| Stage | Readiness for Change |
Strategies |
| Precontemplation | May or may not be aware of reasons for change May not be ready or interested |
Declare openness to discuss substance use at any time Provide pregnancy care within a harm-reduction framework |
| Contemplation | Considering change | Discuss health risks, give information Roll with resistance |
| Preparation | Ready to plan change | Determine start date, validate reasons for change, complete decisional balance Make concrete plans for change |
| Action | Change is happening | Support efforts Anticipate and normalize relapse |
| Maintenance | Change has occurred | Show support and admiration Help strategize how to handle relapses or slips |
Work with the woman to complete each cell of the table. The woman discusses first the pros and cons of not changing followed by the pros and cons of changing.
| Decisional Balance | Benefits/Pros | Costs/Cons |
| Current Behaviour (not changing) |
||
Changed Behaviour |
| Concept | Overview | Strategy |
| Woman as Principal | She is the centre of the birth experience | Encourage her to make decisions and support her choices Ensure that she has a control over her care |
| Family as Context | She defines "family" | May be friends, relatives, parents, coworkers,neighbours, church group, self-help group, etc., or clinic staff Help her establish a support base for the future |
| Birth as a Process | Birth is part of her "life story" | Not just a biomedical event Process does not end at delivery |
| Caregiver as Facilitator | Assist her birth process | Make her birth as positive as possible Success at birth can increase her self-esteem and confidence |
