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P041The essential role of the primary obstetrician for patients seeking abortion care for fetal diagnoses in hostile settings

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      Objectives

      To evaluate the role of the primary obstetrician in abortion experiences of patients with lethal or life-limiting fetal diagnoses in hostile settings.

      Methods

      We conducted a qualitative study of Texas patients with lethal or life-limiting fetal diagnoses using semi-structured interviews. We purposively explored the role of the primary obstetrician through questions related to fetal diagnosis, pregnancy options counseling, abortion decision making, and post-abortion reflections. Two researchers coded all transcripts using an inductive technique and analyzed themes with an iterative approach.

      Results

      We interviewed 18 participants who reported gestational ages at the time of abortion from 13 to 29 weeks. Participants identified the primary obstetrician as a key relationship during their obstetric and abortion care. This central theme was supported by three sub-themes: 1) participants desired reiteration or confirmation of information they received from a specialist; 2) participants wanted information about what to expect during and after an abortion from a trusted source; and 3) participants noted the benefit of having post-abortion follow-up to assess psychosocial concerns and future family planning needs, especially after obtaining an abortion out of state.

      Conclusions

      Patients seeking abortion care for fetal diagnoses in a hostile setting view the primary obstetrician as central to their experience. As fetal diagnosis and abortion are often performed by different specialists in separate locations, primary obstetricians have the potential to provide continuity of care before and after an abortion and bridge the gaps in care created by abortion restrictions. Family planning specialists should facilitate this process by forming relationships with and providing resources for referring obstetricians.
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