Second-trimester abortion attitudes and practices among maternal-fetal medicine and family planning subspecialists

Abstract

Background: Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies. Methods: We surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010-2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E. Results: Seven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications. Conclusion: Recommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.

Second- and Third-Trimester Medical Abortion Providers and Services in 2019: Results From the Canadian Abortion Provider Survey

“…[D&E]) training and services are not available in all academic hospitals, 4,5,8 a finding we confirmed in our survey, limiting patients' choice on how to terminate a pregnancy. Twenty-nine percent of our survey respondents who provided D&Es without offering STMA/TTMA were nonehospital based, which might have improved patient access in some cities where hospitals did not provide D&E (R. Renner, unpublished data, 2022).…”

The ongoing crisis of abortion care education and training in the United States

“…Other Ob-Gyn Fellows including Maternal Fetal Medicine Fellows, who care for patients with foetal anomalies and pregnancy complications, as well as Reproductive Endocrinology Fellows, who care for patients in early pregnancy, are also interested in abortion care training and may not be able to access it at their institutions with new restrictions. Programmes will need to be developed for these Fellows to continue to receive critical training opportunities [30].…”

Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision

“…Previous surveys have demonstrated variation in counseling and management strategies by MFM physicians in the context of fetal indications, 9,11 as well as variation in the abortion methods they would recommend for various maternal and fetal indications. 16…”

“…This study considered the attitudes of MFM subspecialists about abortion services for high-risk individuals and their competence in abortion provision. Previous surveys aimed at MFM subspecialists have assessed the barriers to provision of D&E, 23 compared their attitudes and practice patterns for second-trimester abortions indicated for abnormal pregnancies with those of trained family planning subspecialists, 16 and assessed the risk for maternal death at which point an abortion would be considered medically indicated or recommended, 24 all of which demonstrated heterogeneity in MFM physicians' attitudes and practice patterns regarding abortion. A strength of this survey includes the breadth and depth of family planning topics assessed, from personal training experience and practice patterns to factors that influence the decisions to provide abortion care.…”