Management of late gestation abortion of concern in Birmingham Women’s NHS Foundation Trust

Sean Murphy*

According to an inspection report of the Birmingham Women’s National Health Service Foundation Trust, the facility did not consistently provide women seeking abortion with information to prepare them for the possibility of the survival of an infant following a late gestation abortion, including the need to notify the coroner should the infant die. (p. 4, 15)  Apparently the outpatients’ clinic provided patients with this information verbally. (p. 16)

The effect of late term abortions on staff and patients is described as “distressing,”  one of the risks in need of identification, monitoring and mitigation(p.6).  Ward staff felt unprepared to respond to late term abortions involving the survival of an infant (p. 6), several complaining that they “had not received training that would equip them to deal with the physical and emotional aspects of advanced gestation abortions.” (p. 15, 18)

One issue was the need to develop “differential care pathways,” apparently related to decisions about how to manage a surviving or deceased infant based on the reason for the abortion. (p. 16)

Staff involved in what the report describes as a “new complex termination of pregnancy service” were not adequately prepared or engaged before it began, and “continued to express concerns” over a year after its introduction.  Staff had been allowed to opt out of the service, but several (apparently among those who remained) complained about “distress to women and how they felt ill prepared to care for them.” (p. 31)

The report also states, without explanation, “The trust must ensure all HSA1 certificates for termination of pregnancy are fully completed by the registered medical practitioners signing them.” (p. 34)  This may reflect a continuing problem with certification by physicians of the need for abortions, which is a legal requirement.  Among problems previously identified was the practice of signing the forms in advance without actually seeing a patient.

These elements of the report illustrate the practical realities that inform the decisions of some health care personnel who refuse to provide or participate in abortion.

 

 

 

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