Self-management of first trimester medical termination of pregnancy: a qualitative study of women's experiences

BJOG. 2017 Dec;124(13):2001-2008. doi: 10.1111/1471-0528.14690. Epub 2017 Jun 14.


Objective: To explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic.

Design: Qualitative interview study.

Setting: One National Health Service health board (administrative) area in Scotland.

Population or sample: Women in Scotland who had undergone medical TOP ≤63 days, and self-managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014.

Methods: In-depth, semi-structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method.

Main outcome measures: Women's experiences of self-management of TOP ≤63 days of gestation.

Results: Key themes emerging from the analysis related to self-administration of misoprostol in clinic; reasons for choosing home self-management; facilitation of self-management and expectation-setting; experiences of getting home; self-managing and monitoring treatment progress; support for self-management (in person and remotely); and pregnancy self-testing to confirm completion.

Conclusions: Participants primarily found self-administration of misoprostol and home self-management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self-management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol.

Tweetable abstract: Women undergoing medical TOP 63 days found home self-management to be acceptable and/or preferable.

Keywords: First trimester medical/medication abortion; home self-management; qualitative research; termination of pregnancy; women's experiences.

MeSH terms

  • Abortifacient Agents, Steroidal / administration & dosage*
  • Abortion, Induced / methods*
  • Abortion, Induced / psychology*
  • Adult
  • Decision Making
  • Female
  • Humans
  • Mifepristone / administration & dosage*
  • Misoprostol / administration & dosage*
  • Nurse-Patient Relations
  • Pain Management
  • Patient Education as Topic
  • Patient Satisfaction / statistics & numerical data*
  • Pregnancy
  • Pregnancy Trimester, First
  • Qualitative Research
  • Scotland
  • Self Administration
  • Self-Management / psychology
  • Self-Management / statistics & numerical data*
  • Young Adult


  • Abortifacient Agents, Steroidal
  • Misoprostol
  • Mifepristone