N491 Trends in Healthcare: Seminar Presentation Kendra Myers Yvonne Salter Emily Overmars.
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Transcript of N491 Trends in Healthcare: Seminar Presentation Kendra Myers Yvonne Salter Emily Overmars.
ABORTIONN491 Trends in Healthcare: Seminar Presentation
Kendra MyersYvonne Salter
Emily Overmars
Objectives Explore the history and evolution of abortion in
Canada. Differentiate between the various types and
specific procedures of abortions. Examine the ethical viewpoints in relation to
abortion. Analyse the role of the health care professional
(in particular, the nurse) in the delivery of abortion services to the general public.
Discuss the availability of these services within Nova Scotia.
Outline The history of abortion Current influences on abortion The different methods of abortion, both medical and surgical,
that are used based on the stage of pregnancy The pro-life perspective that opposes abortion The pro-choice perspective that supports abortion The nurse’s role in the abortion process What a nurse should do if he/she disagrees with the practice
of abortion Emotional issues post abortion, supports and services
available Abortion services available in Nova Scotia
Abortion Induced abortion is the
purposeful interruption of a pregnancy
Many factors contribute to a woman’s decision to have an abortion:
- Preservation of the life or health of the mother
- Genetic disorders of the fetus
- Rape or incest
- Personal choice
Wong, Hockenberry, Wilson, Perry & Lowdermilk (2007).
History of Abortion In 1892, parliament passed Canada’s first Criminal
Code, which prohibited abortion, as well as the sale, distribution, and advertising of contraceptives – Many women continued to seek abortions
Abortion was a criminal act in Canada up until 1969 when Canadian physicians and the Canadian women’s movement fought against the prohibition of abortion in the Criminal Code.
In 1988 the Supreme Court of Canada recognized that a woman’s right to continue or to terminate a pregnancy is protected by the Canadian Charter of Rights and Freedoms and struck down the law.
(Browne & Sullivan, 2005) (Rodgers & Downie, 2006)
Current Influences on Abortion
Canada has no legislative or judicial restrictions on abortion. The circumstances under which abortions can be performed is unregulated.
Repeat pregnancy termination procedures are common in Canada, 35.5% of all induced abortions are repeat procedures
(Browne & Sullivan, 2005) (Fisher et al., 2005)
Current Influences cont’d Abortion access throughout Canada has
become an issue, with limited improvement since the legalization.
Medication abortion (the use of a drug or combination of drugs to terminate pregnancy) could improve abortion care across Canada.
Methods of Elective Abortion Surgical Abortion:
Vacuum Aspiration
Dilation and Evacuation
Dilation and Extraction
Labour Induction
Medical Abortion:
Mifepristone
Methotrexate and Misoprostol combined
(The American College of Obstetricians and Gynaecologists, 2010).
Vacuum Aspiration
The cervix is dilated by manually using instruments or by using laminaria.
A uterine aspirator is introduced. Suction in applied, and tissue is
removed from the uterus. This is the most common type of
termination procedure and is used up until 20-22 weeks of gestation.
(Bare et al., 2007).
(The American College of Obstetricians and Gynaecologists, 2010).
Dilation and Extraction
A surgical procedure in which an intact fetus is removed from the uterus via the cervix
Used to terminate a pregnancy after 21 weeks gestation
Also used to removed a deceased fetus Illegal in the United States
(The American College of Obstetricians and Gynaecologists, 2010).
Labour Induction
Installation of saline or urea results in urine contractions
Prostaglandins are introduced into the amniotic fluid
Intravenous oxytocin
(Bare et al., 2007).
Mifepristone
Also known as RU-486 or the “abortion pill”
A progesterone antagonist that prevents implantation of the ovum
As of June 1st, 2005 this drug is no longer available within Canada
(Bare et al, 2007).
Methotrexate and Misoprostol Combined
Methotrexate - teratogen that is lethal to the fetus
Misoprostol - a synthetic prostaglandin that produces cervical effacement and uterine contractions
Highly effective Only used in pregnancies up to
49 days from the last menstrual period
(Bare et al, 2007).
Procedure According to Trimester
First Trimester
Methotrexate and Misoprostol
Mifepristone
Vacuum Aspiration Second Trimester
Labour induction
Dilation and Evacuation (D&E) Third Trimester
Labour induction
Dilation and Extraction
(American Pregnancy Association, 2007).
Risks
Incomplete abortion Infection Hemorrhage Damage to the uterus Death
(The American College of Obstetricians and Gynaecologists, 2010).
Pro-Choice Argument
Women must have the right to make their own decision
Believe that life begins at birth A pregnant women is considered one
person All abortions are medically required and
not “elective” All women should have the right to fully
funded abortion services
(Abortion Rights Coalition of Canada, 2010).
Pro-Life Argument
Abortion is viewed as murder Support fetal rights Believe that life begins at conception Concerned about the long term
emotional effects on women God is the giver of life, not the mother We should protect the sanctity of life
(Christian Net, 2008).
Nurse Role
Prior to abortion: assist with exploring various alternatives and consequences
Continued support after decision has been made:
- Provide information re: procedures, expected discomfort/pain, and type of care needed
Following abortion: assess for grief and facilitate the grieving process
(Wong et al., 2006)
Nurse Role
Nurses provide postabortal instructions, which vary among health care providers
- Instructed to watch for excessive bleeding (> large pad/hr for 4 hrs), cramps, or fever
- The woman may expect her period to resume 4-6 wks after the day of the procedure
- The nurse offers information re: birth control if not done already
- The woman is strongly encouraged to return for a follow-up
- Pregnancy test may be performed to determine success of procedure
(Wong et al., 2006).
Nursing Considerations
It is important for nurses to know the laws regarding abortion
Nurses whose religious or moral beliefs do not support abortion have the right to refuse such an assignment
If possible, nurses should avoid working in environments that will frequently challenge his/her ethical values
Reassignment is usually an option
(Wong et al., 2006) (Day et al., 2006)
Emotional Effects of Abortion The way a woman reacts to an abortion is
most likely determined by the reason she requested the procedure
Reactions a woman may feel following abortion: shame, anger, regret, fear, anxiety, guilt, sadness, failure, loneliness, decreased self-confidence, disturbed body image, difficulty developing or maintaining relationships, emotional numbness
Postabortal counselling should always be encouraged/provided
(Canadians for Choice, 2010).
Abortion Services in Canada
Access to procedure is steadily declining Only 22 abortion clinics across the
country Only accessible in 1 of every 6 hospitals Most providing hospitals require a
doctor’s referral and are located in urban centres
Abortion Services in Nova Scotia Only one facility in NS provides
abortions – Queen Elizabeth II in Halifax Wait time: 1-2 weeks Gestational limit: up to 15 weeks, 6 days Fees: Free to all residents of NS Confidential Conscious sedation &
local anaesthetic
(Canadians for Choice, 2010).
Nova Scotia Association for Sexual Health
Formerly called Planned Parenthood Seven locations throughout province
(Bridgewater, Sheet Harbour, New Glasgow, Amherst, Sydney, Yarmouth & Halifax)
Offer a variety of sexual health & counselling services
The Nova Scotia Association for Sexual Health (NSASH) is dedicated to promoting healthy sexuality throughout the life span, in an
environment that respects and supports choice.
(Canadians for Choice, 2010).
Discussion Questions
When is the fertilized egg considered a human being?
Should nurses sympathise with the pro-life argument or the pro-choice argument?
Do you think the morning after pill is the same as abortion?
If a woman wants an abortion, what rights does the father have?