Washington, DC — All health care providers, especially obstetrician-gynecologists, have a role to play in counseling their patients about reproductive life planning, according to a new Committee Opinion released by the American College of Obstetricians and Gynecologists (ACOG). Every patient encounter provides an opportunity to discuss pregnancy intentions and to promote preconception care or contraceptive access and consistent use, ACOG says in "Reproductive Life Planning to Reduce Unintended Pregnancy."
"Every woman who is capable of having a child should have a reproductive life plan," reports the Committee Opinion. A reproductive life plan is "a set of personal goals regarding whether, when, and how to have children based on individual priorities, resources, and values." Reproductive life planning extends beyond contraception-related or well-woman visits, and can include having birth control conversations in the acute or prenatal care setting.
Reproductive life planning helps to ensure not just prevention of unintended pregnancy, but also optimization of health prior to and between planned pregnancies.
"Right now in the United States, roughly half of all pregnancies are unintended," said Wanda K. Nicholson, MD, MPH, Chair of ACOG's Committee on Health Care for Underserved Women and lead author of the Committee Opinion. "Clearly we are not meeting the needs of all women in terms of preventing pregnancy and counseling about reproductive life planning."
Recommendations for ob-gyns and other health care providers, as laid out in the Committee Opinion, include:
- Take advantage of each patient visit as an important teachable moment to assess each woman's short- and long-term reproductive plans.
- Engage each patient in supportive, respectful conversation about her pregnancy intentions and provide preconception or contraceptive counseling based on the woman's desires and preferences.
- Discuss the range of contraceptive methods and the perceived barriers to contraception, and engage in shared decision making to optimize contraceptive choices with women who desire to avoid pregnancy.
- Educate women about the importance of pregnancy planning and child spacing to reduce adverse pregnancy outcomes.
- Maintain awareness of the Affordable Care Act's contraception coverage provisions as well as local community initiatives that improve women's knowledge of how to access low- or no-cost contraception.
- Support initiatives that reduce poverty and racial and ethnic health inequalities, both of which are major drivers of unintended pregnancy.
"Thanks to the wide range of contraceptive methods available, we are able to meet the varied health needs and preferences of women, from preventing initial pregnancy to aiding in birth spacing, for example through postpartum insertion of long-acting reversible contraception," said Dr. Nicholson. "By including conversations about reproductive preferences in every interaction with our patients, we are acknowledging the essential role that birth control has in a woman's well-being."
Committee Opinion number 654, "Reproductive Life Planning to Reduce Unintended Pregnancy," is published in the February issue of Obstetrics & Gynecology.
Other recommendations issued in the February Obstetrics & Gynecology:
Committee Opinion #653, "Concerns Regarding Social Media and Health Issues in Adolescents and Young Adults"
Although there are many positive aspects of social media for adolescents and young adults, there are also risks. Adolescence is a time of significant developmental changes, during which adolescents exhibit a limited capacity for self-regulation and an increased risk of susceptibility to peer pressure and experimentation. Social media can be harmful, and obstetrician–gynecologists may screen their adolescent and young adult patients for high-risk sexual behaviors, especially if sexualized text communication (sexting), exposure to pornography, online dating, or other risk-taking behaviors are present. Victims of cyberbullying and those who engage in sexting are at increased risk of sexually transmitted infections and pregnancy. The effect of social media may be considered in the differential diagnosis of myriad health problems during adolescence. Referrals to mental health care providers or providing outside resources may be indicated. A multidisciplinary approach to address these issues can include the obstetrician–gynecologist, guardians, and school officials and personnel. Knowledge of resources, including those within the schools and community, allows the obstetrician–gynecologist to provide support to adolescents facing these issues.
Committee Opinion #655, "Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infections in Obstetrician–Gynecologists"
To prevent transmission of bloodborne pathogens, it is important that health care providers adhere to standard precautions, follow fundamental infection-control principles, and use appropriate procedural techniques. All obstetrician–gynecologists who provide clinical care should receive the hepatitis B virus vaccine series. The Society for Healthcare Epidemiology of America has established guidelines for the management of health care providers who are infected with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The guidelines categorize representative obstetric and gynecologic procedures according to level of risk of bloodborne pathogen transmission and include recommendations for health care provider clinical activities, based on these categories and viral burden. It is important to note that when no restrictions are recommended, careful supervision should be carried out as highlighted. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.
Committee Opinion #656, "Guidelines for Diagnostic Imaging During Pregnancy and Lactation"
Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding.
Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.
Committee Opinion #657, "The Obstetric and Gynecologic Hospitalist"
The term "hospitalist" refers to physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities may include patient care, teaching, research, and inpatient leadership. The American College of Obstetricians and Gynecologists supports the continued development and study of the obstetric and gynecologic (ob-gyn) hospitalist model as one potential approach to improve patient safety and professional satisfaction across delivery settings. Effective patient handoffs, updates on progress, and clear follow-up instructions between ob-gyn hospitalists and patients, nurses, and other health care providers are vital to maintaining patient safety. Hospitals and other health care organizations should ensure that candidates for positions as ob-gyn hospitalists are drawn from those with documented training and experience appropriate for the management of the acute and potentially emergent clinical circumstances that may be encountered in obstetric care.
Committee Opinion #658, "Optimizing Support for Breastfeeding as Part of Obstetric Practice"
Although most women in the United States initiate breastfeeding, more than one half wean earlier than they desire. As reproductive health experts and advocates for women's health who work in conjunction with other obstetric and pediatric health care providers, obstetrician–gynecologists are uniquely positioned to enable women to achieve their infant feeding goals. The American College of Obstetricians and Gynecologists recommends exclusive breastfeeding for the first 6 months of life, with continued breastfeeding as complementary foods are introduced through the infant's first year of life, or longer as mutually desired by the woman and her infant. Because lactation is an integral part of reproductive physiology, all obstetrician–gynecologists and other obstetric care providers should develop and maintain knowledge and skills in anticipatory guidance, physical assessment and support for normal breastfeeding physiology, and management of common complications of lactation. Obstetrician–gynecologists and other obstetric care providers should support each woman's informed decision about whether to initiate or continue breastfeeding, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant. Obstetrician– gynecologists and other obstetric care providers should support women in integrating breastfeeding into their daily lives in the community and in the workplace. The offices of obstetrician–gynecologists and other obstetric care providers should be a resource for breastfeeding women through the infant's first year of life, and for those who continue beyond the first year.
Practice Bulletin #161, "External Cephalic Version"
In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org