EXERCISES: INCREMENTAL EXPANSION OF ABORTION CARE

EXERCISE 12.1. Feelings about abortions with advancing gestational duration and your role

In spite of our efforts to be objective, we all hold personal values and belief systems that can influence how we respond to the people seeking health care from us. These exercises can help you explore your values about pregnancy options with advancing gestational durations in the context of professional judgments you may be called to make. In multiple global settings, participants who undertake abortion values exploration show increased knowledge as well as attitudes and behavioral intentions that are more supportive of people seeking abortions (Turner 2008).

1. Depending on the legal status of abortion in your setting, how comfortable are you being involved in abortion with advancing gestational duration in the following ways?
   1. Referring for an abortion
   2. Observing or performing ultrasound procedural guidance
   3. Looking at pregnancy tissue (i.e. products of conception)
   4. Assisting or performing abortion
   5. Taking on a medically complex patient for care (especially for someone coming from a restricted setting with minimal prior work-up/risk stratification).

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2. What is your biggest concern about providing abortions beyond 14 weeks gestation?

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3. If no alternative abortion services were accessible, what kind of patient hardship might motivate you to offer information, referral or services (to the extent of legality in your setting)?

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4. If you are trying to help someone find appropriate abortion services (or referral) > 14 weeks, what might be some key steps, precautions, and supports?

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EXERCISE 12.2: Understanding people’s reasons or situation

1. Describe why pregnant people might present > 14 weeks for abortion care?

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2. What kind of provider and staff support might be helpful in abortion care settings that regularly provide care > 14 weeks gestation?

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3. How might abortion bans contribute to delays and further disparities?

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EXERCISE 12.3: Technical considerations, skills, and cases

1. Beyond the standard screening and preparations for abortion < 14 weeks, what additional screenings or plans might you need for an abortion procedure > 14 weeks?

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2. A person at 17 weeks is undergoing an ultrasound-guided D&E procedure, and experiences localized pain as you make a lateral instrument pass which feels deeper than previous passes, and without fundal landmarks felt previously. How would you proceed?

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3. A person at 16 weeks is undergoing an ultrasound-guided D&E, and after easily removing most of the pregnancy, you have significant difficulty removing the calvarium. What techniques might you consider to safely complete the procedure?

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4. What overarching considerations and information might you need for a medically complex individual > 14 weeks that presents to your health center?

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5. A person at 16 weeks has undertaken a medication abortion at home using mifepristone and misoprostol. They call you 4 hours after fetal expulsion, with a concern that the placenta has not expulsed. What would you recommend?

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