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Objectives
To explore how US obstetrician gynecologists (Ob-Gyns) characterize periviable pregnancy-ending
interventions as obstetric or abortion care, and to understand how those determinations
are made.
Methods
From April to June 2021, we performed an explanatory sequential mixed methods study
of US Ob-Gyns, recruited through overlapping online communities. We administered a
cross-sectional survey requesting characterization of eight potentially ambiguous
clinical scenarios, using chi-square tests to compare determinations by physician
and institutional factors. We then conducted semi-structured interviews in a diverse
nested sample, merging quantitative and qualitative data about decision making in
a joint mixed methods analysis.
Results
We received 209 survey responses, with 101 (48.3%) current abortion providers and
42 (20.1%) never-providers, and completed 21 qualitative interviews. Characterization
of pregnancy-ending interventions as induced abortion ranged from 21.1% for a 22-week
labor induction in setting of chorioamnionitis, to 83.1% for a 24-week feticidal injection
and labor induction in setting of fetal anencephaly. Interventions were less often
characterized as abortion when performed for maternal indications, for instance only
42.6% of respondents felt a 22-week dilation and evacuation for chorioamnionitis was
an abortion, compared to 82.1% for 24-week dilation and evacuation for anencephaly
(p<0.001). Other significant associations with abortion determination included method
type (procedural more likely than medication-only), abortion experience (ever-providers
more likely than never-providers), and state and institutional abortion regulations
(“I have to call it a medical inducement.…I'm not allowed to use the word abortion.”).
Conclusions
Unclear definitions and administrative overreach lead to inconsistency and subjectivity
in care for periviable pregnancy complications. With widespread abortion restrictions,
characterization of interventions can affect access to necessary medical care.
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Copyright
© 2022 Published by Elsevier Inc.
