Elsevier

Contraception

Volume 93, Issue 3, March 2016, Pages 244-248
Contraception

Original research article
Women's experiences with doula support during first-trimester surgical abortion: a qualitative study,☆☆

https://doi.org/10.1016/j.contraception.2015.10.006Get rights and content

Abstract

Objective

To explore how doula support influences women's experiences with first-trimester surgical abortion.

Study Design

We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented.

Results

Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure.

Conclusion

Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postabortion informational and emotional needs.

Implications

In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that otherwise do not permit support people in the procedure room or for women who do not have a support person and desire one.

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.

References (6)

There are more references available in the full text version of this article.

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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.

☆☆

Presentation information: Presented at the American College of Obstetricians and Gynecologist's Annual Clinical Meeting, San Francisco, CA, May 2–6, 2015.

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