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Original research
Patient experiences of undergoing abortion with and without an ultrasound scan in Britain
  1. Rebecca Blaylock1,2,
  2. Patricia A Lohr1,
  3. Lesley Hoggart3,
  4. Pam Lowe4
  1. 1 Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
  2. 2 Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Faculty of Health and Social Care, The Open University, Milton Keynes, UK
  4. 4 Languages and Social Sciences, Aston University, Birmingham, UK
  1. Correspondence to Rebecca Blaylock, Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK; rebecca.blaylock{at}bpas.org

Abstract

Background Routine ultrasound scanning to determine gestational age and pregnancy location has long been part of pre-abortion assessment in Britain, despite not being legally required or recommended in national clinical guidelines. To support implementation of fully telemedical abortion care (implemented in Britain in April 2020), the Royal College of Obstetricians and Gynaecologists (RCOG) issued clinical guidance for an ‘as-indicated’ approach to pre-abortion ultrasound, removing the need for a clinic visit. We aimed to understand patient experiences of ultrasound in abortion care by conducting a qualitative study with individuals who had abortions with and without an ultrasound scan.

Methods Between November 2021 and July 2022, we recruited patients who had a medical abortion at home without a pre-procedure ultrasound at 69 days’ gestation or less at British Pregnancy Advisory Service (BPAS), and also had at least one other abortion with an ultrasound from any provider in Britain. We conducted interviews using a semi-structured interview guide to explore our participants’ experiences and conducted reflexive thematic analysis.

Results We recruited 24 participants and included 19 interviews in our analysis. We developed three themes from our data. These were ‘Ultrasound scans and their relationship with autonomy and decision-making’, ‘Intrusive and out of place: the ultrasound as an inappropriate technology’ and ‘Towards preference-centred, quality care’.

Conclusions Further research and user-testing of strategies to improve the scan experience should be undertaken. Patient testimonies on the negative impact of ultrasound scans in abortion care should reassure providers that omitting them according to patient preference is a positive step towards providing patient-centred care.

  • abortion, induced
  • qualitative research
  • Patient Preference

Data availability statement

No data are available. Not applicable.

https://doi.org/10.1136/bmjsrh-2023-202116

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    Data availability statement

    No data are available. Not applicable.

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    Footnotes

    • RB and PAL are joint first authors.

    • X @Lohrpa, @drhoggart, @DrPamLowe

    • Contributors PAL conceived of the study and obtained funding. PAL, RB and LH designed the study protocol. All authors were involved in data collection. RB led on analysis and was supported by the team. RB wrote the manuscript. All authors provided their edits and comments. PAL is the overall guarantor.

    • Funding This project was funded by the European Society of Contraception and Reproductive Health (grant number P-2019-A-01).

    • Competing interests Patricia Lohr is the Medical Director of British Pregnancy Advisory Service. There are no other competing interests.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.