Experiences of Perinatal Personnel With Values Clarification Workshops About Abortion

Hospital-based labor and delivery (L&D) units have clinical expertise to provide second-trimester induction abortion and can help ensure patient access to abortion as legal and systematic barriers shift the US care landscape. However, hospitals may be reluctant to expand abortion services because of concerns regarding staff acceptance, stigma, and workforce readiness; understanding perinatal personnel's experiences with a structured values clarification and attitude transformation (VCAT) workshop can inform efforts to prepare L&D teams for abortion services implementation.

To explore perinatal personnel's experiences with a VCAT workshop on abortion perspectives and professional responsibilities before implementation of second-trimester induction abortion services in a L&D unit.

In this qualitative study, VCAT workshops about abortion were provided to 174 perinatal health care personnel at an urban community-based hospital in California from July 1 to October 31, 2023, before implementation of second-trimester induction abortion services. After the workshops, 25 participants, including nurses, physicians, and midwives, were interviewed between November and December 2023. Data analysis was performed from July 2024 to January 2025.

A single, 1-hour VCAT workshop that used a virtual adaptation of the Four Corners exercise, which is a previously published VCAT method that prompts participants to reflect on and represent a spectrum of abortion viewpoints.

Perceptions of perinatal personnel regarding abortion care and their experience with a VCAT workshop about abortion.

Ten workshops were conducted with 174 perinatal personnel (137 nurses and staff, 19 certified nurse midwives, and 18 obstetrician-gynecologists), with a median of 17 attendees (range, 4-36). Four major themes in perinatal personnel's experiences with the VCAT workshop were identified: (1) personal and professional contexts, such as personal abortion experiences, workplace stress, and influence of increasing national abortion restrictions on how participants experienced the workshop; (2) promotion of personal reflection and perspective-taking, where participants described how representing others' views deepened their understanding of their own beliefs, challenged assumptions about colleagues, and fostered empathy; (3) reflection on professional responsibilities and the role of L&D in abortion care, with some viewing abortion care as outside the scope of L&D services and others seeing it as another way to provide inclusive, compassionate care to pregnant people; and (4) reinforcement of respect for autonomy as a core shared value, even among those with differing personal beliefs.

This qualitative study of perinatal care personnel preparing to implement induction abortion services in the L&D unit found that VCAT workshops provided structured opportunities for perinatal personnel to reflect on the complex personal and professional dimensions of abortion care. These findings suggest VCAT workshops may support multidisciplinary perinatal teams in implementation of second-trimester induction abortion services with empathy, professionalism, and cohesion.