Where training is routinely integrated opt out , residents report a higher number of abortion procedures and higher self-assessed competence in procedural and counseling skills than those in programs with opt-in or no training Residents in opt-in programs report similar clinical experience to those programs where abortion training is not available This requires programs to allow residents to opt out of, rather than opt into, abortion training Military residency programs may have difficulty fulfilling these requirements because they are subject to additional restrictions.
When compared with residents in programs with opt-in training, residents in programs with routine training were significantly more likely to receive instruction in all modalities of abortion provision and performed proportionally more first-trimester and second-trimester terminations Training in abortion includes many skills that are applicable to general obstetrics and gynecology practice, including counseling around topics such as pregnancy options, early gestational ultrasonography, pain management for gynecology-based office procedures, cervical dilation, and the use of manual vacuum aspiration for early pregnancy loss.
Most residents who partially participate in abortion training affirm the value of a dedicated family planning rotation to these skills Additionally, obstetrics and gynecology residents at one institution gave family planning rotations that included abortion training the highest rating among all third-year resident rotations In response to the need for organized resident education in abortion care, the Kenneth J.
Ryan Residency Training Program was founded in ; currently, 67 U. A recent survey of residents and residency directors demonstrated significant improvement in knowledge and skills related to family planning and abortion for residents involved in this program, even for those who opted out of some aspects of training Although obstetrician—gynecologists perform most abortions in the United States, family medicine physicians play an important role in the provision of these services Family medicine physicians are more likely than physicians in other specialties to provide primary care to underserved women, and specifically to women in rural communities Providing training in first-trimester abortion care to family practice physicians may help reduce disparities in abortion access.
The American Academy of Family Physicians recognizes termination of pregnancy up to 10 weeks of gestation as an advanced core skill for family physicians Studies have shown that first-trimester abortion training may be integrated safely and effectively into family medicine residency programs; however, most family medicine residencies have no abortion training available In programs where abortion is an integrated part of the curriculum, residents generally report positive experiences 23 Residents who completed a required, opt-out abortion training program indicated that the curriculum enriched their educational experience and was consistent with the values of family medicine in providing continuity of care in a primary care setting Another study evaluating resident experience and outcomes from a required, opt-out, comprehensive abortion training program showed interest among family medicine residents and general satisfaction with the program Currently, only 24 of the accredited family medicine residency programs offer integrated abortion training, in part because it is not mandated by the ACGME as it is for obstetrician—gynecologists 23 The Reproductive Health Education In Family Medicine Program was established in to integrate high-quality, comprehensive abortion and contraception training into U.
Advanced practice clinicians, including nurse practitioners, physician assistants, and certified nurse—midwives, provide a large proportion of primary health care to reproductive-aged women, and their contribution is expected to increase with the implementation of the Affordable Care Act 26 Currently, five states allow APCs to provide first-trimester medical and aspiration abortions 28 Data suggest that abortion training is deficient in APC curricula However, several reports show no difference in outcomes in first-trimester medical and aspiration abortion by provider type and indicate that trained APCs can provide abortion services safely 28 31 All rights reserved.
Abortion training and education. To date, 11 people have been killed by antiabortion terrorism in the United States, and incidents of harassment at clinics are on the rise. The result? If allowed to go into effect, it would make getting or performing an abortion with few exceptions a felony, punishable by prison time.
Outside of criminalization, there are gag rules , which prohibit providers who receive federal funding from even discussing abortion with their patients. Other states allow abortion but make the procedure harder to access via targeted restrictions on abortion providers, or TRAP laws —extraneous rules like the size of the room in which the abortion is performed or the width of the corridors in the building.
Other times there are restrictions related to the lease where the office building is located, especially if it's a medical office building associated with a religiously affiliated association. Victoria Barrett, then 39, came up against this restriction when she found herself faced with the decision to abort a much-wanted pregnancy in At 14 weeks she learned that the fetus carried a chromosomal abnormality called trisomy 13 , which causes severe intellectual and physical birth defects.
Most infants born with trisomy 13 die within the first few weeks. Her ob-gyn was kind and compassionate but was unable to provide the abortion herself because of her affiliation with a large Catholic hospital in their area. Instead the ob-gyn referred her to a male doctor in the area who could perform the abortion in a public hospital in Indianapolis, not far from where she lived. Barrett has no regrets about the procedure, completed at 15 weeks, but it's one she still wishes her own doctor could have performed.
Glancing at one of the pages, she accidentally discovered the sex of the fetus—information she had not wanted to know. So what can women in need of an abortion do to get care? For two weeks after her second ob-gyn visit, Clements wavered between aborting the pregnancy and carrying it to term. You may stay in your room or wait in the reception area. We have magazines and portable stereos; you may want to bring something to read or a CD to occupy your wait time, which will be 45 to 60 minutes.
If you are 12 to 14 weeks pregnant, the misoprostol needs two to three hours to work. We will page you when it is time for you to return to the clinic. When you return, we will give you oral medications, including Vicodin, Valium and ibuprofen, and ask you to wait an additional 30 to 60 minutes for those to fully relax you. Continue reading. Your support person can be right next to you for the whole procedure. Use a speculum to view inside your vagina 2. Clean your vagina and cervix with gauze soaked in soap 3.
Apply numbing medication to your cervix 4. Dilate your cervix, the tight opening to your uterus, with thin metal rods 5. Insert a narrow flexible tube into your uterus 6. Apply gentle suction to the other end of the tube to remove all of the pregnancy tissue. Toward the end of the procedure, you may feel a cramp that feels similar to a menstrual cramp in your uterus, as it is shrinking down to its usual size.
Most of the procedure time is spent preparing your body for the procedure. The suction portion only takes about a minute and the entire procedure takes around 15 to 20 minutes. After the procedure, you should remain resting for a few minutes. You will probably have some cramping and spotting.
We will provide you with a heat pack and a menstrual pad as well as juice and crackers. When you feel able, you may get dressed. Your health educator will then give you instructions on how to take care of your body. The doctor will give you antibiotics and a prescription for birth control if you desire it.
You will have arranged ahead of time to have someone drive you home.
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