Sexuality Topics

Pregnancy

As you read through the case example, consider the following questions.

• How did you react to the example? Why do you think you reacted that way?
• If this was your client, what would be the most important discussion points?
• What  additional information do you need to respond to the case example?

Background

Early confirmation of pregnancy may prompt women to seek early medical care and take actions that benefit the health of the pregnancy such as folic acid/prenatal vitamin supplementation, avoiding alcohol and/or substances and eating a healthy diet.

Most women experience some signs and symptoms of pregnancy as early as three weeks after conception. The likelihood of pregnancy increases if signs are present BUT the absence of signs does NOT rule out pregnancy. A diagnosis of pregnancy CANNOT be made based on symptoms alone.

The diagnosis of pregnancy is based primarily upon the laboratory assessment of the hormone of pregnancy- human chorionic gonadotropin (hCG) or diagnosis by fetal Doppler or ultrasound.

Specific questions to ask if pregnancy is suspected:

• When was your last period? Was it normal?
• Do you usually get regular periods? (normal is between every 23 – 36 days)
• Are you sexually active?
• Do you use birth control? (Hormonal contraception and/or condoms.)
• Do you take your birth control correctly and consistently?
• Do you have any symptoms of pregnancy?
• Is there a chance you might be pregnant?

Reported delay of period, sexual activity and imperfect/no use of birth control and client suspicion of pregnancy are predictive that a pregnancy test would be positive.

Signs and symptoms of pregnancy are classified as presumptive, probable and positive.

Presumptive signs of pregnancy are symptoms that may resemble pregnancy signs but can also be caused by something else.

For example:

• Missed period
• Nausea and vomiting
• Fatigue
• Frequent urination
• Breast tenderness

Probable signs of pregnancy are signs that indicate pregnancy the majority of the time; however there is still a chance that they might indicate something else.

For example:

• Positive pregnancy test
• Enlarged abdomen

Positive signs of pregnancy are signs that under any circumstances cannot be mistaken for other conditions,

For example:

• Fetal heart sounds heard by a Doppler
• Ultrasound detection of the fetus
• Fetal movement felt by a doctor

The most common signs and symptoms of early pregnancy are:

• Missed period – should be suspected if delay of menses > 1 week and childbearing years.
• Nausea with or without vomiting (“morning sickness”) – typical during 6-12 weeks and often worse in the morning but can occur at any time during the day.
• Breast tenderness – enlargement of breasts with a heavy sensation associated with tingling and soreness.
• Increased frequency of urination.
• Fatigue – most common in first trimester, less common in the second trimester.

Other common signs of early pregnancy are:

• Irregular bleeding – some women have irregular bleeding on and off, or bleeding around that time that one would expect their period to come.

• Food craving and food aversions.
• Mood changes.
• Lightheadedness.
• Bloating.
• Constipation.
• Heartburn.
• Lower back pain.
• Nasal congestion.
• Uterine cramping.
• Shortness of breath (not associated with cold, asthma, etc.)

Pregnancy Tests

The hormone of pregnancy is called human choronic gonadotropin also known as hCG. hCG can be measured in either the blood or urine. The blood test is the most sensitive test and can detect hCG as early as 6-12 days after ovulation.

Urine tests are generally less sensitive than the blood test. A urine pregnancy test can’t usually detect HCG in the urine until the day of the expected period. If the test is done too soon, the result may not be accurate. If the test is negative and the period does not come, the test should be repeated in one to two weeks or at least 14 days after unprotected intercourse.

Urine pregnancy tests can be done in the home, doctor’s office or laboratory. If a home pregnancy test is done, make sure to follow the instructions on the kit carefully and that it hasn’t passed its expiry date. It is recommended to test a first morning urine sample when the concentration of hormone is highest.

For more information about early pregnancy, see:
http://sexualityandu.ca/en/games-and-apps/am-i-pregnant

For an excellent resource for those experiencing pregnancy and street involvement, see:
http://streetworks.ca/pdfs/pregnancy-book-inside.pdf

Pregnancy Options

If an unplanned pregnancy has been confirmed, a woman has 3 options.

• Continuing with the pregnancy and choosing to parent.
• Continuing with the pregnancy and choosing adoption.
• Ending the pregnancy and choosing abortion.

Parenting

If a woman chooses to become a parent, receiving medical care right away can help make sure that she has a healthy pregnancy. There are many ways to increase the chances of having a healthy baby, such as:

• Developing healthy eating habits.
• Staying active.
• Getting plenty of sleep.
• Limiting caffeine intake.
• Not using cigarettes, alcohol or drugs.
• Checking with a healthcare provider before taking over-the-counter drugs or prescription medications.

Having a healthy pregnancy and choosing to parent is an incredibly important job which has rewards as well as challenges. There are many resources in the Calgary area to help have a healthy pregnancy. Please contact the Alberta Heath Services, Calgary Zone Best Beginnings program at 403-228-8221.

For more information about pregnancy, labour, birth and new parenting, see:
www.albertahealthservices.ca/services.asp?pid=service&rid=1568
www.birthandbabies.com

Adoption

In Canada each province has its own rules and regulations regarding adoption. In Alberta, if a woman chooses to continue the pregnancy and place the child for adoption there are several types of adoptions to choose from:

• Public adoption
• Private adoption
• Direct adoption

Public Adoption

Public adoptions are arranged by a government agency known as The Government of Alberta Children and Youth Services. The services provided by the government agency are confidential and free for birthparents. Typically public adoptions are closed adoptions meaning that the birthparents and adoptive parents are not given any identifying information about each other at the time of adoption. However, in November 2004, Alberta began allowing adopted adults and their birth parents access to identifying information via the Alberta Post Adoption registry. Please contact 403-297-6038 for counseling and support for people thinking about adoption.

For more information public adoption, see:
Calgary and Area Adoption Intake: 403-297-6038
http://child.alberta.ca/home/620.cfm

Private Adoption

Private adoption is any adoption that is not arranged by a public agency. Private adoptions include fees established by the private adoption agency that are paid by the adoptive parents. The services are offered free of charge for birth parents.

Adoptions may be open, closed, or somewhere in between. Deciding to have an open or closed adoption is a personal choice which depends on the comfort levels of the birth parent(s) and adoptive parents.

Private Direct Adoption

A private direct adoption means that the birthparent(s) have chosen to place their child directly with a known family or within their own family. Private adoption agencies can assist with this process.

Open Adoption

An open adoption refers to any situation where the adoptive parent(s) and the birth parent(s) know each other and exchange identifying information. Just how much information they exchange depends on the level of comfort of each person(s).

With an open adoption, the birth parent(s) may choose how involved they wish to be in the child’s life including:

• Meeting the adoptive parent(s).
• Having an ongoing relationship with the adoptive parent(s) and the child.
• Giving letters or photos.
• Receiving photos of the child as the child grows.

Closed Adoption

In a closed adoption, no identifying information is exchanged. It is unlikely that the birth parent(s) and the adoptive parent(s) meet. The birth parent(s) may ask that they receive no information once the child has been placed.

What are the Rights of the Birthfather?

In Alberta, if the birth father is listed on the birth certificate, the baby’s father will (in most cases) be a guardian and he must consent to the adoption.

For more information adoptions, see:
www.adoptionbychoice.ca
www.adoptionoptions.com

Abortion

In Alberta, a woman can access a legal abortion until the end of the 19th week of pregnancy. However, most abortions happen during the first 12 weeks of pregnancy. If the woman has Alberta Health Care, there are no fees for the procedure. Fees apply if the woman does not have Alberta Health Care.

For more information on abortion, see:
http://www.albertahealthservices.ca/services.asp?pid=service&rid=2131

www.kensingtonclinic.com

Bastian, L.A., & Brown, H.L. (2010). Diagnosis and clinical manifestations of early pregnancy. UpToDate.

Calgary Sexual Health Center. (2008). Pregnant and undecided? A resource for women facing an unintended pregnancy. Calgary: Author.

Sexual & Reproductive Health – Alberta Health Services Calgary Zone. (2010). Get the facts on…teen pregnancy, sexually transmitted infections (STI), HIV & AIDS, and teen sexuality. Calgary: Author.

Worthington, C., MacLaurin, B., Dittman, D., & Kitt., O. (2009). Sexual health among Calgary’s street-involved youth. Calgary youth, health and the street – Fact sheet #4. Calgary: University of Calgary.