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ss nucleus - spring 1996,  Crisis Pregnancies - An Ongoing Problem

Crisis Pregnancies - An Ongoing Problem

Despite improvements in sex education and an increasing awareness of methods of contraception, over 170,000 terminations are carried out each year in England and Wales. Doctors who are faced with women experiencing unplanned or 'crisis' pregnancies often find themselves in a dilemma. Do they sign the authorisation form and ignore their conscience or refuse and risk losing the patient? Pressure on time for counselling patients, and in the past a lack of positive alternatives, made the decision even more difficult.

Fortunately now, the need for specialised counselling has been recognised and Pregnancy Crisis Centres are opening up across the UK. In a recent survey, 90% of CMF doctors felt that these Centres should be supported. However, only 15% actually referred their patients for help.

The project

The aim was to investigate practical ways by which links between GPs and the centres could be improved. Ultimately increasing co-operation aims to benefit women who need help at critical times in their lives.

Specifically I was asked to investigate:

  1. What can be learnt from existing links?
  2. What route for providing information?
  3. What format for written information?
  4. Which doctors to approach?

CARE For Life

CFL (known as Christians Caring For Life until 1993) has been in existence since 1989 and is involved in setting up and supporting Pregnancy Crisis Centres across the UK. By September 1995 80 Centres had become fully operational. This number has doubled since 1993 when only 40 centres existed. A further 20 Centres are at the planning stage. In response to this proliferation of Centres a National Co-ordinator was recently appointed to oversee the network. Although each Centre is run independently, affiliation to CFL is useful for provision of training, resources and support.

Each Centre aims to offer free pregnancy testing, skilled counselling, clear information on all the options available, practical support and time to explore all the emotions which surround such complex issues. The counselling is not restricted only to dealing with unplanned pregnancies, but also offers help to women who have experienced terminations or miscarriages. The Centres are all staffed by female volunteers and vary greatly in their age, size and location. The longest established Centres may see up to 1500 women per year. In contrast, services which are in their infancy may only see 50 women in their first year. It is from these small beginnings that mighty works are accomplished.

After discussion, we decided that I should visit three different Centres to get a cross-sectional view of CFL. I also decided to interview local doctors in each area. Basingstoke was chosen as the longest established Centre. Southampton was selected because a local Christian GP had helped to set it up and was still involved. Finally, Brixton was representative of a new Centre in an inner city area.

Findings and discussion

Seventeen of the 54 doctors approached agreed to take part in an interview for the study. Reasons for not participating varied, but were mainly disinterest, not enough time or being on holiday. Non-Christian doctors were chosen randomly while Christian doctors were contacted through the CMF database. Eight of those interviewed were CMF members. Each interview lasted approximately 15 minutes, with a prepared questionnaire being used as a guide. The average GP was found to see only one or two women per month with a crisis pregnancy. This figure obviously varied depending on the age of the patients each GP had on his list and also the socio-economic climate of the area. Several doctors commented that clusters occurred, especially after the Christmas and summer holidays. The results can be grouped in accordance with the above aims:

1. What can be learnt from existing links?

The majority of doctors interviewed were aware of their local Centre through a variety of different routes. Many had received mailings when the Centre opened or at regular intervals since then. Others became aware when some of their patients told them that they had had a pregnancy test carried out by the Centre. All the Christian doctors interviewed referred women to their local Centre. Most non-Christian GPs did not. The reasons for this non-referral varied from preferring to carry out counselling themselves, referring to another outside agency such as the BPAS (British Pregnancy Advisory Service) or a lack of knowledge or confidence in their local Centre. Feedback from patients who attended the Centres was on the whole very positive with only one complaint about a false positive pregnancy test. Links with GPs seemed to be better where a personal contact existed. Quite rightly, most GPs will not refer their patients to another service before they know more about the background and motivation of the staff.

2. What is the best route for providing information?

The general consensus amongst the GPs was that a concise informative letter, together with a leaflet on the Centre, should be sent as the first point of contact. A direct telephone call would not be appropriate as doctors are continually being bombarded by drug companies and other organisations during times which are supposed to be used for consultations. The response to having a personal contact was mixed, but generally endorsed by the surgeries which hold regular Practice meetings, usually at lunchtimes. These meetings, of the whole health care team, seem to provide an excellent forum to give a professional presentation and then be available to answer any questions or concerns which may exist. GPs did not feel that they had time to attend open-days or seminars at the Centre. However, a short presentation with a buffet lunch may have interested some.

3. What format for written information?

A leaflet detailing the services of a local Centre would generally be acceptable to most doctors, subject to it being screened by all the partners. However, several doctors pointed out that this is not the type of leaflet which a woman would casually pick up and keep for later reference. Sympathetic GPs keep a supply of leaflets in their desk and give one out when an appropriate patient presents herself. An organisation called the Patient Support Trust is involved in the national distribution of leaflets, free to surgeries, on behalf of drug companies. They dislike other leaflets being placed into their special racks as they take up valuable space.

Business cards could be used to convey basic information such as a telephone number and opening hours. However, their weakness is that they can't give any detail about the services available.

Most GPs agree that posters very quickly lose their impact and rapidly become part of the 'wallpaper'. With this in mind, many surgeries are now avoiding posters and are opting for a more uncluttered approach to their waiting room.

The issue of advertising has aroused very diverse feelings among individual doctors and practices. Some have chosen to avoid all forms of advertising in their Practice Booklet or waiting room video presentation. Others have wholeheartedly endorsed the opportunity and use the revenue it brings in to print their booklet or provide other services. Further still, some have chosen to steer a middle course and offer free advertising to organisations which they feel serve the community.

What information inspires confidence in a GP? Most doctors were concerned that the Centre provided a service which was both professional and unbiased. Real fears existed among non-Christian doctors that the Centres had a 'hidden agenda' - although many were quick to point out that in practice they have had no problems. The main points of information requested were the telephone number, whether a 24 hour answering machine operated, opening times, a clear map or directions and details of the services offered as well as qualifications and motivation of the counsellors involved. GPs were not aware of the thorough training courses which are undertaken by all the volunteers before they can speak to any women. An increased confidence in the Centres from GPs would undoubtedly lead to greater co-operation and an increased number of referrals.

4. Which doctors to approach?

The data suggest that it is mainly Christian doctors who currently refer women to the Centres. Some non-Christian doctors who have a personal contact or recommendation also make use of the services on offer. One particular practice in Southampton gave the Firgrove Family Trust a substantial donation and therefore feels justified in referring women there to use the free pregnancy testing facilities. In general Christian doctors can relate more closely to the ethos of the Centres and may make more of an effort to encourage women towards positive alternatives. Targeting those doctors who are more sympathetic to the Centres' position may be a better use of resources and provide a point of contact in more practices. Ideally, it would be best to give all GPs the opportunity to learn more about the Centre, but this may not always be possible.

Which way now?

In 1967 Dame Cicely Saunders opened the first hospice in the UK. Now, almost 30 years later, there are over 650 hospices nationwide. Why did their number increase so dramatically? They were recognised as places where people could die with dignity. This compassionate option was presented strongly to the Lord's Select Committee in 1994. Subsequently it decided that euthanasia should not be legalised. Unfortunately, when the Abortion Act of 1967 was introduced, no such network of Pregnancy Crisis Centres existed. The need for such a positive alternative has now been recognised and thankfully new Centres are opening up every month. The number of Centres has doubled in the last two years. From here we need to look forward and think how best the network can be strengthened and promoted. Improving links between GPs and the Centres is just one initiative which should be encouraged.

Recommendations for CMF doctors

  1. Find out if there is a CARE For Life Pregnancy Crisis Centre in your area by phoning the Coordinating Centre in Basingstoke on 01256-850 111. Investigate their services and decide whether you feel confident enough to refer some of your patients to them if the need arises.
  2. Encourage your practice to have a representative from the Centre to do a short presentation at a practice meeting.
  3. Consider the possibility of advertising the Centre and its services in some way by allowing leaflets or posters in the waiting room, the Centre video to be shown or an advert placed in the practice information booklet. For practices where all the partners are not happy to promote the Centre, it may still be possible to put up a small poster in your own consulting room or have a supply of leaflets which could be given out to appropriate women.
  4. Try and increase communication with your local Centre. They always value any feedback, whether it be positive or negative, to help improve their operation.
  5. Pray for the women involved in staffing the Centres who would appreciate your support.
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