If there was one comment that highlighted Navy Medicine's planning for the unplanned, it was "we have to go the extra mile for any patient."

So stressed Dr. Antoinette Marengo-Barbick, staff physician with Naval Medical Center San Diego's OB/GYN department in recent training at Naval Hospital Bremerton to Navy and Army healthcare providers on unplanned pregnancy, contraception, and family planning services.

The in-depth training focused on clinical knowledge and awareness, family planning counseling methods, and Long Acting Reversible Contraception (LARC) skills instruction.

"This training is vital especially for primary care managers. The counseling portion is very important because that is something we do at every visit," said Lt. Cmdr. Katrina Vongsy, M.D. of NHB's Obstetrics and Gynecology department, who assisted to organize the event.

According to Cmdr. Greg Freitag, BUMED action officer and training instructor, one of Navy Medicine's goals is to continue to do a better job in supporting overall readiness for the entire fleet and Marine Corps.

"Unplanned pregnancy in the military can impact retention and recruitment and have a significant impact on a career.

Approximately 50 percent of all births in the U.S. are due to unplanned pregnancy. In the Navy, it has been estimated that two of every three Sailors pregnancies are unplanned," shared Freitag, adding that although 70-85 percent of active duty personnel are sexually active, nearly 40 percent use no contraception.

"As a provider and physician, what's relevant to deckplate Sailors is articulating to them safe practices in order for them to make positive choices," said Freitag.

The average cost of one unplanned pregnancy is $30,000, says Freitag. There were 2,368 deliveries of unplanned pregnancies in 2012, with 32 percent of enlisted women assigned to sea duty having an unplanned pregnancy or childbirth during their first tour.

Freitag attests that leadership has a vital role in helping to prevent unplanned pregnancy. Studies have shown that with female khaki leadership in place, unplanned pregnancy is three times less likely to happen while deployed or assigned to sea duty.

"Unplanned pregnancy is a Navy problem, not a female Sailor issue. Seventy percent of the fathers are military service members. With education, from leaders to the deckplates, more will choose contraception management.

Providing medical advice to the fleet to help care for all our forces is our central message with this training," Freitag said.

The Long Acting Reversible Contraception (LARC) training is the vital part of that training.

"LARC are highly effective. One third of women in the U.S. will try five kinds of birth control and LARC is the best.

Our goal is to train our healthcare force so they can better care and train their patients on using LARC. We want everyone, from general medical office to fleet marine force, to be LARC trained," Freitag said, noting that it is crucial to ensure all providers are prepared to counsel and manage the Sailors and Marines under their care.

Freitag explained that there are plans to extend the LARC training into the Independent Duty Corpsman training curriculum, as well as increase the role of LARC training in primary care.

LARC training is considered to be an integral component of primary healthcare for women, men and families by Navy Bureau of Medicine and Surgery (BUMED) Women's Health Advisory Board and Navy and Marine Corps Public Health Center. LARC training also enhances Navy Medicine's priorities of readiness, value and jointness by undertaking such medical education.

"LARC directly improves readiness with having a more effective force in place and improves value by reducing overall costs," said Freitag. "If a Sailor is unable to deploy due to an unplanned pregnancy, that impacts readiness. So does having to medically evacuate a Sailor underway due to an unplanned pregnancy. Odds are that Sailor will not be replaced. Let's face it, a basket of condoms placed on a desk in the Preventive Medicine office is not an effective, long term contraceptive option. Sex can, and does, happen when deployed."

Rear Adm. Ken Iverson, deputy chief of Navy Medical Operations at BUMED, noted in a memorandum on LARC training that "access to family planning services is an integral component of primary healthcare for women, men and families. Among contraceptive options, LARC has been demonstrated to be a highly effective, safe and cost effective option for most women."

Along with Navy and Army physicians, there were Navy Nurse Corps officers, independent duty corpsmen, and registered nurses in attendance. LARC training is being advocated to all who deliver primary care services to women, including physician assistants, flight surgeons, general medical officers, medical homeport clinicians, and support team members such as health educators.

Marengo-Barbick noted that out of 6.8 million pregnancies in the U.S., 49 percent were unintended.

"The CDC (U.S. Centers for Disease Control and Prevention) says that percentage hasn't changed much in years. As a provider I ask, how can it be a higher percentage in the military with the access to care we have? There are barriers in place, such as multiple counseling visits before receiving requested contraception. The process itself can be a problem. We need to constantly work on that. Every provider who has ever been on deployment and had to arrange to get a crew member off due to pregnancy knows," said Marengo-Barbick.

There is growing interest in LARC. From NMCSD to Naval Medical Center Portsmouth, there are clinics allocating time and space to specifically deal with LARC availability.

"We want to put more tools - highly effective contraception-in our tool box to provide for our patients," said Marengo-Barbick, also dispelling such myths that LARC do not cause pelvic infection, does not increase the likelihood of future pregnancies and are not all large in size.

In explaining the difference between not using and using a LARC for prevention of unplanned pregnancies, Marengo-Barbick raised one hand and noted that if one thousand used no protection, the odds have shown that 800 (or more) would get pregnant. On the other hand, if an intrauterine device (IUD) is used and in place, the number getting pregnant out of 1,000 is less than two.

"We have also got to make it a priority to see a 21-year-old at the last minute if her ship is going out. We have to find a way," Marengo-Barbick said.

Marengo-Barbick cited counseling as an essential part of the entire unplanned pregnancy approach by Navy Medicine in helping the fleet.

"Effective counseling is such an important part of the entire process. We just don't hand someone a pamphlet and expect them to read it with the same understanding as we have. It's not going to happen like that. We also need to leave our 'medicalese' way of speaking at the door and talk to a patient in normal every-day speech. Even if they are in there for a cough, ask them an OKQ - one quick question -about their long term pregnancy thoughts. Ask them, 'how would you feel if you just got pregnant?' If you see a look of horror, go over the IUD, medication, birth control options," Marengo-Barbick said, citing that counseling on the behalf of every provider also means paying attention to what the patient is saying. "Being a good listener also goes a long way to understanding their needs."

Marengo-Barbick attests that every provider has to be there for their patient from the onset to include upfront counseling - explaining the benefits, side effects if any and follow-up needs - IUD insertion, advising on return visit(s), and also ensuring connectivity is in place for timely replies to patient queries.

LARC training continues Navy Medicine's importance in developing and implementing patient-centered plans, working together with Navy and Marine Corps leadership to develop solutions for continuous improvement in unplanned pregnancy and family planning with strong counseling insight and information.

For more news from Naval Hospital Bremerton, visit www.navy.mil/.