Sophie Eyraud
Speeches:
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For the doctor
Sophie Eyraud, MD; Sophie Gaudu, MD, seyraud@wanadoo.fr
Hôpital Antoine Béclère, Centre de régulation des naissances, Clamart, France
The doctor must make sure it is the best solution and the right time for the patient, not
only from a medical, but also from a psychological point of view.
Therefore we should check :
- The intra-uterine location of the pregnancy
- The length of the pregnancy
- The advisability of the treatment
- The treatment of pain
We also must be able to weigh the advantages and disadvantages in terms of the patient’s
perceptions :
Women tend to see the method as less agresive given the absence of surgical intervention
and the possibility to „do their own abortion“ in a familiar environment.
The fact that it takes place rather early in the pregnancy also makes it safer.
But it requires for the woman undergoing the abortion to be actively involved.
We must explain carefully that, unlike aspiration, the procedure takes place over several
days and is statistically less efficient (the failure rate is approximately 2-3%).
As long as the doctor is assured that the method is medically and psychologically
appropriate, medical abortion makes an excellent option for a well-informed woman. -
Medical abortion in the private practice, the French compromise
Sophie Eyraud, MD; Sophie Gaudu, MD
Hôpital Antoine Béclère, Centre de régulation des naissances, Clamart, France
In France, women who decide to get an abortion have been able to access the abortion pill
through their regular doctor outside the hospital context since November 2004.
Under the new French legislation, which only covers abortions in the first 49 days of
pregnancy, a contract must be signed between the doctor and a referral hospital which
agrees to address any complications that may arise. In one sense, this method may seem
to involve excessive supervision: first because many visits are required and second
because the drugs must be taken in the presence of the doctor. But allowing physicians to
practice non-surgical abortions considerably increases the number of doctors available for
the procedure. This law renders abortion more accessible to French patients and for that
reason we see it as a major advance for women's right to choose.
Immediately following the passing of these new measures, we organized a network
between hospitals and doctors working outside of hospitals in order to foster the practice
of non-surgical abortion. The network REVHO* was funded by the Ile de France region’s
public health care system and its activities included training doctors and evaluating the
quality of the care and the satisfaction of patients and health care professionals.
We report the first year's results here:
- In 2005 the network included 59 physicians (primary care and gynecologists) and 7
hospitals.
- 2503 women interrupted a pregnancy with the help of a doctor belonging to the network.
- No serious complication arose.
- The average duration of pregnancy was 6 weeks.
- The average age of the patients was 29 years.
- The success of the method (defined as the absence of a need for surgical intervention)
was 98%.
- Mild complications included:- progressive pregnancy (0.7%)
- full retention of the egg (1.2%)
- significant hemorrhages (0.7%)
- partial retention of the ovular products (2.5%),
The experience of the REVHO network successfully created close linkage between
doctors working in the city and the hospital, thus encouraging the development of the
procedure with the full support of professionals and great satisfaction of the patients .
According to this initial evaluation, the introduction of non surgical abortion outside the
hospital appears to be both safe and efficient.
* REVHO : Réseau Entre la Ville et l’Hôpital pour l’Orthogénie (network between the city
and the hospital for family planning) -
The health system modernization law in 2016 allows the practice of instrumental TOP without general anesthesia in primary care centers subject to partnership agreement with a hospital. The aim is to diversify the care offer and facilitate abortion access for women : proximity, rapidity, and real ability for women to choose the method. The Regional Heath Agency (Ile de France) has commissioned REVHO to assess the feasibility and to assist primary care centers in this practice. We have developed tools and training for medical practitioners and for the staff. Five pilot primary care centers were interested and eligible. Two years have been necessary for implementing the law providing for reimbursement of such practice by French social security (February 2018) and administrative constraints have delayed the beginning of this new practice outside the hospital. Last June, the first three surgical abortions were performed in Aubervilliers with great success and women’s satisfaction. As for any new practice, it will take several years before a generalized implementation with possible extension to other structures and other professionals