Search for tag: "unplanned"

Dr. Jones: Your period is late and you got the test and you're pretty sure it says that it's positive, but this pregnancy wasn't planned. What are you thinking about and how do you feel?

Well, it turns out that in the United States and around the world, about half of pregnancies are unplanned. Unplanned meaning you weren't thinking about having a baby next month, it wasn't exactly on time, but unplanned usually means that you weren't planning on having a baby any time in the immediate future.

In the unplanned category, of these 50% of pregnancies that are unplanned, about half of them are mistimed. You might say that. A woman would say that she was planning on having a baby sometime, but just not right now.

And about half of those unplanned pregnancies are unwanted, meaning the woman when asked in interviews . . . And these interviews are done nationally about every five to six years through the National Survey of Family Growth and many other organizations who try to get a better understanding of this issue. In that spectrum of unplanned pregnancies comes a spectrum of different emotions.

In the virtual Scope studio today is Jamie Hales. And Jamie is a clinical manager at the Huntsman Mental Health Institute. She's here as a social worker to help us kind of think about what are the emotional responses to an unplanned pregnancy. So thank you for being in the studio, the virtual studio with us, Jamie.

Jamie: Thank you. I appreciate you having me.

Dr. Jones: So I'll give you a little bit of my background. I'm a reproductive endocrinologist and an infertility specialist. So, clearly, the unplanned pregnancy among my infertility patients is one that's met with often surprise and joy. But I'm also a family planning specialist and I've been an abortion provider for pregnancy termination.

And the spectrum of emotions is huge in terms of people who come and are faced with a pregnancy that they either didn't want now or didn't want ever. Can you tell me a little bit about your experience and what you've seen?

Jamie: I would completely echo that experience. What I most often see in my practice is more when somebody has had an unexpected pregnancy, it's a happy thing. They're excited about it. But I 100% see people where that is the exact opposite experience.

Sometimes our society, the idea is that, as a woman, you're supposed to be extremely excited about this new journey and chapter in your life. It isn't always that way for everybody, and that's not a bad thing.

And I think something that's really important when you're working with people who are childbearing age is to be as open-minded as possible about this because not everybody's pregnancy journey is the same. There is variation all over the place, and I think it can be hard sometimes for people to admit that, "Yeah, this is something that I'm really struggling with."

Dr. Jones: We go down this pathway of healthy baby, healthy mommy, and we don't spend a little time and say, "Why don't you tell me how you're feeling about this?"

Quite frankly, I'm a mother and a grandmother, and I planned my pregnancy down to the minute, but I was ambivalent. Even though it was highly planned, I was ambivalent thinking, "My life will never be the same." And there was a little bit of worry and grieving about that, even in a very planned pregnancy.

I think it's a matter of recognizing that it's an emotional rollercoaster. First of all, your hormones are different. You are now in a potentially new social domain going forward. You will now be a new person, if you choose to continue the pregnancy, called a mother. And then there's your own emotional makeup and you don't want to do that.

Listen with an open heart. I don't know how to put that in any other way. It's rare to have someone who's so neutral that they've got nothing going on. I worry if I see that.

Jamie: That's a very good point. I think being completely neutral about your pregnancy probably is more of a red flag than having some strong feelings about it either direction.

And those feelings can change, right? One day you may be feeling absolutely fantastic about it, and then there may be other days where that is not the case. And ultimately, it isn't up to the people around you to decide what the normal range of emotion is. That's up to you.

It can be a very fraught topic, but it's also one that I think is very important for us to discuss because this is another one of those situations where you might be out there experiencing some of these thoughts and feelings and think, "Wow, I'm the only one that's dealing with this right now," or, "I don't want to say anything because nobody is going to understand." And it is much more common than I think people realize. 

Dr. Jones: So how do we begin to help women negotiate how they're feeling and what they're planning on doing, figure out what are the resources available to them?

Jamie: Resource-wise, there are a couple of groups that are done online through Postpartum Support International. They have a virtual group for medical termination and also one for post-termination support, even if it wasn't for medical reasons.

So there are really good resources out there, and I think it's important to speak up if it's something that you're struggling with.

Ultimately, at the end of the day, we're not the ones that have to make really tough choices around this. And what the person wants and how they're feeling about it absolutely comes ahead of what any of the rest of us may or may not think about that pregnancy.

If you're going to therapy, that's a really great safe space, I think, a lot of the time to bring up complicated feelings about stuff because it's confidential.

And not everybody in your life may agree one way or the other with your choice whether to continue, not continue, the fact that it happened in the first place.

There are a lot of factors that go into unplanned pregnancies. There's a change in identity. Everyone, I think, comes at it with a different background, a different degree of support and resources.

Dr. Jones: Right. And most women struggle in the sense that they are making a decision thoughtfully, and when they finally make their decision, they're usually pretty sure. But on the way, it's giving them the information that they need so that they can feel that the next 60 years of their life one way or the other is written in a way that they can feel comfortable and move ahead.

I want to thank you so much for joining us. And for everyone who's been listening, thank you for joining us on the "7 Domains."

Dr. Jones: What would the life of women and their children look like if every woman had the information and ability to plan every pregnancy? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah health care, and this is The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: In the United States, almost half of all pregnancies are unplanned. In about half of those, the unplanned pregnancies were mistimed and about one-half of those pregnancies were unwanted. What would happen in the lives of women if they had all the information they needed to make a careful decision about pregnancy, or contraception, and they could get any method of contraception they wanted for free? Dr. Turok is a clinical professor in the Department of Obstetrics and Gynecology here at the University of Utah and a specialist of family planning.

Welcome, Dr. Turok. What happens in young women's lives when they have an unplanned pregnancy?

Dr. Turok: The largest group of women who have abortions in this country are those who have unintended pregnancies and as you mentioned, it a lot of people. It's over a million women a year. And for women who continue with a pregnancy, pregnancy is a chaotic time, as is child rearing, and if you're not planning for it from the get go, it further complicates things.

A population of people who have had planned pregnancies and a population of people who have had unplanned pregnancies and the children thereof, the kids from unplanned pregnancies are more likely to be born premature, to end up in the newborn ICU, to have less medical care in their first year of life, to do less well in school, and to not finish school.

Dr. Jones: So there are good reasons to build a structure around which families can be planned. We all want the kids that come to us, we don't all, but most of us want the kids that came to us because we, after the fact, create this incredible story about our kid was the miracle we didn't planned, but we love. But there are consequences to having babies that aren't planned.

Dr. Turok: There certainly are. The best predictor of having loving parents around to care for a child is to have been planning for that child from the beginning. And it's such an important predictor of how well children do that anything that we can do to help people time their pregnancies so they end up with the children they want, when they want them, only helps everybody.

Dr. Jones: In other countries, I know Europe does a pretty does a good job, people in Scandinavia do a pretty good job planning their children. What's keeping us in the U.S. from planning our children? Why do we have the highest rate of unplanned pregnancies in the Western world?

Dr. Turok: The difference between Scandinavia and the United States are many things. It's sexuality education, it's the conversations that children and young people and their parents have regarding the expectations for intimate partners. And it's the availability of contraception. In Scandinavia many more women use the most effective, reversible methods of contraception like IUD's and implants. And what we've seen in the United States in the past decade is that as communities and states have broadened the availability of these most effective methods, the rates of unintended pregnancy and abortion have plummeted.

Dr. Jones: What is it about America? Is it that we are a multicultural country? Because we don't have a unified healthcare system? Is it because we have diversity in income across the country? We have people who are truly poor. Why are we different than the Scandinavians, other than we don't have as many blonde people?

Dr. Turok: The biggest thing we see in disparities of unintended pregnancy are along socioeconomic lines, and race and class, and women of color, women who have completed less education, women who have fewer financial resources, are much more likely to have unintended pregnancies. In making opposites available and really removing all barriers to obtain methods of contraception will aid those people in determining when and if they have children.

Dr. Jones: We still have to reach out though to women. Women have to be thinking about contraception rather than just saying "oops", or, This is just what happens to me, and it happened to my mother and it happened to my sister." So how are we going to reach out to a vulnerable population of women here in Utah, here in Salt Lake County, to get their attention and say, "Are you sexually active?" Or whatever that means. "Do you want contraception? Do you want it for free? Come and see us." How are we going to reach out to the people who don't think they're going to get pregnant?

Dr. Turok: We've been working on this for quite some time, and the number one place people who want to initiate contraception, who have barrier of obtaining it come to in Salt Lake County is Planned Parenthood. So that's why we are collaborating with the four Planned Parenthood clinics in Salt Lake County to provide any method of contraception that women want that's offered at those clinics for free. And that includes the most expensive and the most effective methods, which are IUD's and implants.

Dr. Jones: And women who come in, they can get their method for free, but some of them actually might be willing to let us contact them in the years to come to see what happened with their lives using whatever method they chose.

Dr. Turok: Right. So we've started this project called "HER Salt Lake," or the HER Salt Lake Contraceptive Initiative, and what it does is we have three six-month periods. The first period is just the way it has been for very long, where people essentially have to figure out how they're going to get their method and pay for it.

The second period we eliminate all the costs. You walk in, you get the method you want, regardless of the ability to pay. And you don't pay anything.

And the third six-month period, we have a media campaign where women 18-29 years old will receive information on they had held devices that promotes the information about IUD's and implants and connects them with the places where they can get it for free. It'll be on Facebook, it'll be on Twitter, but it'll also be on pop up ads. It'll be modulated along the way to optimize the message and the way people receive it and when they get it. It requires a lot of community support, and support from outside resources, but we can get this done and we're working on creating a durable solution for this.

Dr. Jones: Years ago we had a picture of a pie which looked at the pregnancy outcomes in this country with the unplanned rate at a little over 50%, and for years and years that didn't budge, and you told me that your life's work was going to be to move the needle. How do you think it's going?

Dr. Turok: Yeah I think what I said was, if the shape of the pie doesn't change during the course of my work life, I'm going to be really upset that I didn't spend enough time skiing with my kids.

Dr. Jones: Dr. Turok, thanks for joining us and thank you for moving the slice of the pie that will be afforded to children who've been planned.

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