医疗保健提供者与自我管理堕胎相关的报告实践。
Health care provider reporting practices related to self-managed abortion.
机构信息
Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
出版信息
BMC Womens Health. 2023 Mar 27;23(1):136. doi: 10.1186/s12905-023-02266-7.
BACKGROUND
Health care providers reporting patients to government authorities is a main way people attempting self-managed abortion (SMA) become exposed to legal risks. Little is known about health care provider decision-making regarding SMA reporting.
METHODS
We conducted semi-structured interviews with 37 clinicians who provided care in hospital-based obstetrics or emergency departments (13 obstetricians/gynecologists, two advance practice registered nurses providing obstetrics care, 12 emergency medicine physicians, and 10 family medicine physicians) throughout the United States. The interview guide asked participants to describe one or more cases of caring for a patient who may have attempted SMA and about related reporting decisions. We coded responses to answer two questions: What comes to mind for health care providers when asked to think about experiences caring for a patient who may have attempted SMA? Based on health care provider experiences, how might people who providers suspect may have attempted SMA end up reported?
RESULTS
About half of participants had cared for someone who may have attempted SMA for that pregnancy. Only two mentioned SMA with misoprostol. Most participants described cases where they were unsure whether the patient had attempted to end their pregnancy on purpose. In most instances, participants mentioned that that the possibility of reporting never occurred to them nor came up. In some cases, participants described a reporting "adjacent" practice - e.g. beginning processes that could lead to substance use, domestic violence, or self-injury/suicide-related reports - or considered reporting related to a perceived need to report abortion complications. In two cases, hospital staff reported to the police and/or Child Protective Services related to the SMA attempt. These involved passing of a fetus after 20 weeks outside the hospital and a domestic violence incident.
CONCLUSION
Reporting patients who may have attempted SMA may occur via provider perception of a need to report abortion complications and fetal demises, particularly at later gestations, and other reporting requirements (e.g. substance use, domestic violence, child maltreatment, suicide/self-harm).
背景
向政府当局报告试图自行堕胎（SMA）的患者是使尝试 SMA 的人面临法律风险的主要途径。对于医疗保健提供者关于 SMA 报告的决策知之甚少。
方法
我们对美国各地医院产科或急诊部门的 37 名临床医生进行了半结构化访谈（13 名妇产科医生/妇科医生，2 名提供产科护理的高级实践注册护士，12 名急诊医学医师和 10 名家庭医学医师）。访谈指南要求参与者描述照顾可能试图进行 SMA 的患者的一个或多个案例以及相关的报告决定。我们对答复进行编码以回答两个问题：当被要求考虑照顾可能试图进行 SMA 的患者的经历时，医疗保健提供者会想到什么？根据医疗保健提供者的经验，提供者怀疑可能试图进行 SMA 的人可能会如何报告？
结果
大约一半的参与者照顾过可能因该次怀孕而试图进行 SMA 的人。只有两名参与者提到米索前列醇的 SMA。大多数参与者描述了他们不确定患者是否故意试图终止妊娠的案例。在大多数情况下，参与者表示他们从未想到过或提出过报告的可能性。在某些情况下，参与者描述了一种报告“相邻”的做法-例如，开始可能导致药物滥用，家庭暴力或自残/自杀相关报告的程序-或考虑与报告堕胎并发症相关的报告。在两种情况下，医院工作人员向警察和/或儿童保护服务部门报告了与 SMA 尝试有关的事件。这些事件涉及在医院外 20 周后分娩的胎儿和家庭暴力事件。
结论
通过提供者对报告堕胎并发症和胎儿死亡的需求的认识，尤其是在妊娠后期，以及其他报告要求（例如药物滥用，家庭暴力，儿童虐待，自杀/自残），可能会报告可能试图进行 SMA 的患者。
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