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The caseworker must strive to maintain an objective, non-judgmental, supportive approach when counseling an individual faced with a problem pregnancy. Efforts should be focused on reducing pressures to allow for a thorough exploration of alternatives and available resources. Initially, the expectant mother has two choices--carrying the pregnancy to term or seeking to terminate the pregnancy through abortion. If the decision is made to carry the pregnancy to term, she has two further options--keeping the child or releasing him/her for adoption. The caseworker must help the client examine each alternative realistically in terms of present and future implications, and to thoughtfully reach a decision.
The caseworker must be familiar with available resources within and outside the community that can help alleviate problems related to the unplanned pregnancy. An assessment of resources related to medical care, residential care, health support, cash assistance, employment, education, family planning, housing, counseling, and other needed resources should be made. Efforts should be directed toward helping the client make use of the appropriate services.
The expectant mother's needs carry the first priority for counseling, needs assessment and problem resolution. The caseworker knows about and shares with an expectant mother the physical aspects of pregnancy as well as the emotional and psychological impact. If this is the first pregnancy, the expectant mother should be helped to understand the constant changes that are occurring within her body, and what to expect with labor and delivery or other medical procedures, necessary or chosen. Young teens may be particularly uninformed about pregnancy and have special fears that need to be allayed. The importance of early and good prenatal care should be emphasized.
If the expectant mother is not married, there are some special problems and alternatives that must be dealt with. She may be faced with deciding whether to keep the child and rear him/her as a single parent or to get married and rear the child within a marital contract. The impact of the expectant mother's decisions on the child's future should be central in considering alternatives. The best interest of the child and his/her role in the expectant mother's life must be kept in focus. The client may need to explore the attitudes of friends and relatives toward an out-of-wedlock pregnancy, as well as the special legal, economic, social and emotional problems involved in rearing a child as a single parent.
While many expectant fathers are not interested in planning or counseling, many are. Sometimes it is the expectant father who first requests Pregnancy Services. He may experience fear or feelings of guilt or inadequacy, and need professional help in coping with these feelings. If he is not wed to the birth mother, he may have feelings of guilt and self-contempt. Often, though, the emotional attachment between the expectant mother and father is strong enough that the mother's decisions are greatly influenced by the desires of the father.
The expectant father may be concerned deeply about the child's future. He may be confused, wanting to help but not knowing how, and wanting help himself but being unsure of where to get it. Often it is difficult for friends and family members to be objective enough about the pregnancy to be of significant help. An expectant father may not be sure that the caseworker is a person he can trust. A positive approach in which the options are objectively explained and explored with the expectant father can bring him into active participation in planning. Decisions made with the input of both the mother and father lead to better plans being made for the child.
Additionally, he may need encouragement to give the expectant mother moral and financial support. He can be helped to understand the benefit to his child of sharing information about himself, and by taking active responsibility with the mother in making decisions that will affect the future of the child.
Legal considerations for an unmarried expectant father include his legal rights if the expectant mother decides to release the baby for adoption, paternity support requirements and legitimating procedures. If the expectant mother is under age, the prospect of a statutory rape charge is a possibility that should be understood. An expectant father, particularly an adolescent, may need support in continuing his education, job training, employment services, or other assistance to establish or maintain financial independence. Family planning counseling is always appropriate and Health Support Services may be needed to reach employment or educational goals.
An unplanned pregnancy often places stress on more persons than just the expectant mother and the expectant father, particularly if the expectant parents are adolescents. The expectant mother is almost always a part of her family. Even when she is not living with them, she is subject to and reacts to the family's influence. An unplanned pregnancy creates a family crisis, both emotionally and financially.
Most teenagers live at home and are financially dependent on their parents. Since the pregnancy of a teenage girl living at home usually cannot be concealed from her parents, they become involved with all the ramifications of this event. The expectant teenage father's parents also become involved, sometimes through legal or other confrontation with the girl's parents, or through the intervention of a social agency.
The caseworker's role in working with involved relatives is to assist them in carrying out their parental roles by understanding the situation themselves, understanding their adolescent, and lending positive support in working through the problem. The caseworker may help the parents to express and accept their own feelings of bewilderment, shock, guilt, anger, sorrow, etc. Assisting parents to reestablish communications with their son or daughter during a crisis situation can be a positive step in helping the expectant parents to deal with the decisions to be made.
Alternatives such as marriage, adoptive placement, or rearing a child out-of-wedlock should be carefully explored with the couple's parents when appropriate, as well as with the expectant mother and father. After the expectant mother has reached a decision regarding a course of action, the caseworker should support the parents of the expectant mother and expectant father and encourage them to make their position clear relative to their willingness to provide moral or financial support. Parents should be encouraged to state clearly what they will or will not be able to do in the situation. They should indicate how much money they will spend in providing medical care and living arrangements, how much support they will give should marriage be decided upon, and whether or not they would want to take the child into their home and rear him/her or help with rearing. A clear stand by parents can help the expectant parents to reach decisions about the baby and about their own future direction.
Other significant individuals besides parents may be deeply involved with the expectant mother or the expectant father. These individuals may be other relatives, a minister, guidance counselor, close friend, foster parents, etc. One or more of these individuals may initially inquire about services or request services for the expectant mother or expectant father. The primary concern of other involved individuals will probably be the welfare of the expectant parent(s). However, their own emotional involvement may be such that they are in need of assistance to deal with their own strong feelings about the unplanned pregnancy.
The caseworker's role will be to explain the alternatives and resources available and to encourage the involved individuals to be supportive of the expectant parents. The caseworker can help them work through their own feelings and clarify to the parents their position relative to their willingness and ability to provide assistance.
Special care needs to be taken to assure that confidentiality between the caseworker and the expectant parents is not violated.
Adolescent pregnancy is a serious threat to the life and health of a young woman whether in or out of marriage and has serious health, socioeconomic and personal implications for young women, young men and their off spring. An important aspect of counseling an expectant teenager is the fact that (s)he is still in an adolescent stage of development which is turbulent enough without an unplanned pregnancy. A teenage client needs assistance in finding better ways of coping in the world, learning to have control over one's life and moving toward independence and finding his or her own identity. Educational information needs to be offered on such topics as physical aspects of pregnancy, childcare, family planning and birth control. The school-age expectant parent has particular concerns related to educational goals and employability status as well as potential parental responsibilities.
The caseworker should be alert to indications that the pregnancy is the result of sexual abuse or exploitation. If abuse is suspected, it is to be reported to the Protective Services staff.
Alternative counseling involves helping a client consider possible choices for resolving the crisis situation. The focus of alternative counseling is on decision making rather than on philosophy or treatment. The caseworker's attitude should reflect acceptance of the client in the existing situation and should provide support in utilizing all available resources to assist in the decision-making process. The caseworker's objective should be to help the client move quickly toward a realistic, acceptable decision about the unplanned pregnancy. The alternative counseling process should involve the following steps:
1. Full identification of the problem(s)
2. Explanation and understanding of the implications for the client of the present situation.
3. Assessment and understanding of the client's feelings about the situation.
4. Gathering of information about all related aspects of the situation.
5. Careful examination of the positive and negative aspects of all available alternatives for resolving the situation.
6. Selection of an alternative and initiating plans for following through with the choice.
Alternative counseling should be made available to the expectant mother, the expectant father and others involved with the unplanned pregnancy, individually or together, as appropriate.
The alternative caseworker must be flexible enough to help persons impacted by the unplanned pregnancy, other than the expectant mother, cope with their individual feelings about the situation and move toward acceptance of the ultimate decision made about the resolution of the pregnancy by the expectant mother.
The expectant mother should be helped to explore the following alternatives for resolution of the pregnancy:
1. Abortion
If the client decides to terminate the pregnancy, the caseworker should counsel with her about the different abortion procedures, the expected results, the possible physical discomforts and risks, and possible emotional reactions. Assistance should be given to ensure that the decision is made as free of pressure from the husband, boyfriend or parents, as possible. She should have a general knowledge of the various medical procedures used to perform abortions, of the laws governing abortion, of the medical facilities available for the performance of abortions, and of the financial resources available to eligible individuals -- the North Carolina State Abortion Fund and Titles XIX (Medicaid). Medicaid information can be found on the Division of Medical Assistance website at http://www.dhhs.state.nc.us/dma/home.htm . For more information on abortions refer to Family Services Manual Volume VII, Chapter III, Health Support Services - Medical Services Component. Administrative Rules for the NC State Abortion Fund (10A NCAC 71G) can be found at http://ncrules.state.nc.us/default.htm.
A client, who initially panics at the thought of a child and immediately thinks of abortion, may need supportive counseling so that she may think rationally about such a decision before proceeding. She may need reassurance and acceptance that qualms about impending parenthood are not unusual.
2. Adoption
If during the course of counseling the client decides to have the baby, and is considering making a plan for adoption, the caseworker should inform her of the authorized and licensed child placing agencies in the state that she might utilize. These agencies include county departments of social services and private adoption agencies licensed by the North Carolina Department of Health and Human Services. All one hundred county departments of social services provide adoption services. In addition, there are private adoption agencies licensed in North Carolina that provide adoption services to birth parents. For a listing of these agencies, go to
http://www.ncdhhs.gov/dss/licensing/docs/cpalistadoption.pdf
For additional information about adoption, and citations of specific statutes, refer to Family Services Manual Volume I, Chapter VI, Adoption. This can be found online at http://info.dhhs.state.nc.us/olm/manuals/manuals.aspx?dc=dss.
3. Keeping the Child
a. In an Existing Marriage
The fact that a pregnancy conceived in wedlock is considered by the expectant parents as an unplanned pregnancy is indicative that other problems are also present that need attention. The reasons for considering this an unplanned pregnancy may be medical, emotional, economical, social and/or personal. If the decision is made to keep the child, continued support and counseling may be needed to ensure a nurturing environment for the child and reassurance for the parents that there are resources to help them.
The following services should be available, if needed, either from the agency or through referrals to other community agencies:
(1) vocational or educational services
(2) financial assistance
(3) housing services
(4) home management services
(5) psychological or personal counseling services
(6) day care services
(7) legal services
(8) medical services
(9) temporary foster care services
(10) family planning services
b. As a Single Parent
The expectant mother may decide that she would like to keep her baby and rear the child by herself. If this is her decision, she will need a great deal of support from her parents or relatives, from social service agencies, from other community resources and from the father of the baby, if this is a continuing relationship. If she is very young, parenting will be doubly hard for her, as she must assume responsibilities that she may not yet be mature enough to handle appropriately. Resources for provision of ancillary services, such as childcare and job training, should be arranged as needed.
c. Marriage
If the recipient and the expectant father decide to marry, they will need supportive services of the same type as those needed by the couple in an existing marriage or the single parent. Instead of relying greatly on family members for support, they will be able to offer each other emotional support. However, there may be stress, conscious or unconscious, because of the circumstances under which the marriage took place. Statistics show that marriages in which pregnancies occur prior to the marriage result in separation and divorce more often than marriages in which the wife was not pregnant before marriage. With this in mind, the couple needs to have counseling services available to them. Resources for provision of ancillary services should be sought for the couple as needed.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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