Abstract
BackgroundFollowing self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking.MethodsThe study team conducted semi-structured interviews with physicians, advanced practice clinicians, and nurses who had experience with patients presenting with early pregnancy complications in emergency and/or labor and delivery departments in five hospitals near the Texas-Mexico border. Interview questions focused on respondents’ roles at the hospital, knowledge of abortion services and laws, perspectives on SMA trends, experiences treating patients presenting after SMA, and potential gaps in training related to abortion. Researchers conducted interviews in person between October 2017 and January 2018, and analyzed transcripts using a thematic analysis approach.ResultsMost of the 54 participants interviewed said that the care provided to SMA patients was, and should be, the same as for patients presenting after miscarriage. The majority had treated a patient they suspected or confirmed had attempted SMA; typically, these cases required only expectant management and confirmation of pregnancy termination, or treatment for incomplete abortion. In rare cases, further clinical intervention was required. Many providers lacked clinical and legal knowledge about abortion, including local resources available.ConclusionsTreatment provided to SMA patients is similar to that provided to patients presenting after early pregnancy loss. Lack of provider knowledge about abortion and SMA, despite their involvement with SMA patients, highlights a need for improved training.
Highlights
Growing evidence suggests that some people in the United States (US) manage the termination of a pregnancy on their own outside of the health care system [1,2,3,4,5,6]
self-managed abortion (SMA) prevalence estimates are higher in Texas relative to a national 2014 study, which found that approximately 2% of US abortion patients have ever attempted SMA [5, 6]
For some who try SMA, Emergency Department (ED) providers may be the only point of contact with the medical system; ED providers are well-positioned to provide insight into SMA trends and experiences of patients who seek hospital care, which could inform guidance to improve their care. The aim of this exploratory study was to document hospital provider perspectives of SMA, the care provided to patients who present to the ED after attempting SMA, and provider preparedness to respond to these patients. We explored these questions through interviews with providers who had experience treating patients who presented with early pregnancy complications in hospital settings, including the ED and labor and delivery (L&D), to document their experiences with patients presenting after possible SMA
Summary
Growing evidence suggests that some people in the United States (US) manage the termination of a pregnancy on their own outside of the health care system [1,2,3,4,5,6]. A study of Texas abortion patients in McAllen, San Antonio, and Fort Worth conducted in 2017–2018 found that 16%, 9%, and 15%, respectively, reported seeking or trying any method to end their pregnancy before going to the clinic [2]. Following self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking
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