title: Now is the chance: patient-provider communication about unplanned pregnancy during the first prenatal visit.
abstract: OBJECTIVE
  Unplanned pregnancy is associated with psychosocial stress, post-partum depression, and future unplanned pregnancies. Our study describes how topics related to unplanned pregnancy were addressed with patients during the first prenatal visit.
  
  
  METHODS
  We audio-recorded and transcribed initial prenatal visits between 48 patients and 16 providers from a clinic serving racially diverse, lower-socio-economic patients. We conducted a fine-grained thematic analysis of cases in which the patient's pregnancy was unplanned.
  
  
  RESULTS
  Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits for unplanned pregnancies (83%) included discussion of the patient's feelings about the pregnancy. Approximately half (51%) of the visits touched on partner or other types of social support. Six patients (17%) were offered referrals to counseling or social services. Only four visits (11%) touched on future birth control options.
  
  
  CONCLUSIONS
  Most initial prenatal visits for unplanned pregnancies included discussion of patient feelings about the pregnancy. However, opportunities to discuss future birth control and for more in-depth follow-up regarding social support and psychological risks associated with unplanned pregnancy were typically missed.
  
  
  CONCLUSIONS
  Obstetrics care providers should be cautious about making assumptions and should consider discussing pregnancy circumstances and psychosocial issues in more depth when treating patients facing unplanned pregnancy.
authors.affiliation: VA Puget Sound, Seattle, WA 98101, USA. Rebecca.Meiksin@va.gov
authors.forename: Rebecca
authors.initials: R
authors.lastname: Meiksin
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
authors.forename: Tina
authors.initials: T
authors.lastname: Bhargava
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
authors.forename: Diane
authors.initials: D
authors.lastname: Dado
authors.forename: Richard
authors.initials: R
authors.lastname: Frankel
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Bruce
authors.initials: B
authors.lastname: Ling
authors.forename: Susan
authors.initials: S
authors.lastname: Zickmund
mesh_terms: D000293:Adolescent; D000328:Adult; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011295:Prenatal Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013637:Tape Recording; D013997:Time Factors; D055815:Young Adult