General Prenatal Care

Initial Encounter
Manage Medical Emergency
Approach to Care

Stages of Change

Decisional Balance

Woman-Centred Care

Follow-Up Visits
Infectious Diseases
Toxicology Testing

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Approach to Care

Motivational Interviewing: Stages of Change

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

Decisional Balance

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 (changing)

Woman-Centred Childbirth Care

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"	o May be friends, relatives, parents, coworkers, neighbours, church group, self-help group, etc., or clinic staff o 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

This site last edited: June 2008