Providers miss opportunities to prevent depression in and discuss birth control with women with unplanned pregnancies
Research Activities, August 2011, No. 372
The American College of Obstetricians and Gynecologists recommends that clinicians screen pregnant women during the first prenatal visit for depression, stress, support, and whether the pregnancy was planned. This screening allows providers to pinpoint women who may be at risk for post-partum depression or who may need social support once the baby arrives. A new study finds that this counseling is inconsistent, and clinicians miss opportunities to discuss future birth control and social support with women whose pregnancies were unplanned.
Judy C. Chang, M.D., M.P.H., of Magee-Women's Hospital, and colleagues recorded conversations during 48 prenatal visits with 16 providers in an academic medical center in Pittsburgh. Thirty-five of the women indicated that their pregnancies were unplanned. Most of the visits included discussion about how the women felt about their unplanned pregnancies (29 of 35 visits), but only 8 women's visits included discussion about pregnancy options. What's more, providers referred just six women to counselors or social services, despite evidence showing that an unplanned pregnancy is a risk factor for depression during and after pregnancy. Finally, future birth control plans were addressed in the visits of just 4 of the 35 women whose pregnancies were unplanned.
Because one unplanned pregnancy is a red flag for future unplanned pregnancies, the authors suggest that providers are missing opportunities to help women prevent future unplanned pregnancies. This study was funded in part by the Agency for Healthcare Research and Quality (HS13913).
See "Now is the chance: Patient-provider communication about unplanned pregnancy during the first prenatal visit," by Rebecca Meiksin, M.P.H., Dr. Chang, Tina Bhargava, M.A., and others in the December 2010 Patient Education and Counseling 81(3), pp. 462-467.