Doula support during first-trimester surgical abortion: a randomized controlled trial

Abstract

Objectives To evaluate the impact of doula support on first trimester abortion care. Study Design Women were randomized to receive doula support or routine care during first trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100-mm visual analog scale. The study had statistical power to detect 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Results Two hundred and fourteen women completed the study: 106 received doula support, 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6mm [±26.3mm] vs. 43.6mm [±25.9mm], p=0.18) or procedure completion (68.2mm [±28.0mm] vs. 70.6mm [±23.5mm], p=0.52). Procedure duration (3.39min [±2.83min] vs. 3.18min [±2.36min], p=0.55) and patient satisfaction (75.2mm [±28.6mm] vs. 74.6mm [±27.4mm], p=0.89) did not differ between doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (p<0.01). Conclusions Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support, therefore, may address patient psychosocial needs.

Women's experiences with doula support during first-trimester surgical abortion: a qualitative study

“…The clinic has incorporated doulas into first-trimester abortion care. Doulas in this setting have completed a two-day training session, undergone proctoring, and have been deemed ready to function independently in the clinic [3]. Doula training consisted of a two-day course conducted by a family planning fellowship-trained obstetrician-gynecologist (JC) and two doula trainers with 5 years of combined doula experience.…”

“…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].…”

“…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 it [3]. Despite negative findings, therefore, women did value doula support.…”

Factors influencing women's levels of satisfaction with first-trimester surgical abortion

“…Alternatively, perhaps the family member, spouse or friend was not as supportive as the women believed they would be, or in fact, the women realized they were getting better support from the clinic staff member assigned to be with them throughout the process. A recent randomized trial demonstrated that doula support during the procedure did not improve pain or satisfaction scores for women having a first-trimester surgical abortion [13]. In essence, it appears that a clinic staff member who is with the patient from start to finish has a greater impact on overall satisfaction than another person (e.g., doula or family member) who is present during the procedure.…”