Priority Topic: Pregnancy

Key Feature 3: In a patient with suspected or confirmed pregnancy, establish the desirability of the pregnancy. 
Skill: Clinical Reasoning, Patient Centered
Phase: History, Treatment

A 42 year old female presented to clinic today for a positive home pregnancy test, as the day sheet divulged. I walked in the room, and "naively" asked, "So what brings you in to the clinic today?" I watched for any twitch of facial myoemotion. "I did a home pregnancy test and it was positive. Two, actually." She was remarkably neutral given the news she was sharing. So I responded in an equally neutral tone, "Okay. How do you feel about it?" And there it was, a subtle crack of a smile and a verbal confirmation of happiness, "Well, I actually feel quite happy about it :)" 

I went into this encounter knowing there was most likely a pregnant lady in the room, but I did not know whether it would be a happy or a sad pregnant lady. (Joke: Can one ever really know when it comes to pregnant ladies though.) As the Society of Obstetricians and Gynaecologists of Canada (SOGC) state (as neutral as can be), "Nearly 50% of all pregnancies in Canada are unplanned. Unintended pregnancy is a common and can be a difficult experience for women of all ages, from adolescence to near menopause... Your options include keeping the baby, abortion, or adoption." 50% is a pretty neutral statistic, which helps reinforce for me the need to start off any newly suspected pregnancy visit without expectation regarding desirability. If it turns out that the woman is happy, you can then pop that (nonalcoholic) champagne bottle open! But if not, you've taken important first steps to create a safe space where women may feel more at ease to talk about an unwanted pregnancy.