As providers of preventive health and chronic disease care for men and women during their reproductive years, family physicians are well-positioned to proactively care for women, men, and families prior to, during, this web page after pregnancy.
Preconception care is defined as individualized care for men and women that is focused on reducing maternal and fetal morbidity and mortality, increasing the chances of conception when pregnancy is desired, and providing contraceptive counseling to help prevent unintended pregnancies. Details and risk factors associated with previous pregnancies are integral to interconception care.
National attention to preconception care interventions dates back to when the inaugural Healthy People initiative included a focus on the reduction of unintended pregnancies. To deliver on the promise to provide comprehensive care to patients, family physicians must possess the knowledge, ability, and skills Position Paper On Abortion provide preconception care. This position paper discusses the critical role family physicians play in preconception care and provides evidence-based recommendations addressing reproductive health care, which is essential to the promotion of healthy families.
Infant mortality is often used as a key indicator of the overall health of the nation. A woman is 10 times more likely to die from childbirth related complications in the United States than in countries such as Austria or Poland and significant racial and ethnic disparities persist within the United States.
Many of the potentially modifiable risk factors that affect future pregnancy outcomes occur prior to pregnancy. Preconception care offers family physicians and source patients an opportunity to discuss these risk factors so they can be minimized.
There are clinical practice guidelines based on good quality evidence for interventions that improve outcomes; this fact, strengthens the case for a more robust delivery of preconception services in routine primary care. Yet, the delivery of preconception care has been less than satisfactory due to numerous barriers. The postpartum visit provides one opportunity for interconception care; however, patient attendance is not guaranteed. Some women may lose insurance coverage in the early postpartum period, which makes it difficult for them to get access to appropriate follow up care.
Unfortunately, most of these barriers still exist. Changes in the current healthcare landscape are removing some of these barriers through expanded health insurance coverage, improved reimbursement for preventive services, and public health initiatives. In addition, clinical Position Paper On Abortion guidelines based on good-quality evidence have been developed for preconception interventions that improve maternal and fetal outcomes. Family physicians are Position Paper On Abortion suited to lead healthcare system change related to preconception care.
They are the most frequent provider of ambulatory primary care services to women aged Innovative strategies that incorporate preconception care into routine primary care visits are needed. Transforming the way preconception care is delivered is critical to success. Preconception care is primary care and it should be a priority for primary care providers in all settings.
The American Academy of Family Physicians AAFP outlines the following evidence-based recommendations for preconception care provided by family physicians.
WHEREAS, the dark and tragic night of abortion continues to overshadow our land, and. WHEREAS, the Associate Reformed Presbyterian Church has previously declared its. Research Paper For Abortion Research paper for abortion 72nd Street, East zip need someone to write my term paper on death penalty for 10 samay ka sadupyog. RHEDI maintains a list of Family Medicine Residencies with Fully Integrated Abortion Training. Read the AAFP's position paper on preconception care. Preconception care is defined as individualized care for men and women that is focused on reducing maternal and. Title Length Color Rating: Legality of Abortion - Of all the legal, ethical, and moral issues we Americans continuously fight for or against, abortion may very well.
If a woman is sexually active and wants to prevent or delay pregnancy, comprehensive contraceptive services should be offered. All women who wish to delay or prevent pregnancy should be offered the following:. Position Paper On Abortion physicians should use a tiered approach to present information on reversible contraceptive methods; information about the most effective methods should be presented first, followed by information on less effective methods.
Due to the association of short interpregnancy levels with an increased risk of adverse perinatal outcomes, birth spacing should be discussed with patients. Longer interpregnancy intervals over 59 months were also associated with poor outcomes. The family physician should take into account the health Disease Paper Term and benefits of the timing of the subsequent pregnancy and should discuss effective contraceptive options.
All women of reproductive age should be advised to take a daily supplement prenatal or multivitamin of to mcg of folic acid daily and to consume a balanced, healthy diet of folate-rich foods. Management of overall health and chronic conditions is crucial for proper preconception care. Chronic hypertension can increase maternal and fetal morbidity and mortality during pregnancy. Family physicians should provide counseling on lifestyle changes and appropriate medication adjustments for women who are diagnosed with hypertension.
Women who could become pregnant while taking angiotensin-converting enzyme ACE inhibitors or angiotensin II receptor blockers should be counseled about the adverse fetal effects of these medications and offered contraception.
Women taking these medications who are planning a pregnancy or are not using an effective contraceptive method should strongly consider switching to a medication that is compatible with a healthy pregnancy.
All women check this out reproductive of childbearing age who have diabetes should be counseled about the importance of glycemic control before pregnancy.
Women who have suboptimal diabetes control should be encouraged to use an effective contraceptive method. Counseling on medication usage is an important part of preconception care. Examples include ACE inhibitors, angiotensin receptor blockers ARBswarfarin, valproic acid, lithium, statins, and methotrexate. All women of childbearing age should be screened for the use of teratogenic medications and should be counseled about the potential impact of medications for chronic health conditions on pregnancy and fetal outcomes.
When possible, known teratogenic medications should be switched to safer medications before link. Women who have a chronic condition that poses a risk of serious morbidity to mother and infant, should be counseled to take the minimum number and the lowest dosages of medications that are essential to control the condition.
For women who do not desire pregnancy, a plan for effective contraception should be discussed and initiated. Preconception care should also include counseling on immunizations.
All women of reproductive age should have their immunization status for tetanus-diphtheria-pertussis Tdap ; measles-mumps-rubella MMR ; and varicella reviewed annually and updated as indicated. Mental health assessment should be included in preconception care. She should also be informed about the risks and benefits of treatment options for depression and anxiety disorders during pregnancy.
Position Paper On Abortion necessary, medications should be adjusted prior to conception. This timing decreases the exposure of Position Paper On Abortion fetus to multiple medications and allows the medication dose to be tapered in order to minimize the risk of withdrawal symptoms. Another important part of preconception counseling is addressing lifestyle risks—including alcohol, tobacco, and substance use—and providing resources and support for lifestyle modifications.
Alcohol use in pregnancy is the cause of fetal alcohol spectrum disorders FASDsa range of effects that include physical problems and behavioral and intellectual disabilities, and can have lifelong implications. Family physicians should provide brief interventions that include describing the effects of drinking during pregnancy and warning that Position Paper On Abortion are no safe levels of alcohol consumption during pregnancy.
Preconception care should also address occupational hazards and exposures, sexually transmitted infections STIsand physical and emotional abuse. For all women of childbearing age and their partners, family physicians should regularly assess STI risks, provide counseling and immunizations as indicated to prevent acquisition of STIs, and provide indicated STI testing and treatment. Appropriate evaluation, counseling, and treatment for physical injuries, STIs, unintended pregnancy, and psychological trauma should be offered—including emergency contraception—if appropriate.
For counseling, legal advice, and other services, women should be offered information about community agencies that specialize in cases of abuse. When pregnancy is desired, discuss medications, health conditions, and activities that may affect fertility. All women of reproductive age should be advised to take folic acid and to consume a balanced, healthy diet of folate-rich foods.
Women at high risk for NTDs should take higher levels of folic acid.
Assess pregnancy risks Position Paper On Abortion the basis of maternal age, maternal and paternal health, obstetric history, and family history.
Women of reproductive age should have blood pressure checks during routine care. If diagnosed with hypertension, they should be counseled on lifestyle changes and medications that are safe in pregnancy.
Women of reproductive age should be screened for depression and anxiety disorders and counseled about potential risks of untreated illness. All women of childbearing age should be screened for alcohol consumption, tobacco use, and drug use. For all women of childbearing age and their partners, assess STI risk, provide counseling and immunizations as indicated to prevent acquisition of STIs, and provide indicated STI testing and treatment.
All women of reproductive age should be screened for current, recent past, or childhood physical, sexual, or emotional interpersonal violence and referred to appropriate resources when needed. Most family http://cocktail24.info/blog/write-my-top-personal-essay-on-hillary.php and preconception care programs, research, and clinical practice guidelines have focused almost exclusively on women.
Both the CDC and the U. The overall objective is to ensure optimal and positive outcomes of their reproductive and sexual behaviors, while minimizing the potential negative consequences of unhealthy lifestyle choices and unprotected sex. In addition, preconception care for a man should include counseling on the timing of pregnancy and on fathering children when he and his partner choose to do so; on overcoming fertility issues; and on ensuring healthy pregnancy for his partner and optimal post-partum outcomes for both his partner and their child or children.
Studies of factors that affect sperm quality, quantity, concentration, and motility — have identified the following: A man who has HIV or another STI directly puts his pregnant partner and the Position Paper On Abortion at risk for pregnancy complications and maternal and fetal morbidity.
Paternal factors including genetics and age have been shown to have an effect on fetal outcomes. Screening for genetic conditions should be discussed and offered when appropriate. Schizophrenia was found to be two times more likely in the child whose father was older than 45 years of age at conception and three times as likely if the father was older than 50 years of age. Similarly, a diagnosis of autism in the child is almost six times more likely in a child whose father was older than 40 years of age.
Assess social history, lifestyle risk factors Including smoking, substance abuse, and unsafe sexand behavioral issues. Beginning Position Paper On Abortion adolescence, consider screening for and counseling to avoid intimate partner violence and coercive relationships and promote respectful and consensual sexual relationships.
Preconception care is primary care, and providing quality preconception care is the responsibility of all primary care providers.
Successful implementation requires transforming care delivery and making preconception care based on the best available click here routine. Benefits of Preconception Care. Barriers to Delivery of Preconception Care. Preconception Interventions Position Paper On Abortion Women. All women who wish to delay or prevent pregnancy should be offered the following: A full range of U.
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Reproductive Planning Discuss reproductive goals and issues at each visit When pregnancy is desired, discuss medications, health conditions, and activities that may affect fertility Folic Acid All women of reproductive age should be advised to take folic acid and to consume a balanced, healthy diet of folate-rich foods.
Chronic Disease Management Hypertension: Women who have diabetes should be counseled about the importance of glycemic control.
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Immunizations Immunization status should click reviewed annually and updated as indicated. Preconception Interventions for Men Most family planning and preconception care programs, research, and clinical practice guidelines have focused almost exclusively on women.
Chemicals associated with woodworking, painting, making pottery and stained glass, and gun cleaning may affect sperm production.
Stress has been shown to negatively impact sperm morphology and concentration. Reproductive Planning Male reproductive health issues should be an integral part of every wellness visit. Summary Preconception care is primary care, and providing quality preconception care is the responsibility of all primary care providers.
Newes AG, et al. Zolna, Unintended pregnancy in the United States: Am J Obstet Gynecol Silver, Racial and ethnic disparities in United States: Semin Perinatol ,