Screening Pregnancy

Learn the best practices for determining if somebody is pregnant when they get to jail.

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Key Points

HOW

  • Offer pregnancy testing to all females (and trans males) under the age of 55 within 24 hours of arrival. Intake staff member should explain why and encourage but don’t require testing:
    • “We recommend doing a urine pregnancy test to see if you are pregnant. This is important so that we can give you the medical care that you need. We will not test your urine for anything else. Will you give a urine sample for a pregnancy test?”
  • If pregnant, screen for any urgent maternal signs (especially bleeding and pain) and signs of being unwell. “Are you having any vaginal bleeding or pain in your lower abdomen?” If yes, consult with a medical provider as soon as possible!
    • Tell the patient you’ll refer them to a medical provider for an appointment for options counseling and routine prenatal care.
  • Screen for opioid and other substance use next.
  • Keep pregnancy test kits in stock at your jail.


WHY

  • Identifying pregnancy as soon as possible is important to provide the appropriate medical care and substance use treatment.
  • Identifying pregnancy early will help jail staff better interpret any signs of being unwell.
  • Assessing pregnancy solely by missed menstrual periods is not reliable. Oftentimes people who use substances have irregular periods.
  • Patients who report being on birth control should still be tested!
  • Pregnancy care and options counseling is time-sensitive.


KEEP IN MIND

  • Remember, being in jail while pregnant doesn’t mean they are a bad parent.
  • Pregnancy tests are cheap! Everyone with the capacity of pregnancy should be tested at medical intake!
  • Test for pregnancy and discuss pregnancy test results in private.
  • Do not assume whether pregnancy is expected or if it is happy/sad news.
  • If pregnant, assess the patient for any urgent maternal warning signs, especially bleeding and pain, and any signs of being unwell.
  • Retest in 1-2 weeks if the test is negative or declined at intake, but the patient or provider believes they might be pregnant.
  • Review the urgent maternal warning signs and educational materials on being pregnant/postpartum with OUD with patients. Educate your patients about these symptoms so are aware while in jail and in the community. 

Deeper Dive

HOW

Where can jail staff purchase disposable pregnancy tests from?

You can purchase disposable pregnancy tests in bulk from Amazon and keep them in stock.


Who should receive a pregnancy test? How should we ask them to take a pregnancy test?

The medical intake staff member should ask all females (and trans males) under the age of 55: “We recommend doing a urine pregnancy test to see if you are pregnant. This is important so that we can give you the medical care that you need. We will not test your urine for anything else. Will you give a urine sample for a pregnancy test?” 


What steps should we take if the patient agrees to a pregnancy test?

If the patient agrees to test, provide privacy for them to give a urine sample. Discuss the results with them in private.  Don’t make assumptions about whether this will be happy or sad news for the patient. See scripts.


What should happen next, whether positive or negative for pregnancy?

If pregnant, screen for any urgent maternal signs (especially bleeding and pain) and signs of being unwell. “Are you having any vaginal bleeding or pain in your lower abdomen?”

  • If yes, consult with a medical provider (any bleeding in pregnancy can be concerning). Tell the patient you’ll refer them to a medical provider for an appointment for options counseling and routine prenatal care.
  • If the test is negative or the patient declines, but the patient believes there is a chance for pregnancy, retest them in 1-2 weeks.

Screen for opioid use and alcohol/benzo use


WHY 

Why should jails screen for pregnancy at intake?

Identifying a pregnant patient as soon as they enter jail will enable staff to provide appropriate medical care and pregnancy accommodations as soon as possible.


Why is a urine pregnancy test necessary for screening?

Urine pregnancy testing for all females and trans males under the age of 55 is more accurate than just asking when their last menstrual period was and only running a pregnancy test if it was more than 4 weeks ago. This is not a reliable approach, especially because many people who use substances have irregular periods.  

Pregnancy tests are cheap! (<$1/test)


What additional things should jail staff consider when testing for pregnancy?

Recommend, but don’t require women to do a pregnancy test. Explain to the patient why it’s important (see How). If they decline to test, document it in the medical record and tell them that they can request a pregnancy test later.

People who have had a hysterectomy (removal of the uterus, also known as the womb) do not need a pregnancy test. If someone has had a tubal ligation (having your “tubes tied”) or is on another method of contraception, they are less likely to get pregnant, but it is still possible, so you should still offer a test to them.

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