Maternity Healthcare Professionals’ Knowledge and Confidence Regarding Termination of Pregnancy Pathways

Maya Katz, Melissa Whitten, Sara Hillman

Objective:

One-third of women will access termination of pregnancy (TOP) services by the age of 45. A major barrier to accessing safe terminations in the UK is the lack of training and education opportunities offered to healthcare providers.

This work aimed to (1) explore the knowledge, awareness and confidence of healthcare professionals working in maternity services regarding TOP pathways of care; (2) identify areas of education and training need across the cohort to help inform ongoing development of training tools within the unit.

Design: A mixed methods cohort study conducted in a central London teaching hospital maternity service.

Method: A qualitative online survey consisting of 35 questions was distributed using an opportunity sampling approach to midwives and obstetricians working in the maternity unit within University College London Hospital during February-April 2022. Multiple choice and Likert scale questions were analysed using independent T-tests and two sample testing approach. A thematic analysis was undertaken for free text answers using an inductive approach to identify recurrent themes and any distinctions between the two groups.

Results:

We received 54 responses; 70.4% (n=38) from midwives and 29.6% from obstetricians (n=16). 72.2% of the cohort (n=39) had previously provided care to women undergoing TOP.

Obstetricians were significantly more confident than midwives in most areas of practice relating to pathways of care. Midwives working in a Fetal Medicine Unit environment were more knowledgeable and confident than midwives working in other areas of the maternity service.

Areas of knowledge and confidence identified to have the greatest training need included feticide, live birth following TOP, post-mortems and bereavement provisions. Knowledge regarding surgical TOPs was weak amongst midwives; they were significantly less confident in discussing surgical TOP pathways than medical TOP pathways (p=0.0015), and more confident discussing complications around medical TOPs than surgical TOPs (p=0.017). Obstetricians were significantly more confident than midwives (p=3.84x10^-6) in discussing surgical TOP pathways. Knowledge around feticide was significantly weaker amongst midwives (p= 0.00012).

 

Staff across both groups felt highly confident regarding referral of patients to bereavement midwifery support services. Practical experience with the bereavement midwives to consolidate knowledge and build confidence was identified as a training aspiration.

Conclusions:

Identification of training needs will help inform the design of a future training tools for HCPs around caring for women undergoing TOP. Training packages must ensure that they reflect the different training needs of the wider multiprofessional team.