Pregnancy Options Guide

PREGNANCY OPTIONS GUIDE To help you make an informed decision about your unexpected pregnancy

Your Body. Your Options.

Your Future.

Welcome.

Be informed. Be empowered.

Depending on your situation, a late period can be terrifying. Maybe you feel lost or alone, unsure or confused. Maybe your friends and family are giving you different opinions on what you should or shouldn’t do.

Maybe you feel conflicted. We understand.

This is big.

We’re about you. We’re about choices.

Choice is liberating. Real choice means that you are aware of and understand all your options and their potential outcomes. This guide is for you – to empower you with the information you need to make an informed decision.

You have options. You are not alone.

Pregnancy Care Canada Pregnancy Care Canada is a national best practice organization helping to establish, train, and mentor local pregnancy care centres to effectively care for individuals impacted by an unexpected pregnancy.

@pregnancycarecanada @PregnancyCareCanada pregnancycarecanada.ca

CONTENTS

First Things First 05 Whose Decision Is This?

06 Am I Pregnant?

07 Pregnancy & Your Body 08 Fetal Development 09 Decision Checklist

Your Options 11 Abortion 14 Adoption 16 Parenting

Decision-Making 19 My Dreams & Goals 20 Thinking About My Choices 21 Journal Questions 22 Making A Decision

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FIRST THINGS FIRST 4

Whose Decision Is This?

Am I Pregnant?

Pregnancy & Your Body Fetal Development Decision Checklist

PREGNANCY OPTIONS GUIDE

FIRST THINGS FIRST

WHOSE DECISION IS An unexpected pregnancy can be confusing and scary. The thought of telling family, friends, or your partner about the pregnancy can feel overwhelming.

The choices you make during your pregnancy are big decisions. Only you can make them, but you don’t have to face those decisions alone.

Although it is good to share your situation with a few trusted people, it’s important to remember that your pregnancy decision is ultimately up to you. Having this responsibility may feel uncomfortable, but it can be comforting to know that accurate information on your options is available, and you don’t have to face the decision alone.

this?

if someone pressuring you is a huge source of support and you care about their opinion.

The people close to you – boyfriend or partner, parents, friends – may need time and space to process what they’re thinking and feeling. It can also be helpful for you to share your thoughts and feelings with them.

If others close to you need someone to talk to, let them know a pregnancy care centre can offer confidential support. You can go there together or they can meet with someone on their own. Centre personnel are available to meet with partners, parents, and friends.

We want you to have the information and space you need to make this important decision. Reading this guide and meeting with a support worker at a pregnancy care centre can help you sort through all the information, and your thoughts and feelings about your options – so you can make a decision you are comfortable with.

With an unexpected pregnancy, some women may feel joy or wonder, while also feeling more difficult emotions, and this can complicate the decision-making process. Others may feel pressured to make a decision they aren’t sure about. This can be hard, especially

An unexpected pregnancy brings many questions and emotions. The choices you make during your pregnancy are big decisions. Only you can make them, but you don’t have to face those decisions alone.

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FIRST THINGS FIRST

WHOSE DECISION IS

this?

Other women have identified the following people or circumstances as having influenced their decision. On a scale from 1 to 5, rate how these could influence your decision: 1 – not at all 5 – completely 1 2 3 4 5

my partner’s opinion

1 2 3 4 5

my current health

1 2 3 4 5

my relationship with my partner

1 2 3 4 5

my finances

1 2 3 4 5

my family members’ opinions

1 2 3 4 5

my beliefs about pregnancy

1 2 3 4 5

my friends’ opinions and experiences

1 2 3 4 5

my immigration status

1 2 3 4 5

my cultural or religious beliefs

1 2 3 4 5

my reaction to a past abortion

1 2 3 4 5

my plans, goals, and dreams

1 2 3 4 5

other:

pregnant?

FIRST THINGS FIRST

AM I

You may be feeling some symptoms, but other factors can cause similar symptoms of pregnancy. If you haven’t taken a pregnancy test yet, don’t get too far ahead of yourself. Take a pregnancy test at home, go to a local pregnancy care centre, or see your doctor.

Symptoms Some women experience many pregnancy symptoms, and others may experience only one or two. Common pregnancy indicators are:1 • a missed period • nausea or vomiting

• breast tenderness and enlargement

• frequent urination • fatigue

A urine pregnancy test will typically be positive after the first missed period and is considered adequate to confirm a pregnancy. However, if there is uncertainty about the diagnosis, a blood test may be required.

An ultrasound is the best way to determine how far along a pregnancy is and confirm that the pregnancy is within the uterus.

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PREGNANCY OPTIONS GUIDE

FIRST THINGS FIRST

PREGNANCY AND

your body

A pregnancy usually lasts between 37 and 42 weeks. A pregnancy is divided into thirds, called trimesters.

Women experience hormonal, physical, and emotional changes throughout all three trimesters.

Doctors calculate the age of a pregnancy from the first day of the last menstrual period, although actual fertilization (egg fertilized by sperm) takes place later in the menstrual cycle.

For example, if a woman is six weeks pregnant, it has probably been four weeks since fertilization.

During pregnancy, it is important for a woman to see a healthcare professional.

At fertilization, the fertilized ovum (egg) contains all of the DNA (genetic information) that, together with environmental influences, determines many of the physical and personality qualities, including sex, hair and eye colour, height, and skin tone.

Fallopian Tube

Ovary

In the second week after fertilization, the fertilized ovum attaches itself to the lining of the uterus and begins to draw nutrition from the mother’s body, allowing it to grow.

Pregnancy Health: Healthcare Professionals During pregnancy, it is important to see a healthcare professional. For more information on your health and fetal development, you can talk to a family doctor, obstetrician-gynaecologist, public health nurse, or midwife.

Pregnancy Health Resources The Government of Canada has an online resource guide for healthy pregnancies. You can view the Guide to Healthy Pregnancy at canada.ca.

Pregnancy Care Centres Free resources, information, and support are available at pregnancy care centres. You can find a centre near you at pregnancycarecanada.ca.

Uterus

Ovary

Cervix

Vagina PREGNANCY OPTIONS GUIDE

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development

FIRST THINGS FIRST

FETAL

Most women discover they are pregnant after missing a menstrual period. This is comonly about week five of the pregnancy (three weeks after fertilization).

There is often curiousity about fetal development during pregnancy, especially when a woman begins to feel movement (as early as 16 weeks).

Many websites and books provide information on pregnancy and fetal development, and your provincial healthcare will cover at least one ultrasound appointment.

Week 7 (five weeks after fertilization) Nervous system activity can be recorded. The arms, legs, fingers, and toes are developing and become recognizable.

Week 10 (eight weeks after fertilization) At ten weeks, the embryo is called a fetus. All major internal organs, such as the lungs, kidneys, and liver are developing. The fetus begins to move and respond to stimuli.

Week 12 (ten weeks after fertilization)

The following are milestones that take place during the first trimester.

During the remainder of the pregnancy, the organs grow and mature in order to function independently outside the womb. The brain and muscles work together to kick, curl toes, press lips together, and produce some facial expressions. The genitalia have started developing. The fetus is now about 6 cm (2.4 inches) long.3

Week 5 (three weeks after fertilization)

Fetal Development Apps

The embryo starts to develop its heart, nervous system (later giving rise to the spinal cord and brain), eyes, ears, nose, and digestive tract. Ultrasound can detect the embryo’s heartbeat about week six of the pregnancy (or four weeks after fertilization).2

There are apps available that can help you track your pregnancy and fetal development. Here are just a few: Pregnancy Tracker, BabyCenter, and Pregnancy +.

Most women discover they are pregnant after missing a menstrual period. This is often about week five of the pregnancy.

“I felt informed and more confident once I knew all the information and thought through each option.”

Maria, British Columbia *

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checklist

FIRST THINGS FIRST

DECISION

The reality of an unexpected pregnancy is that no option is easy. There can be grief attached to each one. The level of grief you experience with each option depends on a variety of factors, such as your values and beliefs. It can help to take the time you need to think through all your options carefully.

Decision Checklist 1 – Am I pregnant?

As mentioned earlier, the first step is to confirm a pregnancy. You may feel some symptoms, but other factors can cause some symptoms of pregnancy.

It’s important to have a pregnancy confirmed by a healthcare professional.

2 – Do I know my options?

This guide gives information on your three options. All the options have pros and cons. Because the best decision is an informed decision, take the time to think about each option, so you can feel confident in the choice you make.

3 – How do I decide?

Consider how each option could affect your future – emotionally, mentally, physically, and spiritually. It can be helpful to take a day to think about one option at a time. Then, think about how you will feel right away, one year later, five years later, and so on. You won’t know exactly what every outcome will be, but this can help you process some of your thoughts and feelings about all available options.

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YOUR OPTIONS 10

Abortion Adoption Parenting

PREGNANCY OPTIONS GUIDE

YOUR OPTIONS

ABORTION

procedures

There are various abortion procedures available during different stages of pregnancy. Approximately 90% of abortions occur in the first 12 weeks of pregnancy.4 Depending on the situation, an ultrasound may be done before an abortion.

There are several methods of medical abortions available in Canada.

Medical Abortion (typically up to 9 weeks)5 There are several methods of medical abortions available in Canada. One method, Mifegymiso®,6 is a combination of two drugs – mifepristone and misoprostol. The first pill, mifepristone, is taken by mouth. Mifepristone blocks the hormonal support necessary for a pregnancy to continue. The second drug, misoprostol, is taken buccally (absorbed through the cheek mucosa) or vaginally, one to two days later. Misoprostol causes the uterus to contract, and cramping and bleeding will occur as the embryo and placenta are expelled.

Other types of medical abortion include methotrexate (which stops cell growth) and misoprostol, or misoprostol alone.

A medical abortion may take several days to complete and require one or more visits to the abortion provider. If an incomplete abortion occurs, then a surgical procedure may be necessary.

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YOUR OPTIONS

ABORTION

procedures

Surgical Abortion7

Second trimester

With each of the following surgical procedures, the cervix is dilated (opened) to allow instruments to enter the uterus. Dilation may be done using misoprostol, laminaria (seaweed sticks), an osmotic dilator (expanding sponge), or metal rods. A local anesthetic and medication to reduce pain, blood loss, and risk of infection may be given. The tissue removed from the uterus may be examined to identify fragments of the embryo or fetus and the placenta.

Dilation & evacuation (D&E) requires two appointments. After 24 hours of dilation, this procedure may use forceps (and suction) to remove fetal parts. For abortions in the late second trimester, prior to the procedure, a needle may be used to inject potassium chloride at the fetal heart with ultrasound guidance, to ensure the fetal heart has stopped beating before evacuation.

There are different procedures which may be used for a surgical abortion: First trimester After dilation, abortion is performed by inserting a long tube (cannula) into the uterus and the contents are removed by suction.

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Induction of labour may be used as an alternative in the second trimester.

Labour is induced and the fetus is delivered. As above, potassium chloride may also be used prior to induction of labour to ensure the fetal heart has stopped beating before delivery.

YOUR OPTIONS

ABORTION

risks

Abortion is considered a safe medical procedure. However, as with any medical procedure, there are potential risks you need to consider before making a final decision.

Physical8 • heavy bleeding • infection • increased risk of premature births in subsequent pregnancies (after surgical evacuation of the uterus)9 • injury to cervix or uterus (during surgical evacuation of the uterus)10

They depend on a woman’s age, stage of pregnancy, religious or cultural beliefs, previous mental health, the stability of her relationship with her partner, or whether others are pressuring her to have an abortion.12 Women who experience negative emotions after an abortion have reported the following reactions:13 • sadness • guilt or shame • emotional numbing • depression

• small risk of scarring that can be associated with infertility or miscarriage11

• nightmares or flashbacks

Emotional

Pregnancy care centres provide help and support for women who experience negative emotions after an abortion. For more information or to locate a centre, visit pregnancycarecanada.ca.

After an abortion, many women feel relief, while others have negative emotions. Reactions may be immediate, or conflicted feelings may come up years later. Responses vary.

• thoughts of self-harm • alcohol or drug abuse

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adoption

YOUR OPTIONS

Adoption is often quickly dismissed as an option for an unexpected pregnancy.

A very common response to adoption is “I could never do that.”

We understand this reaction. Adoption is not an easy choice. Giving another couple or person the opportunity to raise your child as their own is a difficult decision to make.

Women who choose to place for adoption do so for a number of reasons: to provide the best opportunity for their child; to give another couple who may not be able to have children naturally the opportunity to parent; or because they do not want to have an abortion.

It’s important to understand the different options within adoption.

Adoption is one option to consider if you are financially, emotionally, or otherwise unable to raise a child at this time.

There can be a lot of misconceptions about adoption. If you think adoption may be an option you would consider, be sure you have all the facts and information.

Adoptions may be public or private; however, not all provinces or territories allow private adoptions. Visit the

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Adoption Council of Canada website for more information about specific regulations.14 Public adoptions are facilitated by a branch of a province’s social services program, such as the Children’s Aid Society.

Private adoptions are facilitated by a private adoption agency. The agency provides profiles of prospective parents, and you choose who you would like to parent your child.

If you decide to pursue a private adoption, you can choose from three types which offer different degrees of involvement with the adoptive family.

1.

Open Adoption. You have contact with the adoptive family, and ongoing communication with your child can include pictures, phone calls, texts, and visits.

2.

Semi-open Adoption. You have some contact with the adoptive family, but an adoption professional handles most communication.

3.

Closed Adoption. You have no contact and only non-identifying information is shared with the adoptive family.

The adoption process is different in Quebec. Contact your local pregnancy care centre or the CISSS (social service centre) in your region to find out more.

Planning and Timelines The decision for adoption can be made any time during your pregnancy or even after your baby is born. Also, you have the right to change your mind within a set period of weeks after signing an adoption agreement. This timeline is different for each province.

It can be very helpful to talk with an adoption agency. They can provide you with accurate information and discuss options based on your situation. Their job is not to talk you into an adoption but to provide education and support, no matter what you decide. There is no cost for a meeting and you are under no obligation.

Even if adoption is the right choice for you, planning an adoption for your child can be emotionally difficult. There is a unique grieving process involved. Therefore, it’s important to have support throughout the entire adoption journey. Family and friends can be a good source of support, but it can also be helpful to access the counselling provided by the adoption agency or the support offered at a pregnancy care centre.

Accessing post-adoption support can help you move forward positively and encourage you to pursue your goals.

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parenting

YOUR OPTIONS

The thought of becoming a parent can be overwhelming at any time, but especially if the news of your pregnancy is unexpected. Caring for a child is a big responsibility. But often, parents say raising a child is one of the most rewarding experiences in their life.

Many people would like to be parents at some point in their lives. Although the timing and your current situation may not be what you had planned, your pregnancy offers you the opportunity to experience the joy of becoming a parent.

You may have a number of genuine concerns about parenting, including finances, education, and employment.

If you are on a tight budget, a support worker at a pregnancy care centre

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can help you explore ways to meet the costs of a new baby. Daycare options, free or low-cost baby supplies, and government assistance may be available to you as a parent.

If you are concerned about finishing school or losing work opportunities, it’s important to explore all your possibilities. Just like with budgeting, a centre support worker can help you collect information on employment laws, maternity benefits, and childcare to help in your decision-making.

Circumstances can change in a week or a year, so it’s important not to make decisions only based on what’s going on in your life right now.

Parenting Resources You may have heard the proverb, “It takes a village to raise a child.”

This saying means that parenting is much easier with the help of a supportive network.

Often a partner, family, or friends are willing to offer support. Depending on your situation, you may also want to find out about support in your community; there are usually many resources available.

A pregnancy care centre can help you find the best resources and support for you and your situation. Most centres have links and contacts for helping organizations, as well as information regarding prenatal classes, moms’ groups, and parenting classes.

If the option of parenting interests you but you feel overwhelmed by all the things you need to know – consider looking into parenting classes. Many communities offer these classes for free or for little cost. As well as preparing you for parenting, they are a great way to meet other moms and build new friendships.

At times, parenting will require personal sacrifice, and you may need to delay some of your goals.However, by making a long-term plan and finding solutions to challenges, you can have the confidence you need to embrace the future as a parent.

Circumstances can change in a week or a year, so it’s important not to make decisions only based on what’s going on in your life right now.

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FIRST THINGS FIRST 18

My Dreams & Goals Thinking About My Choices Journal Questions Making A Decision

PREGNANCY OPTIONS GUIDE

DECISION-MAKING

MY DREAMS &

goals

It can be helpful to take some time to consider your goals and dreams. These could be related to education, career, family, travel, etc. The unexpected situations in our lives present us with opportunities to think about what’s really important to us. And sometimes, we change our perspective on things as we sort through our thoughts and feelings about a new situation.

For example, some people may tell you it’s impossible to achieve your dreams if you get pregnant, especially if you decide to parent. But this is

not necessarily true. Instead, you may reach your dreams and goals in different ways than what you had planned. Maybe a dream needs to be put on hold for a while. Or maybe as your circumstances change, some of your goals change too.

Which dreams and goals do you still want to achieve? Are there ways to still accomplish these dreams and goals no matter which option you choose? Brainstorming solutions can help you visualize each option and make the best decision for you.

Unexpected situations in our lives present us with opportunities to think about what’s really important to us.

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DECISION-MAKING

THINKING ABOUT MY Our lives are full of choices.

Researchers at Cornell University say we make about 200 decisions a day on food choices alone.15 Each choice we make impacts our lives in some way, whether big or small, and some of these choices are more important than what to eat for lunch!

Don’t make a decision based on fear. Make an informed decision, based on hope.

Our ability to make choices can be empowering and liberating. Real choice means that you are aware of and understand all your options and their potential outcomes – that you are making your choice from a place of knowledge.

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PREGNANCY OPTIONS GUIDE

choices

The decisions we make today can positively or negatively affect the rest of our lives. That’s why it’s so important to consider and weigh your options when making choices for your life.

A few things are helpful to consider when making a life decision: accurate information on your circumstances, your goals and dreams for your future, and most important of all – your values.

Don’t make a decision based on fear. Make an informed decision, based on hope.

This guide provides you with information on all your options and some journal questions to help you work through your thoughts, feelings, and values – so you can make an informed decision that is right for you.

Take the time you need to consider how each option will impact your life and your future.

DECISION-MAKING

JOURNAL Journal Questions

questions

Use these questions to think about your options and your future. It’s time to get your thoughts and feelings out of your head and “on paper” – and then it’s time to dream a little.

Abortion Before getting pregnant, what did I think and feel about abortion? What do I think and feel now?

Do I understand the different medical procedures and the possible risks? Do I have any fears or concerns?

If I choose abortion, will this change how I view myself? What emotions might I experience?

Is there anyone pressuring me to have an abortion?

Would someone close to me be against my choice of abortion? How would I deal with this?

If I choose abortion, will I feel comfortable sharing that with my partner, family, and friends?

Adoption Before getting pregnant, what did I think and feel about adoption? What do I think and feel now?

Do I understand the difference between open and closed adoption? Is there one that I would prefer and why?

If I choose adoption, will this change how I view myself? What emotions might I experience?

Is there anyone pressuring me to place my baby for adoption?

Would someone close to me be against my choice of adoption? How would I deal with this?

If I choose adoption, what qualities would I want the adoptive parents to have?

Parenting Before getting pregnant, what did I think about becoming a parent? What do I think and feel now?

Do I understand what I need to be a good parent? Do I have any fears or concerns?

If I choose to parent, will this change how I view myself? What emotions might I experience?

Is there anyone pressuring me to keep the baby?

Would someone close to me be against my choice to parent? How would I deal with this?

If I want to choose this option, what resources and supports can I access?

Looking Ahead What are the pressures I’m feeling right now? How might these pressures or circumstances change over time?

Has my perception or understanding of my pregnancy options changed? Do I need more information about any of the options?

What’s important to me, no matter what?

What are my strengths and things I’m proud of?

What are some goals and dreams I have?

What do I want to be doing in one year, five years, and ten years?

Am I able to support myself? If not, do I know where I can go for support?

Pushing any fears aside, what is my heart telling me to do?

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DECISION-MAKING

MAKING A

decision

We understand that making a decision about your pregnancy can feel overwhelming. If you need support – someone to listen as you talk through your thoughts, feelings, and options – a pregnancy care centre can help. They offer medically accurate information and compassionate, nonjudgmental support to anyone facing an unexpected pregnancy.

Regardless of the decision you make, we want you to know we are here for you.

Even after you’ve made a decision, you can still connect with a pregnancy care centre for resources and support. Centres have follow-up support tailored for each client and the decisions they make.

If you decide to parent, a centre support worker can connect you with local helping organizations, parenting

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classes, and many have material supports such as clothing, diapers, formula, etc.

If you place for adoption, a centre can provide the emotional support you need during and after the adoption placement.

Your decision is yours alone to make, but you don’t have to be alone while making it.

If you have an abortion, most centres offer one-on-one or group post-abortion support. They are a safe place to talk about anything you may be feeling or experiencing.

Your decision is yours alone to make, but you don’t have to be alone while making it.

Endnotes 1 Lori A. Bastian, Haywood L. Brown, Clinical manifestations and diagnosis of early pregnancy. Literature review current through: Aug 2022. www.uptodate.com/contents/clinical-manifestations-and-diagnosisof-early-pregnancy (Accessed September 2022).

2 The Endowment for Human Development, Prenatal Summary. www.ehd.org/prenatal-summary.php (Accessed September 2022).

3

Ibid.

Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance — United States, 2018. MMWR Surveill Summ 2020;69(No. SS-7):1–29.

4

5 Deborah A. Bartz, Paul D. Blumenthal, First-trimester pregnancy termination: Medication abortion.

Literature review current through: Aug 2022. www.uptodate.com/contents/first-trimester-pregnancytermination-medication-abortion (Accessed September 2022).

6 Mifegymiso product monograph. April 15, 2019. pdf.hres.ca/dpd_pm/00050659.PDF (Accessed September 2022).

7 Jody Steinauer, Overview of pregnancy termination. Literature review current through: Aug 2022. www.uptodate.com/contents/ overview-of-pregnancy-termination (Accessed September 2022).

8 Jody Steinauer, Overview of pregnancy termination: complications. Literature review current through: Aug 2022. www.uptodate. com/contents/overview-of-pregnancy-termination (Accessed September 2022).

9 Saccone G, Perriera L, Berghella V. “Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis.” Am J Obstet Gynecol. 2016;214(5):572-591. doi:10.1016/j.ajog.2015.12.044 10 Schenker JG. “Etiology of and therapeutic approach to synechia uteri.” Eur J Obstet Gynecol Reprod Biol. 1996;65(1):109-113. doi:10.1016/0028-2243(95)02315-j; March CM. “Intrauterine adhesions.”

Obstet Gynecol Clin North Am. 1995;22(3):491-505.

11

Ibid.

P.K. Coleman, K. Boswell, K. Etzkorn, and R. Turnwald, “Women who suffered emotionally from abortion: a qualitative synthesis of their experiences,” Journal of American Physicians and Surgeons 2017; 22(4): 112-118.

12

13 P.K. Coleman, “Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009,” British Journal of Psychiatry 199 (2011): 180-86; D.M. Fergusson, J.L. Horwood and J.M. Broden, “Abortion and mental health disorders: Evidence from a 30-year longitudinal study,” British Journal of Psychiatry 193 (2008): 444-451; N.P. Mota, M. Burnett and J. Sareen, “Associations between abortion, mental disorders, and suicidal behaviour in a nationally representative sample,” Canadian Journal of Psychiatry 55, no. 4 (2010): 239-247.

14

Adoption Council of Canada. www.adoption.ca (Accessed September 2022).

Wansink B, Sobal J. “Mindless Eating: The 200 Daily Food Decisions We Overlook. Environment and Behavior.” 2007;39(1):106-123.

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*Client quotation is used with permission. Name has been changed.

Acknowledgements We are grateful for the many contributors involved with creating the Pregnancy Options Guide, specifically Ashley Kumar, Laura Lewis, Nataizya Mukwavi, and Rebecca Peters.

Our special thanks to co-editors of the Abortion Adoption Parenting booklet: Ginimi Chan, Adrienne Mugwanya, Brian Norton, and Musu Taylor-Lewis.

For accuracy and accountability, the Pregnancy Options Guide has been reviewed by 80 specialized practitioners in Canada, including perinatal nurses, family physicians, obstetrician-gynaecologists, medical ethicists, psychiatrists, psychologists, and social workers.

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