Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

Abstract

Objective: To quantitatively and qualitatively describe specific barriers encountered by Maternal-Fetal Medicine (MFM) subspecialists to providing second-trimester termination by dilation and evacuation (D&E) using a mixed methods approach. Methods: We surveyed all members of the Society for Maternal-Fetal Medicine, and all faculty and fellows associated with MFM fellowships regarding practice characteristics and barriers to second-trimester termination. We categorized barrier responses into five categories: lack of training, logistical issues, negative culture, personal issues and no barriers. We compared respondent characteristics across barrier categories. We qualitatively analyzed barrier-related themes from respondents' comments using a grounded theory approach. Results: Of the 689 (32%) physicians who completed the survey, 591 (86%) reported at least one barrier to D&E provision. Main barriers among D&E providers (n=216) and D&E non-providers (N=473) differed, with providers reporting negative culture (37%) and logistical issues (33%) and non-providers reporting personal issues (36%) and lack of training (28%). Qualitative themes related to practice barriers paralleled the above categories. Conclusion: Addressing logistical barriers faced by D&E providers may streamline D&E services. Establishing routine D&E training in MFM fellowships is critical for supporting MFMs who wish to provide D&E. Collaborative partnerships with family planning subspecialists may facilitate this process.