Abstract
ObjectivesThis study sought to explore labor and delivery (L&D) nurses’ experiences caring for women undergoing induction for intrauterine fetal demise (IUFD) or termination for fetal anomalies, and to characterize reluctance towards participation in abortion care or – conversely – the commitment to provide services. Study DesignResearchers conducted a qualitative study that consisted of open-ended, semistructured interviews with 15 registered nurses who care for women on L&D at a large metropolitan hospital. We analyzed these data for content and themes. ResultsLabor and delivery nurses struggle emotionally, logistically, and morally with bereavement care, whether their patients are experiencing an IUFD or termination for fetal anomalies. The analysis generated the following themes: the emotionally intense work of perinatal loss, feelings of incompetence in bereavement care, ethical conflicts, and judgment of both termination and IUFD patients. In addition, nurses who chose to provide care for patients undergoing induction termination for fetal anomalies described a duty to care for all patients despite the increased logistic and emotional burden. ConclusionsMuch of the discomfort L&D nurses reported caring for patients undergoing induction termination stems from the emotional toll, lack of skills, and bureaucratic burden of bereavement care rather than a moral objection to abortion. Instituting interventions to improve staffing, simplify paperwork, augment bereavement training, and improve support for the emotional burden of caring for these patients may therefore increase access to competent and compassionate abortion care. ImplicationsLabor and delivery nurses struggle with bereavement care whether their patients are experiencing an IUFD or termination for fetal anomalies. Instituting interventions – like interdisciplinary simulation – to support nurses in bereavement care may increase the number willing to participate in abortion care, thereby improving patient access.
Highlights
Popular portrayals of Labor and Delivery (L&D) units focus on happy outcomes, but this ignores the reality that some patients experience perinatal fetal loss through intrauterine fetal demise (IUFD, defined as fetal loss at or after 20 weeks gestational age) or induction termination for fetal anomalies or other obstetric com
The 15 L&D nurses reported similar challenges caring for women experiencing IUFDs and induction termination
Nurse ambivalence to participate in abortion care has been shown to negatively affect patients and to block access to care [11]
Summary
Popular portrayals of Labor and Delivery (L&D) units focus on happy outcomes, but this ignores the reality that some patients experience perinatal fetal loss through intrauterine fetal demise (IUFD, defined as fetal loss at or after 20 weeks gestational age) or induction termination for fetal anomalies or other obstetric com-plications. In the United States (US), providers generally provide labor inductions for IUFDs or second trimester abortion in the inpatient setting (typically on an L&D unit) employing prostaglandin analogues to induce uterine contractions and the expulsion of all products of conception. Few other studies have explored the basis of these views or whether the hesitancy to participate in care stems from opposition to abortion versus a discomfort with perinatal loss generally. Specific factors such as personal experience and commitment to patient autonomy that drive nurses to accept these assignments are incompletely understood
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