanned pregnancies (83%) included discussion of the patient's feelings about the pregnancy. Approximately half (51%) of the visits touched on partner or other types of social support. Six patients (17%) were offered referrals to counseling or social services. Only four visits (11%) touched on future birth control options. CONCLUSION: Most initial prenatal visits for unplanned pregnancies included discussion of patient feelings about the pregnancy. However, opportunities to discuss future birth control and for more in-depth follow-up regarding social support and psychological risks associated with unplanned pregnancy were typically missed. PRACTICE IMPLICATIONS: Obstetrics care providers should be cautious about making assumptions and should consider discussing pregnancy circumstances and psychosocial issues in more depth when treating patients facing unplanned pregnancy.

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