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Schultz A, Smith C, Johnson M, Bryant A, Buchbinder M. Impact of post-Dobbs abortion restrictions on maternal-fetal medicine physicians in the Southeast: a qualitative study. Am J Obstet Gynecol MFM 2024; 6:101387. [PMID: 38772442 DOI: 10.1016/j.ajogmf.2024.101387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The United States Supreme Court overturned federal abortion protections in Dobbs v Jackson Women's Health Organization. Many states in the Southeastern United States responded with restrictive policies that limit and criminalize abortion care. OBJECTIVE This study aimed to characterize the effect of abortion restrictions on maternal-fetal medicine physicians in the Southeastern United States after the Dobbs decision. STUDY DESIGN Qualitative, semistructured interviews with 35 maternal-fetal medicine physicians in 10 Southeastern states between February 2023 and June 2023 were conducted. Our recruitment strategy relied on convenience and snowball sampling. Audio-recorded interviews were analyzed using Dedoose software and a descriptive qualitative approach that incorporated deductive and inductive approaches. RESULTS Emergent themes were identified, and a conceptual framework was developed on the basis of overarching themes. This study found that abortion laws and external constraints after the Dobbs decision resulted in ethical, professional, and legal challenges for maternal-fetal medicine physicians that led to changes in clinical practice and deviations from patient-centered care. These forced changes resulted in negative effects on maternal-fetal medicine physicians, such as increased fear, hypervigilance, and increased workload. In addition, these changes prompted concerns about health risks and negative emotional effects for patients. Supportive colleagues, hospital systems, and policies were associated with decreased stress, emotional distress, and disruption of healthcare delivery. CONCLUSION Abortion restrictions in the Southeastern United States limit the ability of maternal-fetal medicine physicians to provide or facilitate abortions in the setting of fetal anomalies and maternal health risks. Maternal-fetal medicine physicians perceived these restrictions to have negative professional and emotional repercussions for themselves and negative effects on patients. Supportive colleagues and clear guidance from hospital systems and departments on how to interpret the laws were protective. Our findings have implications for the maternal-fetal medicine workforce and patient care in the region.
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Affiliation(s)
- Abby Schultz
- Departments of Obstetrics and Gynecology (Schultz and Bryant), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cambray Smith
- Health Policy and Management (Smith), University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Madelyn Johnson
- Health Behavior (Johnson), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy Bryant
- Departments of Obstetrics and Gynecology (Schultz and Bryant), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mara Buchbinder
- Social Medicine (Buchbinder), University of North Carolina at Chapel Hill, Chapel Hill, NC
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Carbone L, Raffone A, Travaglino A, Saccone G, Di Girolamo R, Neola D, Castaldo E, Iorio GG, Pontillo M, Arduino B, D'Alessandro P, Guida M, Mollo A, Maruotti GM. The impact of COVID-19 pandemic on obstetrics and gynecology hospitalization rate and on reasons for seeking emergency care: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2187254. [PMID: 36894183 DOI: 10.1080/14767058.2023.2187254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND During the lockdown due to COVID-19 pandemic, utilization of emergency care units has been reported to be reduced for obstetrical and gynaecological reasons. The aim of this systematic review is to assess if this phenomenon reduced the rate of hospitalizations for any reason and to evaluate the main reasons for seeking care in this subset of the population. METHODS The search was conducted using the main electronic databases from January 2020 to May 2021. The studies were identified with the use of a combination of: "emergency department" OR "A&E" OR "emergency service" OR "emergency unit" OR "maternity service" AND "COVID-19" OR "COVID-19 pandemic" OR "SARS-COV-2" and "admission" OR "hospitalization". All the studies that evaluated women going to obstetrics & gynecology emergency department (ED) during the COVID-19 pandemic for any reason were included. RESULTS The pooled proportion (PP) of hospitalizations increased from 22.7 to 30.6% during the lockdown periods, in particular from 48.0 to 53.9% for delivery. The PP of pregnant women suffering from hypertensive disorders increased (2.6 vs 1.2%), as well as women having contractions (52 vs 43%) and rupture of membranes (12.0 vs 9.1%). Oppositely, the PP of women having pelvic pain (12.4 vs 14.4%), suspected ectopic pregnancy (1.8 vs 2.0), reduced fetal movements (3.0 vs 3.3%), vaginal bleeding both for obstetrical (11.7 vs 12.8%) and gynecological issues (7.4 vs 9.2%) slightly reduced. CONCLUSION During the lockdown, an increase in the proportion of hospitalizations for obstetrical and gynecological reasons has been registered, especially for labor symptoms and hypertensive disorders.
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Affiliation(s)
- Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniele Neola
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Emanuele Castaldo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gabriele Iorio
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Martina Pontillo
- Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Bruno Arduino
- Maternal-Child Department, AOU Federico II hospital, Naples, Italy
| | | | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Giuseppe Maria Maruotti
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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