REPRODUCTIVE HEALTH PLANNING PRECONCEPTION INTERCONCEPTION HEALTH 12017 Stochler

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 3 rd 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 18 th 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 47

North Carolina 48

Utah Public Health Department 49

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Sample Reproductive Life Plan 51