Transcript Reproductive Health Planning/Interconception Health

REPRODUCTIVE HEALTH
PLANNING
&
PRECONCEPTION
INTERCONCEPTION
HEALTH
1/2017
Stochler Mason/Syed Zaheer
IDHS MCH Nurse Consultants
1
PROGRAM OBJECTIVES
Upon completion of this presentation program
participants will understand:
A. Rationale for Preconception &
Interconception education.
B. Rationale for the Development of a
Reproductive Life Plan and the impact it has
on Reproductive Health.
2
REPRODUCTIVE HEALTH
• Preconception education
• Interconception education
• Reproductive life plan
Family planning methods
Selection of parenting choices,
short term goals, long term goals,
and career planning
3
DEFINITION OF
REPRODUCTIVE HEALTH
Reproductive health addresses the
reproductive processes, functions and
system at all stages of life. Reproductive
health implies that people are able to have a
responsible, satisfying and safer sex life and
that they have the capability to reproduce
and the freedom to decide if, when and how
often to do so.
4
DEFINE PRECONCEPTION
EDUCATION
• Preconception education interventions
cover a variety of topics related to those
behaviors, such as nutrition, exercise
and weight management, birth control
methods, STI prevention, controlling
chronic disease, reducing alcohol
consumption, quitting smoking and use
of elicit drugs, or improving mental
health.
5
GOALS OF PRECONCEPTION CARE
1. To enhance knowledge, and improve attitudes
and value for health care prior to conception.
2. To identify reversible health risks to women of
child bearing age before conception to promote
healthy pregnancy outcomes.
3. To educate women on risks prevention before
pregnancy.
6
Cont’d Goals of Preconception
4. Increase public awareness of the
importance of preconception care.
5. To assure women receive evidence
based risk screening, health
promotion and intervention that will
enable a woman to enter pregnancy
in good health.
7
PRECONCEPTION AWARENESS
Preconception awareness has been emphasized by the State of
Illinois for over two decades, and prenatal care has long been a
cornerstone for improving pregnancy outcomes.
From the earliest recorded time, women have been advised to
increase their level of wellness, and to avoid hazardous
substances before becoming pregnant. If we go back to 600 BC,
ancient Spartans ordered their maidens to exercise in order to
have stronger and healthier offspring.
In recent years the importance of maternal health before
pregnancy has drawn increasing attention to preconception and
interconception spacing between pregnancy care.
8
DEFINITION
What is Preconception care?
• Preconception care is the care before
pregnancy.
• It is directed towards the identification of
medical and social problems prior to
conception.
• It focuses on the provision of prevention and
interventions to promote healthy pregnancy
outcomes.
9
MEDICAL AND GENERAL RISK
INDICATORS
•
•
•
•
•
•
•
•
Oral ,Teeth and gums
Gastro-Intestinal
Reproductive tract infect ,e.g., bacterial vaginosis
Chronic infections, e.g., UTI
Sexually transmitted diseases (STDS), Zika
Human Immunodeficiency Virus (HIV)
Tuberculosis
Evidence Based Risk screening by MD, NP,APN,RN
10
GENETIC RISK FACTORS
• Advanced maternal age 35 or older at EDD
• Repetitive spontaneous abortions or
unexplained fetal deaths
• Personal or family history of birth defect,
chromosomal abnormality or genetic disease
e.g., congenital heart disease, cystic fibrosis
• Autosomal dominant disease, e.g.,
Huntington’s Chorea, x-linked diseases, e.g.,
hemophilia.
11
OBSTETRIC HISTORY RISK
INDICATORS
•
•
•
•
•
•
•
•
•
•
•
•
Poor obstetrical history
Multiple gestation
Infant with congenital anomalies
Low birth weight Infant
Premature labor
Bleeding after 20 weeks
Pregnancy induced hypertension
Abnormal amniotic fluid volume
Intrauterine growth restriction
Fetal cardiac arrhythmia
Abnormal fetal lie
Psychological such as Depression, Bipolar, Schizophrenia
12
SOCIOECONOMIC RISK
INDICATORS
•
•
•
•
•
•
•
•
•
Minority ethnic identity
Unemployment
Low Income employment
Household income , federal poverty level
Patient unable to make co-payments
Patient has no telephone
Homeless (couch surfing, no stable residence)
Lives in shelter
Domestic Violence, intimate partner abuse
13
BARRIERS TO PRECONCEPTION
CARE
• Unintended pregnancy- Incidence of
unplanned pregnancy is 49%
• Usual entry into prenatal care in the 3rd month
after LMP – Late entry in care
• Planned pregnancies are seldom planned with
a health care provider
• Health Care disparities
• Lack of knowledge about the importance of
good health habits prior to conception
• Limited access to health care services
14
RECOMMENDATION FOR IMPROVEMENT
OF PRECONCEPTION HEALTH CARE
Am I ready for Conception
• Complete comprehensive risk screening for Medical,
OB, Behavioral Health, Psychological, Socioeconomic
and Genetics.
• Identified Qualified Provider (certified OB/Gyn, Family
Practice, OBFNP, CNM).
• Knowledge and practice of three messages for healthy
life styles
• Get fit: be active, eat healthy, exercise
• Quit: smoking, drinking, using drugs
Plan it: RLP, regular visit to doctor, dentist, practice safe sex
prevents STI / HIV and unintended pregnancy.
15
RECOMMENDATION FOR IMPROVEMENT
OF PRECONCEPTION HEALTH CARE
16
BOOSTER FOR PRECONCEPTION
• 400-800 micrograms of folic acid
• Stop smoking and drinking alcohol
• Keep medical conditions under control
(HTN, Diabetes)
• Consult your doctor about the use of any
over the counter and prescription medicines
such as dietary or herbal supp.
• Avoid contact with toxic substances, stay
away from chemicals, cat and rodent feces.
17
INTEGRATING PRECONCEPTION
CARE IN HEALTH CARE SETTING
• Health service provider should provide
preconception care education and counseling to
women / men of child bearing age as part of a
routine health maintenance care.
• Take advantage of opportunities to recruit women
into preconception care; counseling women with
negative pregnancy test, and all of sexually active
women and men about preconception care.
• Recommendation: Public announcement, TV,Radio
18
INTERCONCEPTION DEFINITION
What is Interconception Care?
• Interconception care is the care before
pregnancy. Sometimes refer to as
“preconception care between pregnancies.
• Interconception care is provided to women of
reproductive age between pregnancies.
• This care addresses specific risk factors of
previous pregnancy outcome e.g.Preeclamptic
Gestational diabetes, HTN, DVT, Preterm labor.
19
GOAL OF INTERCONCEPTION
CARE
The goal of Interconception care is same as
Preconception care & include following objectives:
• To provide additional intensive interventions to
women who have had a previous pregnancy that
ended in an adverse outcome (i.e. infant death,
fetal loss, birth defects, low birth weight or
preterm births).
• Increase awareness of the importance of
pregnancy spacing. Recommendation by March
of Dimes 18th months and ACOG 18-23 months.
20
WHEN SHOULD INTERCONCEPTION CARE BE PROVIDED
• Schedule pre-conception health visits
•
•
•
•
•
Annual GYNE exams
Prenatal care visits
STI visits
Health fairs
Home visits
21
WHO SHOULD PROVIDE INTERCONCEPTION EDUCATION
•
•
•
•
•
•
•
•
•
•
OB / GYN’S
FAMILY PRACTICE DOCTORS
PEDIATRICIANS
NURSE PRACTITIONERS AND NURSEMID WIVES
MENTAL HEALTH PROVIDER
HEALTH EDUCATORS
SOCIAL WORKERS
PUBLIC HEALTH WORKERS AND NUTRITIONISTS
HOME VISITING PROGRAM
SCHOOL BASED HEALTH CENTERS
22
CDC RECOMMENDATIONS TO
IMPROVE REPRODUCTIVE HEALTH
INCLUDE THE FOLLOWING:
•
•
•
•
•
•
•
•
•
Individual responsibility across the life span
Consumer Awareness
Preventive visits
Interventions for identified risks
Interconception Care
Pre-pregnancy Checkup
Health Insurance Coverage for low income women.
Public health programs and strategies
Research & Evaluation
23
REPRODUCTIVE LIFE PLAN
• Why do a Reproductive life Plan?
• Who should do Reproductive Life
Plan?
• What are the Benefits of RLP?
• When should a RLP be done?
• How to Discuss a RLP?
24
OBJECTIVES(RLP)
•
•
•
•
Discuss the components and process of RLP.
Increase ability to assist clients to develop RLP
Identify personal, social and health factors
Provide Risk assessments, health promotion
counseling to women/men of child bearing
age.
• Provide interventions for identified risks.
• Promoting healthy life style.
25
WHAT IS A REPRODUCTIVE LIFE
PLAN?
• A set of personal goals regarding the
conscious decision about whether or not to
bear children.
• It is a process of planning for pregnancy.
• How many children someone want to have ,
and when they want to have them. This helps
them in spacing of pregnancies, or prevent
unintended pregnancy when they are not
ready.
26
WHY DO A REPRODUCTIVE LIFE
PLAN?
• Essential steps in the delivery of family
planning services.
• Helps clients assess their own goals; motivates
behavior
• Helps staff prioritize which family planning
services to provide.
27
WHO SHOULD DEVELOP A RLP
•
•
•
•
•
•
•
•
•
•
Women
partners
Providers
Primary care providers
Case managers : RNs & Social workers
Home visitors
Family Nurse Partnership
School Nurses
Health Educators
Dieticians
28
WHAT ARE THE BENEFITS OF A RLP?
• Can increase perceived control
of reproductive future thus
Empowerment
• Reframes conception chance
• Overcome Ambivalence about
Pregnancy
• Could increase women’s
wellness in reproductive years
and beyond.
• Encourages behavioral change
• Could decrease unintended
pregnancies, short
interconception periods and
poor pregnancy outcomes
• Challenges providers to make
the client interaction more
patient-centered
• Written plan helps goal setting
29
WHEN SHOULD a RLP BE DONE?
• Entry into the health care system at any level.
• During Last Trimester and Post Partum visits.
• Repeated and Reviewed over child bearing
years
• Should be assessed at least annually (well
woman visits)
• Ask every woman capable of becoming
pregnant, “Do you hope to become pregnant
in the next year?”
30
HOW TO DISCUSS A RLP
•
•
•
•
Open Questions: information and feeling
Affirmations: Positive and reinforcing
Reflections: repeat, rephrase, paraphrase
Summary of key points
* Sensitivity to cultural diversity
* Personal beliefs and values are not to be
integrated in the process.
31
WHAT TO CONSIDER DEVELOPING A
REPRODUCTIVE LIFE PLAN
•
•
•
•
•
•
•
Age
Educational goals
Career plans
Living situation
Financial situation
Social support
Relationship with
partner
• Readiness to become
a parent
• Medical history
• Current health status
• Health behaviors
• Contraceptive use
32
AN EFFECTIVE RLP IS
COMPREHENSIVE & INCLUDES:
Health Components:
• Health status
• Health problems
• Immunization
• Medications
• Reproductive health
• Pregnancy readiness
• Pregnancy goals
• Family history
• Personal habits/
behaviour
•
•
•
•
•
•
•
•
•
•
•
Personal components:
Age related
Culture
Living situation
Personal development
Emotional health
Partner relationship
Personal safety
Health care coverage
Financial security
Support and resources
33
WHAT IS REPRODUCTIVE LIFE
PLANNING
• Men and women setting life goals in terms of
childbearing.
• Planning the timing and spacing of healthy
pregnancies.
• Identifying and modifying medical, behavioral
and social factors negatively affecting pregnancy
outcomes.
• Managing pre-existing conditions and behaviors
before, between and beyond pregnancies.
34
HOW THE RLP GUIDES THE DELIVERY
OF CARE
•
•
•
•
•
•
Clients who seek pregnancy
Offer counseling to help achieve pregnancy
Offer preconception health services
Clients who are not seeking pregnancy
Offer contraceptive services
Offer preconception health services, especially
for clients who are at high risk for unintended
pregnancy
• Clients who are not sure encourage her/him to
develop a reproductive life plan, provide services
35
INFANT MORTALITY STATISTICS
YEAR, 2014
ILLINOIS
COOK
BIRTHS
INFANT DEATHS
INFANT MORTALITY
Rates are per 1000 live births
158,522
1044
6.6
69526
467
6.7
Chicago
40137
Suburban Cook 29389
284
183
7.1
6.2
WILLIAMSON
MACON
ST.CLAIR
PEORIA
11
17
41
27
13.5
12.4
12
9.7
813
1366
3420
2770
36
ILLINOIS INFANT MORTALITY
1907-2014
YEAR
2014
2000
1990
1980
1970
1960
1950
1940
1930
1920
1907
NUMBER
1044
1528
2090
2788
4415
5959
4855
4398
7152
10641
11947
RATE
6.6
8.3
10.7
14.7
21.5
25.0
25.6
35.3
55.8
89.0
140.0
37
ILLINOIS INFANT MORTALITY RATE BY
RACE 1980-2014
(Rates are per 1000 live births)
YEAR
WHITE
AFRICAN AMERICAN
OVERALL
2014
5.5
12.6
6.6
2010
5.3
13.6
6.8
2005
5.7
15.4
7.2
2000
6.5
16.3
8.3
1995
7.2
18.2
9.3
1990
7.6
22.1
10.7
1985
9.1
21.3
11.6
1980
11.6
26.1
14.7
Illinois infant mortality rate has declined by more than 40%since 1986, in part
due to investment in the WIC and Family Case Management programs
38
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
1. A reproductive Life Plan is:
A. a set of goals the one makes about
having or not having a children.
B. a plan for spacing children
C. a plan to prevent pregnancies when you
are not ready
D. a plan to set goals in your life
Answers: A&C, B&D, A,B,C and all of above
39
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
2. A Reproductive Life Plan is considered as:
A. personal road map
B. is flexible and one can make changes/or
revisions
C. it includes family planning , career/educational
goals, financial and other personal life planning
Answers: True or False
40
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
3. Who can assist you in developing your
Reproductive Life Plan
A. self
B. case manager
C. provider {doctor, nurse)
D. spouse, significant other, partner, other
Answers: A&B, C, A&D, All of the above
41
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
4. Preconception Health is defined as:
A. a woman’s health before becoming
pregnant
B. knowing how health factors could affect
her unborn baby if becoming pregnant
C. knowing how to maintain a healthy
pregnancy
Answers: A&C, A&B, B&C, All of the above
42
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
5. What are some things you can do to ensure a
healthy pregnancy
A. consult doctor before becoming pregnant
B. take folic acid daily (400-800 micro grams)
C. having the required vaccines
D. management of current and chronic health problems
(diabetes, depression and BP)
E. Prevention of STD’s avoid alcohol, quit smoking
F. Being physically active,develop and exercise plan
Answers: A&C, B&D, All of the above
43
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
6.
Interconception care involve intensive
interaction to women who have had a
previous pregnancy with an adverse
outcome.
True
False
44
REPRODUCTIVE LIFE
PLAN/PRECONCEPTION &
INTERCONCEPTION HEALTH Q & A
7. The provision of Interconception care can
be accomplished at the following.
A: Schedule Visit
B: Annual Gyne Exam
C: Health Fair
D: Day Care visit
Answers: AB, AC, ABC, All of the above
45
APPENDIX
• References:
• Reproductive Life Plans
You’re a Busy Women (Utah Department of Health)
Are you ready? (North Carolina Dept. of Health)
Reproductive Life Plan (Chicago Public Health Dep)
46
REFERENCES
• Reproductive Health Planning
Freda, M,. Moos, M. The History of Preconception Care: Evolving Guidelines and Standards
www.womenhealth.gov/pregnancy/before-you-get-pregnant/preconception-health
Files, J.A., Frey, K., David, P., Hunt, K., Noble, B., & Mayer, A. (2011) Developing a Reproductive Life Plan.
Journal of Midwifery & Women’s Health.
OPA Clearing House
www.opaclearinghouse.org/title.html
Are You Ready? Sex and Your Future
Whb.ncpublichealth.com/Manuals/AreyoureadysexandyourfutureRevised-9-10-10.pdf
www.cdc.gov
Centers for Disease Control and Prevention. Preconception Health. Retrieved on March 17, 2015, from
www.cdc.gov/preconception/documents/rlphealthproviders.pdf.
www.culturediversity.org/mide.htm (Cultural Competence)
www.cdc.gov/nchhstp/newsroom/docs/STDs-Women-042011.pdf
Centers for Disease Control and Prevention. Recommendations for improving preconception
health and health care: United States: a report of the CC/ATSDR
Preconception Care Workgroup and the Select Panel on Preconception Care. MMWR Morbidity
Mortal Weekly Report 2006; (551-23)
Looking Back Moving Forward, North Carolina’s Path to Healthier Women and Babies’ 2007; NC
PRAMS Fact Sheet 2009, Unintended Pregnancies. 2004-2006
Rollnick, S. , Miller, W.R. , & Butler, C. C. (2008). Motivational interviewing in health care:
Helping patients change behavior. New York: NY: Guildord
Resources
Infant Mortality-General Information
Publications
Illinois Infant Mortality 1907-2014
Illinois Infant Mortality Rate by Race 1980-2014
47
North Carolina
48
Utah Public Health Department
49
50
Sample Reproductive Life Plan
51