背景:美国最高法院在Dobbs诉Jackson妇女卫生组织案中推翻了联邦堕胎保护。美国东南部的许多州都采取了限制性政策,限制了堕胎护理并将其定为犯罪。
目的:描述堕胎限制对多布斯后美国东南部母胎医学医师(MFMs)的影响。
方法:我们进行了定性,2023年2月至6月期间,对东南10个州的35个MFM进行了半结构化采访。我们的招聘策略依赖于便利和滚雪球抽样。使用Dedoose软件和结合演绎和归纳方法的描述性定性方法分析了录音访谈。
结果:确定了紧急主题,并根据总体主题制定了概念框架。我们发现多布斯之后的堕胎法和外部约束导致了道德,专业,以及MFM面临的法律挑战导致临床实践的变化和以患者为中心的护理的偏差。这些被迫的变化导致对MFM的负面影响,如增加的恐惧,高度警惕,这些变化也引发了人们对患者健康风险和负面情绪影响的担忧。支持的同事们,医院系统,政策与减少压力有关,情绪困扰,以及医疗保健服务的中断。
结论:美国东南部的堕胎限制限制了MFM在胎儿异常和孕产妇健康风险的情况下提供或促进堕胎的能力。MFM认为这些限制会对自己产生负面的职业和情感影响,以及对患者的负面影响。支持性的同事以及医院系统和部门关于如何解释法律的明确指导是保护性的。我们的发现对该地区的MFM劳动力和患者护理具有重要意义。
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.
This study aimed to characterize the effect of abortion restrictions on maternal-fetal medicine physicians in the Southeastern United States after the Dobbs decision.
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.
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.
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.