Medical Abortion

Costescu, Dustin; Guilbert, Édith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V.; Pymar, Helen; Soon, Judith A.; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen

doi:10.1016/j.jogc.2016.01.002

Cited by 73 publications

(140 citation statements)

References 232 publications

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“…Increasing the availability of medication abortion improves access and people accessing services' satisfaction without compromising safety. 13,14 According to Dressler et al, only 15% of abortions in Canada are medication abortions. 5,6 A standard medication abortion is a combination of 200 mg mifepristone and 800 mcg misoprostol, packaged together as Mifegymiso in Canada.…”

Section: Introductionmentioning

confidence: 99%

“…11,29,30 The Society of Obstetricians and Gynecologists of Canada notes that restricting abortion provision to gynecologists alone and failure to train registered midwives is perpetuating a potential access barrier in Canada. 14,31 Furthermore, the Canadian Association of Midwives released a statement in 2016 in support of reproductive rights for all people, stating that reproductive health care includes access to safe abortion care. 32 Registered midwives in British Columbia are primary care providers whose scope of practice includes prenatal, intrapartum, and postpartum care for low-risk individuals.…”

Section: Introductionmentioning

confidence: 99%

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Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Dowler

Rushton

Kornelsen

2019

J Midwife Womens Health

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Introduction Across Canada and internationally, access to abortion remains challenging, particularly for those living in rural and remote communities. International research and policy call for the training of advanced practice clinicians, including midwives, to provide abortion services to fill the ever‐increasing access gap. Research in other jurisdictions has examined the attitudes of midwives toward this potential expansion of scope of practice, but such studies have not been undertaken in British Columbia. This qualitative research study explored the attitudes of registered midwives toward expanding their scope of practice to include the provision of medication abortion in British Columbia. Methods In‐depth qualitative interviews with British Columbia registered midwives were conducted and analyzed using thematic analysis. Results Fifteen interviews were conducted. Analysis of the interviews identified 5 primary themes: the incorporation of medication abortion into the midwifery scope of practice to increase access, the congruence of the midwifery model of care and provision of medication abortion, the role of registered midwives as guardians of reproductive rights, the need for a paradigm shift in how the profession is viewed, and the practicalities of potential scope expansion. Discussion This study shows some British Columbia registered midwives are interested in including medication abortion in their scope of practice. Midwives have the potential to bridge some of the health care delivery gaps in areas underserved by abortion providers and communities where medication abortion is not available. Further research is needed to more fully understand the perspectives of registered midwives in British Columbia as a whole.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Dowler

Rushton

Kornelsen

2019

J Midwife Womens Health

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“…In July 2015, Health Canada approved Mifegymiso® (a combination product containing mifepristone 200 mg and misoprostol 800 mcg) for medical abortion, making Canada the 63rd country to approve the medication since 1988 [22,23]. In 2016, the Society of Obstetricians and Gynecologists (SOGC) published new Canadian clinical practice guidelines for medical abortion [24], prior to commercial availability of the product. However, the initial approval of mifepristone in Canada stipulated restrictive constraints that did not conform with the clinical guidelines or usual clinical practice including distribution of the medication only directly to physicians and pharmacists who had completed a certified training program and registered with the licensed distributor, prescribing and dispensing limited to these certified physicians, ultrasound required for gestational dating prior to administration, physician observation of patient ingestion of mifepristone, and use up to only 49 days gestational age [22].…”

Section: Introductionmentioning

confidence: 99%

“…These stipulations were not consistent with the extensive evidence on safety and effectiveness for this medication. Family planning experts deemed the restrictions unnecessary [24,25].…”

Section: Introductionmentioning

confidence: 99%

Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

Devane

Renner

Munro

et al. 2019

Pilot Feasibility Stud

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Background: Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods: In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh's conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin's framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré's validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results: We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada.

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“…M ifepristone, the gold standard drug for medical abortion, 1 was approved by Health Canada on July 29, 2015. 2 Under the federal terms of approval, physicians who wish to prescribe this treatment for their patients are required to dispense the medication themselves, which may necessitate purchase from the manufacturer, management of inventory and retail sales to patients.…”

mentioning

confidence: 99%

Requiring physicians to dispense mifepristone: an unnecessary limit on safety and access to medical abortion

Norman

Soon

2016

CMAJ

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Medical Abortion

Abstract: Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care.

Cited by 73 publications

References 232 publications

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Medical Abortion in Midwifery Scope of Practice: A Qualitative Exploration of the Attitudes of Registered Midwives in British Columbia

Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

Requiring physicians to dispense mifepristone: an unnecessary limit on safety and access to medical abortion

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