Women's decision making regarding choice of second trimester termination method for pregnancy complications

To describe how women terminating a pregnancy for fetal or maternal complications decide between surgical (dilation and evacuation [D&E]) and medical abortion.

A qualitative study was conducted among women who underwent D&E or medical abortion before 24 weeks of gestation for fetal anomalies or pregnancy complications at an academic medical center where both methods are offered. Women were interviewed by phone 1 week after the procedure about their counseling experiences and reasons for choosing a particular method. Data were analyzed by 3 researchers using a grounded theory approach, and interviews were stopped upon thematic saturation.

Of the 21 women, 13 (62%) chose D&E and 8 (38%) chose medical abortion. Key themes that emerged from the interviews were valuing the ability to choose the method, and the importance of religious beliefs, abortion attitudes, and emotional coping style. Women's preferences for a method were largely based on their individual emotional coping styles.

Decisions to undergo D&E or medical abortion are highly personal and could affect how women recover after ending a desired pregnancy. Women should be offered counseling about and access to both methods. Understanding these decision processes may help when counseling women faced with these diagnoses and decisions.