Original research articleWomen's experiences with doula support during first-trimester surgical abortion: a qualitative study☆,☆☆
Introduction
Doulas are lay health workers traditionally trained to support women in labor [1]. During labor and delivery, doulas provide both verbal support (e.g., verbal guidance, relaxation techniques) and physical support (e.g., hand-holding, massage). Doula support is used in 3% of US deliveries and is associated with improved pain management, shorter labor, and decreased cesarean delivery rates [1], [2]. More recently, doula support has expanded to other reproductive contexts, including miscarriage, adoption, and abortion. The use of doulas in abortion care has only recently been studied [3].
During surgical abortion, doulas adapt techniques used in labor and delivery [3], [4]. Doula support may be especially relevant to women presenting for first-trimester surgical abortion, as many receive local anesthesia and are awake during the procedure [5]. A randomized controlled trial conducted in a clinic that uses local anesthesia and that does not routinely allow support people to be present during procedures found that, though doula support did not improve pain or satisfaction with first-trimester surgical abortion, 96% of women who received doula support recommended that it be routinely offered and 72% of women who did not receive doula support would have liked to have received it [3]. Despite negative findings, therefore, women did value doula support. This qualitative study explores why women in this clinic endorsed doula support, despite not experiencing measurable improvements in pain or satisfaction.
Section snippets
Materials and methods
This study took place in a high-volume, urban, first-trimester surgical abortion clinic between May and July 2014. The clinic has incorporated doulas into first-trimester abortion care. Doulas in this setting have completed a 2-day training session and undergone proctoring and have been deemed ready to function independently in the clinic [3]. Doula training consisted of a 2-day course conducted by a family planning fellowship-trained obstetrician–gynecologist (JC) and two doula trainers with 5
Study recruitment and demographics
During the study period, 1144 women aged 18 years or older obtained a first-trimester surgical abortion. Anticipating potential challenges in reaching participants by phone, we approached 191 women over 10 clinic sessions to obtain consent to be contacted for phone interviews. A total of 144 women provided consent to be contacted by phone: 36 declined to provide consent, and 11 did not meet eligibility criteria. We completed interviews with 30 women, at which point the interviews reached
Discussion
Doula support at the time of abortion is a relatively new concept. Whereas a large body of evidence demonstrates benefits of doula support during labor and delivery, research is lacking on the impact of doula support during abortion. This paper elucidates some of the ways doulas support women during abortions. Doulas provided company for women, who felt cared for, pleasantly distracted and soothed. While women did not perceive doula support as a solution to physical discomfort during abortion,
Acknowledgements
The authors would like to thank Kate Palmer for her role in developing and managing the abortion doula program.
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Funding: Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR000431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Presentation information: Presented at the American College of Obstetricians and Gynecologist's Annual Clinical Meeting, San Francisco, CA, May 2–6, 2015.