Uterine evacuation as routine women's health care: The experience of the Residency Training Initiative in Miscarriage Management

Spontaneous abortion (SAB) is common and part of routine women's health care; it can be managed in the office setting by generalists, but is usually managed by specialists in the operating room under general anesthesia. Evidence supports offering women a choice of management options, including manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) was designed to train Family Medicine (FM) residents, faculty, and support staff in MVA for SAB and to normalize office-based uterine evacuation as routine primary care. The RTI-MM is multi-dimensional and theory-based. We sought to identify factors that facilitated normalization of MVA. Methods. Our process evaluation utilized program data and semi-structured interviews with 35 RTI-MM participants at 10 diverse FM residency sites in Washington State. Interviews focused on barriers and facilitators to implementation of MVA. Results. Our data revealed several themes: quality of care, abortion, and leadership. A desire to improve quality of care by offering patient-centered miscarriage services was a feature of normalizing MVA, as were clear policies about abortion services and clarifying the differences and similarities between abortion and miscarriage care. At a program level, stable leadership experienced in uterine evacuation was key to reducing staff discomfort with the procedure. A common barrier to normalization of MVA was discomfort interacting with patients experiencing miscarriage. Values about sexuality and discomfort with procedures prevented some sites from seeing MVA as within the scope of primary care. Conclusions. Exposure to MVA in the context of SAB may help normalize the procedure.