New female patients & contraception

Buprenorphine Post
miket
Posts: 15

Postby miket » Wed Sep 02, 2015 6:42 am

Grateful for your input, Ken, Sam, & C. Thank you C very much for the quick start algorithm link......Mike

cdegood
Posts: 3

Postby cdegood » Wed Sep 02, 2015 6:42 am

To respond to the original post, there has been a movement in women's health to uncouple the pelvic exam (which is for cervical cancer and STD screening) from managing contraception (which is to avoid unintended pregnancy). You do not need to do a pelvic exam in order to start contraception. Here is the link to the quick start algorithm:

http://www.reproductiveaccess.org/resource/quick-start-algorithm/

Most of my female patients have a lot going on in their life when they come into treatment. We do a urine HCg and if they are interested in avoiding unintended pregnancy I am happy to help them with pills/ring or depo shots until they can get established with an outside provider.
-C

MChaplin
Posts: 183

Postby MChaplin » Wed Sep 02, 2015 6:42 am

Thanks ken and others- it went better than expected. What I did was try to unite with her against the disease. I told her we both did all we good but she had a devastating illness and in the end that is what killed her. She said after that what grave her a small amount of relief was my saying this outcome was inevitable and that if she hadn't died on that attempt she would have continued to suffer until her eventful demise. Like end stage cancer. It seemed that by hearing me say that I had done the best I could and so had she she was able to forgive herself which I think was the real issue. Much as I was nervous abou a lawsuit I have complete confidence that I did nothing wrong and nothing out of the standard of care. And I did tell her that I had acted in accordance with practice guidelines. Unfortunately she is still filled with self blame- and sorrow.

sslonim
Posts: 118

Postby sslonim » Wed Sep 02, 2015 6:42 am

Miket - FWIW, I too have had patients who delivered (in different hospitals) complain that the hospital took their normal babies and put them through NAS treatments (if my memory is right I believe 10-14 days in hospital before being allowed to go home). Sam

kcairns
Posts: 571

Postby kcairns » Wed Sep 02, 2015 6:42 am

know-it-all obs leading the charge in only country in world where infant mortality not declining...i'll stand w such as the 24 wk pregnant woman who long hid her iv heroin use to avoid addict-shaming, now 24 h after starting and learning of treatment including opioid agonist medication, she radiant this am and baby rerouted to path of normal gestation, birth weight and head circumference while in my head ring words of Zia Haider Rahman..."understanding is not what life has given us, answers can only beget questions, honesty demands not a declaration of faith but of ignorance, the only mission laid to our charge, if any hand is in it, is to let unfold the questions, to take to the river knowing not if it runs to the sea, and accept our place as servants of life"

miket
Posts: 15

Postby miket » Wed Sep 02, 2015 6:42 am

Thanks Ken....Oh believe me its not me so much as the " Volunteer State", that treats these/ my patients like 2nd class citizens for their reproductive decisions whether they are using street opioids or in proper OBT. There are literally hospitals here in my area that immediately place every child born to mothers ( Both In proper treatment as well as those not in treatment) in the NICU for NAS even when doing excellent post delivery) .I actually had a patient breastfeeding her infant with nothing other than a "sneeze" after feeding well that was immediately placed in the NICU on Morphine protocol.....Best I can do is suggest to my moms where to avoid delivering based on skewed statistics and extremely judgmental neonatologists..Just for giggles look up the incidence of NAS in East TN..Its very unfortunate that to advocate for my patients I have to suggest where they "might choose to deliver their infants vs where to avoid".....Im actually having my post delivery Moms facilitate groups with my current pregnant Moms on what their experience was like at the hospital they delivered at. Thank God the legislature here finally passed "Safe Harbor Act"......Although the Mom and infant are protected from DCS intervention the act itself doesn't protect them from suffering humiliation during their stay...

kcairns
Posts: 571

Postby kcairns » Wed Sep 02, 2015 6:42 am

Hi Mike, thanks for your abilities and commitment ...all who w high standards provide agonist therapy care to opioid addicted women of childbearing age benefit reproductive health greatly and decrease nas..personally beyond that I do not feel entitled to enter into any woman's specific reproductive decisions.., and (in order to be outrageous - but not in re you as you have made it clear you are speaking of women who have declared themselves unready for more children at present - but re much expressed feeling out there, I add) in the majority of instances she has been made addicted by incorrect nationwide prescribing of opioids to young women and she does not need to be further punished by feeling it her responsibility to lower national incidence of nas through any outside influence on her right to bear her family as she chooses


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