The option to look: patient-centred pregnancy tissue viewing at independent abortion clinics in the United States

Abstract

Abortion providers' approaches to patient-centred pregnancy tissue viewing (PCV)when a patient requests to see their products of conceptionis understudied in abortion care. This mixed-method study aimed to identify: (1) if, when, and how PCV is facilitated at US independent abortion clinics; (2) how staff are trained to offer viewing; and (3) provider experiences facilitating PCV. We surveyed administrators from 22 independent abortion clinics affiliated with the Abortion Care Network about their PCV practices and then completed in-depth semi-structured interviews with 25 providers to better understand their experiences facilitating PCV. Results indicate that most of the clinics that provide PCV do so by patient request. A variety of providers facilitate viewing, including counsellors, educators, physicians, nurses, and medical assistants. Timing, viewing location, and staff training vary by facility. Benefits of and barriers to PCV emerged through three themes: (1) patient-centred care;(2) misinformation about fetal tissue; and (3) personal navigations as providers. Providers and administrators report PCV aligns with their patient-centred clinic missions and offers patients opportunities for choice, closure, and access to information. Yet, anti-abortion misinformation about fetal tissue impacts the ways providers must navigate complex conversations about PCV professionally and personally. Clinic resources and concern about adverse patient reactions to identifiable fetal parts present barriers to offering viewing. Understanding providers' experiences and approaches to PCV is an important first step to developing quality practices that can be shared across clinics. The findings of this study support the need for more research and training on PCV in abortion care.

Abortion providers help their clients and themselves when they talk about the fetus

“…Patients may ask to see their tissue after surgical abortion, but we do not know how, when, and why these requests occur, how clinicians respond, and if or how providers facilitate patientcentered pregnancy tissue viewing (PCV)." 3 Talking about the fetus requires confronting intense cultural prohibitions associated with "the stopping of a beating heart", social/political debates about "personhood", and the difference between a fetus and a viable human baby. Talking about the fetus, and viewing fetal remains, entails facing the bloody, gory parts of abortionsomething providers fear will draw anti-abortion fire, particularly towards providers.…”

“… “Seeing pregnancy tissue is a daily experience for abortion providers, but it is seldom discussed outside clinic walls. Patients may ask to see their tissue after surgical abortion, but we do not know how, when, and why these requests occur, how clinicians respond, and if or how providers facilitate patient-centered pregnancy tissue viewing (PCV).” 3 …”

“… 5 Hann and Becker have made the sobering point that much of how we think about the fetus – its shape, size, and features – has been shaped by these anti-abortion tactics. 3 A widespread diminished collective capacity for nuanced reflection and discussion about the significance of fetal life to society may be a troubling consequence.…”

“…One important example is the growing practice of patient-centred tissue viewing (PCV) described by Hann and Becker in this journal. 3 As the authors emphasise, accurate information about the fetus and opportunities for sharing in the viewing of fetal remains can lessen the impacts of internalised abortion stigma for both patient and provider. Additionally, by engaging directly with one of the most uncomfortable realities of abortion, the experience of viewing and responding to fetal remains in this highly intimate and emotion-saturated situation contributes to increased tolerance for painful and often contradictory emotions, capacity for mourning, and resilience of both patient and provider.…”

“…Among Hann and Becker’s conclusions is the possibility that PCV and related practices are necessary correctives for the highly negative psychological impacts on providers and their teams associated with pervasive public misinformation about the fetus and powerful injunctions against talking about the fetus and fetal remains. 3 These injunctions, by producing significant areas of avoidance and disjuncture in communication, interfere with building safe environments conducive to sharing and learning in our clinics.…”