Counselling (premarital, contraceptive, preconceptional)

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Premarital

Premarital counselling helps couples prepare for marriage and helps ensure that you and your partner have a strong, healthy relationship — giving you a better chance for a stable and satisfying marriage. This kind of counselling can also help you identify weaknesses that could become problems during marriage.

Why it's done

Premarital counseling can help couples improve their relationships before marriage. You'll be encouraged to discuss topics related to marriage, such as:

  • Communication
  • Beliefs and values
  • Roles in marriage
  • Affection and sex
  • Desire to have children
  • Family relationships
  • Decision-making
  • Dealing with anger
  • Time spent together
  • Sometime, Finances

Premarital counseling helps partners improve their ability to communicate, set realistic expectations for marriage and develop conflict-resolution skills. In addition, premarital counseling can help couples establish a positive attitude about seeking help down the road.

Keep in mind that you bring your own values, opinions and history into a relationship, and they might not always match your partner's. For example, family systems and religious beliefs vary greatly. Many couples have experienced very different upbringings with different role models for relationship and marriage. Many people go into marriage believing it will fulfill their social, financial, sexual and emotional needs — and that's not always the case. By discussing differences and expectations before marriage, you and your partner can better understand and support each other during marriage.

Contraception

The choice of a contraceptive method is a complex decision; medical providers have an important role in providing information and supporting patients' decision making about contraceptive methods through contraceptive counseling. In this topic, we will review the goals of quality contraceptive counseling, review different approaches to this counseling and their relationship to health equity, and provide a step-by-step guide to providing high-quality, patient-centered counseling. Information specific to each contraceptive method is presented in detail separately.

In this topic, we will use the term "women" to describe those who use female contraceptive methods. However, we recognize that not all people capable of pregnancy identify as women, and we encourage the reader to consider the specific counseling needs of transgender men and gender nonbinary individuals. Clinicians should ask all patients who identify as male about their contraceptive needs as well.

preconception

Obstetricians and Gynecologists recommend that all health encounters during a woman's reproductive years, particularly those that are a part of preconception care, should include counseling on appropriate health behaviors to optimize pregnancy outcomes and prevent maternal mortality.

Preconception care is defined as a set of interventions that aim to identify and modify biomedical, behavioral and social risks to the woman's health or pregnancy outcome through prevention and management. Certain steps should be taken before conception or early in pregnancy to maximize health outcomes. Consider the following clinical issues.

Checklist of preconception care topics

Education:
  • Smoking, alcohol abuse and other drug use
  • Folic acid supplementation, 400 mcg daily as a standard of care
Counseling:
  • Sexually transmitted infections including HIV
  • Family planning and pregnancy spacing
  • Healthy body weight and diet
  • Importance of oral health
  • Increased risk of hepatitis C in those with tattoos and/or body piercings
  • Lead and other environmental and/or occupational exposures
  • Genetic disorders (including cystic fibrosis and sickle cell genotypes)
Assessment:
  • Physical assessment including physical examination and medical and family history
  • Carrier screening (racial/ethnic background/family history)
  • Immunization record including rubella, hepatitis B, and varicella
  • Complications with past pregnancies (postpartum hemorrhage, thrombotic event, preeclampsia/eclampsia, PIH, gestational diabetes, Rh incompatibility, etc.)
  • Identification and assistance for victims of domestic violence
  • Psychosocial screening for parent readiness.
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