For this month’s Notes from the Field, we are sharing a patient experience from one of our Network members, Dr. E. Dr. E is a former RHAP fellow and member of the Mid-Atlantic Cluster who practices in the Delmarva area of Maryland, which is largely rural.
A few weeks ago, a 17-year-old female patient and her mother came to Dr. E for a follow-up visit for a medication abortion. The young woman was still experiencing bleeding and cramping three weeks after she took the abortion pills, and was becoming very anxious that the abortion “hadn’t worked.”
“She came to see me because the pain was so bad that she had missed school that day. She actually had to drive across state lines to New Jersey to get her medication abortion, so she wasn’t able to go back to that clinic – they told her to go to her primary care provider if she needed to have a follow-up appointment.” The nurse who checked the patient in came to Dr. E, worried that they wouldn’t be able to take care of her.
“Once I heard the situation, I told the nurse, ‘We got this! We’re okay!’ and the patient came in. She was very nervous, so we talked for a while before giving her a pregnancy test, which was negative. She got visibly calmer as I provided her reassurance that the abortion worked and that sometimes you can have some bleeding for a while. I offered her another dose of misoprostol to help decrease the bleeding, and then we talked about contraception. She told me she doesn’t want to get pregnant again, so we used the RHAP Birth Control Fact Sheet and went over every single method. She decided on the Depo Shot and I was able to prescribe it to her that day.”
For Dr. E, this experience further highlighted the importance of pushing for access to medication abortion in her clinical setting. “Because of where she lives, the closest in-state clinic was a Planned Parenthood, where she would have had to wait two weeks, making her ineligible for the medication abortion. Instead, she drove to another state, which speaks to the importance of having local providers who are available and able to offer these services right in our community.” As an added bonus, her patient was able to receive treatment in her primary care clinic, rather than in the Emergency Department (where many patients with bleeding tend to go).
Dr. E shared that this patient’s story reminded her of why she appreciates the training she received in the Fellowship, and how it’s helping her now as a family physician in a rural community health center. “When she presented, before I even spoke to her and I heard what was happening, I had a moment where I was like ‘Oh! I know what this is and I know how to manage it right now!’” The Reproductive Health Care and Advocacy Fellowship trained Dr. E to be able to offer patient-centered, full-spectrum reproductive health care as part of her family medicine practice. “They left with smiles on their faces, reassured that everything was okay… it was really rewarding and reminded me of why I do this type of care.”