National Partnership for Women & Families

Monthly Women's Health Research Review

Women Value Doula Care During Abortion Procedure, Study Finds

Summary of "Women's Experiences With Doula Support During First-Trimester Surgical Abortion: A Qualitative Study," Chor et al., Contraception, Oct. 16, 2015.

"Doulas are lay health workers traditionally trained to support women in labor" through verbal and physical support, according to Julie Chor of the Department of Obstetrics and Gynecology at the University of Chicago and colleagues. The researchers noted that while "[d]oula support is used in 3% of US deliveries and is associated with improved pain management, shorter labor, and decreased cesarean delivery rates," it recently "has expanded to other reproductive contexts, including miscarriage, adoption and abortion."

Chor and colleagues cited prior research showing that, while "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." The researchers wrote that their study "explores why women in this clinic endorsed doula support, despite not experiencing measurable improvements in pain or satisfaction."

Methods

The researchers conducted the study between May and July 2014 at "a high-volume, urban, first-trimester surgical abortion clinic" that incorporated trained doulas into its abortion care. "Five doulas provided support in the clinic during the study period, with a range of 3 months to 5 years of practice in providing abortion doula support," the researchers noted.

According to the researchers, doulas at the clinic met patients immediately before their abortions, provided support during the procedure and escorted them to a recovery area afterward. The doulas provided "verbal coaching, hand-holding, massage, breathing guidance and relaxation techniques" during the procedure.

"The clinic typically performs 15 to 30 first-trimester surgical abortions per daily clinic session," the authors noted. "Family members or support persons other than doulas [were] generally not allowed to be present during procedures," but on days when the doula volunteers were not available, staff members without doula training stood in. Doula or staff aid was optional.

The researchers recruited women at the clinic for their study based on criteria including over 18 years of age, gestational age less than 14 weeks, desiring pregnancy termination and able to provide informed consent." According to the researchers, participants "completed a short background survey prior to participating in a semistructured interview" on "how the presence or absence of doula support shaped their abortion experience." For the study, the researchers interviewed 30 women, including "19 participants [who] received doula support, and 11 participants [who] did not."

Results

Reasons Women Accepted or Declined Doula Support

The researchers identified "a number of factors that informed [a woman's] decision whether to accept doula support," including "wanting companionship during the procedure and being concerned about the procedure." According to the researchers, women who had support for their abortion decision from friends or family likened having a doula to having a family member in the room, while others who did not have social support for their abortion decision said a doula compensated for that absence.

Meanwhile, women said they declined doulas for "a sense of stoicism, desiring privacy and not wanting to add emotion" to the procedure. The researchers found that while "many ... were satisfied with their clinic experience, some who declined doula support expressed regret about not having a doula."

The researchers also found that the "few women [who were] familiar with doula support" accepted support based on "a positive perception of doula care" or rejected the support "due to a belief that doulas did not belong in abortion care."

Key Aspects of Doula Interaction

According to the researchers, "Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas." The researchers noted that while some "women compared doulas to loved ones, a few women explained that the anonymity of doula support created a welcomed safe space in which to experience the abortion." For example, one woman said the doula providing care for her during her abortion "'wasn't there to judge.'"

Further, the study found that "[m]any women valued the use of verbal support to distract and ease," such as breathing exercises, "continuous reassurance" and conversation on other topics. Several women also "praised doulas' provision of physical support, such as handholding and massage, which provided women with a greater sense of comfort and safety during their procedures."

Opinions of Expanding Doula Support in Abortion Care

"The vast majority of women responded positively when asked whether doulas might play additional roles during the abortion visit," the researchers wrote.

However, they noted that some "[w]omen regarded potential preprocedure interactions with doulas as an opportunity to address emotional needs, further clarify the procedure and connect prior to the procedure." For example, one woman said she would have appreciated the support she received during her abortion prior to the procedure, while "[s]everal women indicated that they would have appreciated speaking to doulas about what to expect during the procedure."

Meanwhile, some women "perceived the possibility of having postabortion discussions with doulas as an opportunity to explore specific health-related topics and receive additional emotional support." For example, some women "recognized a potential role for doulas as health educators and were interested in speaking with them about reproductive health topics," while others "would have liked to build on the connection formed during the abortion to discuss persistent psychosocial concerns." According to the researchers, "[a] few women were not interested in postabortion doula support, feeling that doulas lacked medical expertise or that they wanted to 'move on.'"

Discussion

"This paper elucidates some of the ways doulas support women during abortions," the researchers wrote, adding, "Doulas provided company for women, who felt cared for, pleasantly distracted and soothed." While women said doula support was not "a solution to physical discomfort during abortion," they did say it "helped them cope with" it.

According to the researchers, "this study underscores the importance of providing women support during their abortion experience." They suggested that "[d]eveloping a volunteer doula service [as] one approach to providing this needed support, especially for women who lack a support person, in low-resources settings with limited staffing and in settings that otherwise do not permit family or friends to be present during the procedure." The researchers also recommended "further vetting of the term doula, clarifying the role that doulas play during abortion and distinguishing doulas from other staff members." They concluded, "By adapting skills and practices from the labor and delivery setting, doulas addressed certain emotional and physical needs that, for some women, may not be fully addressed in fast-paced, high-volume abortion settings."