Reflections on the BSACP/RSM 2021 Online Conference on ‘Abortion Care: Ensuring Excellence, Promoting Wellbeing and Improving Training’, 7 October 2021

28 November 2021

The British Society of Abortion Care Providers (BSACP) held its annual conference online for the second year in succession, and once again succeeded in attracting a broad range of health care professionals to listen to and learn from the knowledgeable invited speakers and the free communication presentations given by some of the discipline’s more junior researchers and clinicians.  So as to give a wider-ranging impression of the conference’s themes, three attendees were invited to submit short articles summarising what for them were the highlights of this year’s event.

 

In the face of considerable adversity, it has been a year of remarkable achievement by British abortion care providers, and the BSACP/RSM 2021 annual conference met to mark that achievement, and discuss the many elements necessary for the sector to continue to provide abortion care.  As Jonathan Lord, Co-Chair of BSACP, noted in his welcome, telemedicine as the primary modality for early abortion has moved from being an aspiration of providers to a reality, and papers published by BSACP members on the continuing viability and benefits of the use of telemedicine in early medical abortion are attracting international attention (three recent examples being the articles available at https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16668, https://srh.bmj.com/content/47/4/261 and https://srh.bmj.com/content/47/4/246).  Particular congratulations were in order for the British Pregnancy Advisory Service (BPAS) telemedicine team, who a few days earlier had won the British Medical Journal (BMJ) Women’s Health Team of the Year award.

Beyond this achievement lies the success of all members in keeping services open in difficult times, some members being not only clinicians but also lobbyists in hostile political climates.  Even with the exceptional commitment of service care providers, the pressures of the past 18 months on the wellbeing of service care providers has been considerable, so this conference focused on three goals: ensuring that excellence continues, promoting the wellbeing of members, and improving training to ensure that abortion care continues to attract committed clinicians.

The first two sessions therefore focused on training the next generation of healthcare students. Jayne Kavanagh, Associate Clinical Professor in Medical Education, University College London Medical School, and Corrina Horan reported on their inquiry into the extent to which medical schools teach abortion care to their students, and the striking disparities between schools in the amount of teaching of abortion in the general medical curriculum.  They found that even amongst those students who were specialising in other fields, those students recognised that they would frequently be encountering women who needed abortions or had recently had abortions, given the numbers of women who seek abortions each year, and so at least a basic understanding of procedures was needed.  Focusing on building up the next generation of conscientious committed doctors and nurses in abortion sector, Rebecca McKay then reported on the creation of the new BSACP/FSRH Special Skills Module in Abortion Care.

Several lectures explored how to ensure the wellbeing and caring for colleagues, in order to be able to provide the best care for service users. Helen Garr, Medical Director Designate at NHS Practitioner Health, spoke of the multiple ways those leading teams could take time to ‘check in’ about the mental wellbeing of the entire team. She urged each clinician to ‘check in’ with themselves, and not believe that they should hide feelings of stress because it might drag down the team, but openly discuss these feelings.  Laura MacIsaac, Professor and Associate Director of Fellowship in Complex Family Planning, New York, spoke of the idea of kindness as something to embrace, describing her team’s experiences of providing abortion care in New York in the midst of COVID-19 lockdown and in an increasingly hostile political climate.

Both Jonathan Lord and Patricia Lohr focused on how kindness and care could be placed at the centre of the patient experience.  Jonathan looked at how to ensure the best pain relief for minor gynaecological procedures, an issue which hit the headlines earlier this year when women described inadequate pain relief and unhelpful clinician attitudes when having intrauterine devices (IUDs) fitted.  His answer, to “be obsessive about being patient-centred”, struck a chord with many online when it was tweeted.  Patricia questioned the received wisdom about the necessity of an ultrasound scan before early medical abortion, drawing on research gathered during the period of telemedicine abortions which suggests that a routine scan is an unnecessary and possibly unkind inconvenience for the service user.

Ailish McEntee, MSI UK Named Midwife for Safeguarding Adults and Children, and Elizabeth Chloe Romanis, Assistant Professor at Durham Law School, tackled how to ensure safeguarding in telemedical early medical abortion, one of the most contentious issues to arise in the debate over abortion reform.  They brought an interdisciplinary mix of practical midwifery experience and academic legal knowledge to demonstrate that concerns about safeguarding in telemedicine ignored the reality that people in need of safeguarding often felt more comfortable expressing this over the telephone than face to face in clinic, and fed into a wider unhelpful perception of those seeking abortion as vulnerable and incapable.

In order to practise what was preached about wellbeing, in the morning and afternoon breaks between sessions attendees were led through a series of stretches which could be done in the workplace by Charlotte Gatenby, something much appreciated by those of us who have become locked to our desks during the pandemic on Zoom calls. Annette Schlaudraff suggested simple mindfulness exercises which could be worked into even a busy shift.

The free communication presentations demonstrated the range of research being carried out to capture different element of the patient’s abortion experience.  It was agreed that an over-representation of Scottish colleagues in the free communication presentations was reflective of the excellent research originating from the Chalmers Centre and Edinburgh rather than partisanship on the part of the judges!

Lesley Hoggart provided an invaluable summary of much of the research which has been conducted on telemedicine termination of pregnancy, including that by BSACP members, and looked forward to a future of which we cannot yet be certain, but where it seems hopeful that telemedicine, where appropriate, will become established as a routine part of abortion care.  Positive clinical innovation needs to be accompanied by societal change, and so Lesley announced the creation, together with Jayne Kavanagh, of a new charity, Abortion Talk (https://www.abortiontalk.com).  This new initiative will address the dominance of anti-choice telephone helplines by providing a pro-choice service for women to ring to seek information about abortion or to discuss their thoughts and feelings.  Abortion Talk also delivers workshops to abortion providers and facilitators, and works with stakeholder organisations to raise awareness of abortion stigma and the value of talking about abortion.

The conference generated a truly collaborative atmosphere which focused on the need to ensure the wellbeing of providers and patients alike. Predicting what further changes may occur in the medical landscape before the next conference is perhaps a near impossible task but the conference showed that there is a dedicated group of clinicians and others who are ready to take on all challenges in order to ensure that all service users have access to the highest quality of abortion care.

Charlotte Kelly, Patient and Public Involvement Representative on BSACP Council

 

Today I attended my first BSACP virtual conference on ‘Abortion Care – Ensuring Excellence, Promoting Wellbeing and Improving Training’.  It is fantastic that BSACP as have adapted so well since the COVID-19 pandemic hit and have smoothly run this virtual event.

As a Specialist Nurse working in abortion care I found this conference really thought-provoking as providing high-quality, evidence-based practice is something that is very important to me.  This is a great way to help abortion care nurses provide the best quality and up-to-date care as there were a range of presentations from highly regarded clinicians.

Often change can be difficult.  Indeed, in abortion care there have been significant changes in the last 2 years due to COVID-19 and the introduction of telemedicine abortion.  Listening to others’ experiences and research findings helps implement change as we can see the benefits, or indeed things that have not worked quite so well.  When clinicians share their knowledge, other clinicians can reap the benefits.

As telemedicine is so new and has been implemented in my area of work in the last 17 months or so, hearing about others’ positive experiences in this domain was reassuring.  It was particularly interesting looking at aspects of safeguarding and telemedicine – research has shown that there is little difference between disclosures made in this way or face to face.  This is something that I personally have been anxious about in the past, but listening to the speakers today has helped to ease these worries and reinforces the times when it isn’t appropriate for non-touch telemedicine abortion and the importance of individualised clinician assessment.  Telemedicine can also be beneficial to those in abusive relationships as they may not be able to leave their home to attend an appointment safely.

As discussed at the conference by Dr Rebecca McKay, I am excited about developing my knowledge base further by enrolling on the Special Skills Module in abortion care.  This will be useful to anyone who is involved in abortion care and will be a recognisable and transferable qualification.  This will be a great new way of helping to train new staff in standardised abortion care.  This is also an excellent way to build upon existing theory and skills for nurses already working in abortion care.

In the free communications session, an interesting piece of research by Angharad Dixon demonstrated the lower uptake of long-acting contraceptive devices post-abortion, particularly since COVID-19. This surprised me as termination of pregnancy rates have recently escalated and it is not as easy to have a long-acting contraceptive device fitted by a general practitioner currently.  Hopefully there will be further work into why this is happening and how to combat this.

Additionally, within the workplace it certainly feels like the abortion rate has increased since the start of the COVID-19 pandemic.  Researchers from Scotland have been looking at the rates of women having more than one termination, and as expected these rates have escalated.  It would be really interesting to do some qualitative research into why this is happening, and what we can do to help prevent women from finding themselves in this situation.

Another particularly useful presentation was given by Dr Jayne Kavanagh who explained about the ‘Abortion Talk’ service.  This is a confidential telephone service to support anyone affected by abortion, including patients and staff.  I was not aware of this service and I feel this will be useful for women to help them come to terms with what is often a difficult decision concerning abortion.  This is a service that I will certainly mention to those who need extra support.

Burnout is certainly seen within hospitals due to ever increasing pressures, especially since the pandemic.  It was refreshing and enlightening to listen to a talk about the clinician’s wellbeing and the ways in which we can manage this and help build up our resilience.  I plan to introduce the ‘Three Good Things’ intervention within our workplace to help empower our hardworking nursing team.

Going forward I will certainly be encouraging other members of the nursing team to attend future BSACP conferences, and indeed I look forward to attending future events myself.  The benefits to our unit are paramount, and also our experiences can help to shape other units too so that we can all give the best possible care to our patients.

Many thanks to those who played a part in making this superb conference happen.  It was obvious that considerable efforts were put into the selection of presentations and the planning of the conference overall.

Nicola Cash, Emergency Gynaecology Specialist Nurse, Emergency Gynaecology Assessment Unit (EGAU), North West Anglia NHS Trust, Peterborough City Hospital, Peterborough, UK

 

This year’s BSACP conference on ‘Abortion Care: Ensuring Excellence, Promoting Wellbeing and Improving Training’ was a refreshing collective of knowledge and insight focusing on caring for the wellbeing of those having abortions and abortion providers alike.  There was an engaging array of speakers covering aspects of wellbeing which were refreshingly relatable and tangible to real life.  The break-time sessions for mindfulness and body stretching were a greatly appreciated intervention; SRH doctors proving themselves to be multitalented once again! (I certainly think Dr Charlotte Gatenby, CSRH Trainee, has the raw talent and skills to be a fitness instructor – although we wouldn’t want her to give up the day job!).

During the day, we heard plenty about the importance of self-care, and ideas for techniques that can help both individuals and teams to improve their resilience in the face of challenge.  In the spirit of the morale-boosting ‘Three Good Things’ technique, highlighted by Dr Laura Maclsaac in her insights from across the pond, I would like to share my highlights from the day.

Good Thing #1

I was quite shocked (but sadly not surprised) to hear of the almost complete lack of abortion teaching as part of the curriculum in many UK medical schools; a measly average of fewer than 2 hours from freshers to graduation.  I spent more cumulative time making beans on toast in my medical school days! Interestingly, the research by Dr Jayne Kavanagh and Dr Corrina Horan found that medical students report that they want and value abortion teaching.  Our attention was also drawn to the excellent free teaching resources from the Royal College of Obstetricians and Gynaecologists (RCOG) and Doctors for Choice.  I personally feel I can particularly engage with the notion of ‘conscientious commitment’ to abortion care: two words which nicely encompass what abortion care means to me, and a much-needed term to legitimise a positive stance on the conversation around the spectrum of involvement in abortion care.

Good Thing #2

Mr Jonathan Lord’s presentation on analgesia for gynaecological procedures was a timely, honest and informative review of the ‘hot topic’ which has been receiving a lot of air time of late.  We were reminded of how the basics can often go a long way to making a procedure, such as an IUD insertion, a much more pleasant experience for our patients.  ‘Vocal local’ is a particular favourite technique of mine; after all, who doesn’t want to chat about holidays and the weather.

Good Thing #3

Dr Elizabeth Chloe Romanis’ session on safeguarding in the world of telemedicine was a really eloquently communicated argument for the advantages of remote care, to counteract some of the opposing views on this contentious subject.  Her presentation highlighted to me the utmost importance of individualised care: there is no ‘one-size-fits-all’.  I was enthused by her passion and advocacy for the subject, and reflected in particular on the important point she made regarding the need to move away from the assumption that those accessing abortion care must be vulnerable by default – a timely reminder that abortion is a routine and normal part of healthcare.

Overall, the day was a thought-provoking and refreshing look at some of the often neglected aspects of abortion care – a real success (and not a technical glitch in sight!).

Emma Lincoln, ST4 Community Sexual & Reproductive Healthcare (CSRH) Trainee, Cambridgeshire Community Service, Cambridge, UK