New Zealand College of Sexual & Reproductive Health

Abortion Training

Module 1: Consultation – communication and decision making

6. Review of key learning points

1. Abortion legislation in Aotearoa New Zealand and patient rights

2. Providing patient-centred abortion care

  • Abortion service providers need to be able to provide high-quality care to Māori in a way that respects their identity, tikanga and worldview as Māori. Cultural safety training should be incorporated into abortion providers’ continuing education
  • Abortion service providers should routinely enquire about intimate family violence and be alert to any evidence of reproductive coercion. A system for referral to appropriate support services should be in place.
  • Disabled people are often experts on their own conditions, and this should be recognised and respected by abortion care providers. Barriers limiting accessibility and effective communication need to be identified and overcome before providing abortion services.

3. Establishing the gestation and location of pregnancy and focused medical history

  • The pregnancy should be confirmed by urine or serum testing, and a focused medical history needs to be taken to identify any contraindications or risk factors for early medical abortion (surgical abortion then advised)
  • The gestation can be determined by ultrasound, the LMP date, and bimanual examination
  • βhCG alone should not be used for dating and must be corelated with the LMP, clinical examination and/or the ultrasound scan findings. If the βhCG is significantly higher than anticipated, consider the possible of a molar pregnancy
  • Approximately 1% of known pregnancies are ectopic (when a fertilised ovum implants outside of the uterine cavity). If suspected, patients should be referred for further ultrasound assessment or emergency care. Typical symptoms include:
    • Amenorrhea with PV spotting or bleeding (the most common presentation)
    • Pelvic pain, usually one-sided
    • Other pregnancy symptoms
    • If ruptured, then symptoms of shock (e.g. pallor, sweating, fainting, increasing pain, shoulder tip pain)

4. Effective shared decision making with people about their pregnancy outcome

  • Health practitioners should be well prepared to describe and discuss the options for continuing pregnancy and abortion, communicating clearly in a manner best suited to the individual’s needs
  • It is the abortion service provider’s responsibility to ensure informed consent is obtained, and to communicate and work with the person to help them make the best decision for themselves
  • In instances where the pregnant person appears to feel ambivalent about abortion, suggest they give themselves more time, make a follow-up appointment and offer counselling
  • People requesting an abortion should be offered an informed choice of medical or surgical methods, taking into account the gestational age, their medical history, health practitioner skill and local service provision options
  • Practitioners should routinely offer opportunistic testing for STI, and contraceptive counselling and provision

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