Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences

Abstract

CONTEXT Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers. METHODS From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21–44 who had had exposure to religious‐based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information. RESULTS Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy. CONCLUSIONS To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.

Ethics, Abortion Access, and Emergency Care Post‐Dobbs: The Gray Areas

“…This scenario has been well-documented for years in Catholic health care systems and is familiar in its dominant and singular decision held within the expertise of the physician, rather than in the chosen preferences of the patient. 34,35 The Dobbs decision and subsequent regulation of abortion, including outright bans, has extended these potential clinical failures as well as resultant moral injuries to secular hospitals in the affected states. Essentially, Dobbs made secular hospitals in the affected states complicit in the same welldocumented harms that already occurred in Catholic health care.…”

Reproductive healthcare denials among a privately insured population

“…A growing body of literature has focused on women’s knowledge around religious restrictions on care ( Freedman et al, 2018 , Wascher et al, 2018 ), expectations and preferences related to care in religiously affiliated settings ( Stulberg et al, 2019 , Takahashi et al, 2019 , Wingo et al, 2020 ), priorities in selecting a hospital for reproductive care ( Hebert et al, 2020 ), and provider perspectives on reproductive care restrictions ( Hasselbacher et al, 2020 , Liu et al, 2019 ). In general, much of this work has focused on hospital refusal to provide specific services, but less is known about the role insurance plays in a patient’s access to reproductive care free from religious restrictions.…”