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Filippa S, Jayaweera RT, Blanchard K, Grossman D. Do miscarriage care practice recommendations align with individuals' needs?: A scoping review. Contraception 2024; 136:110448. [PMID: 38588848 DOI: 10.1016/j.contraception.2024.110448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Miscarriage is a common occurrence; yet individuals often have negative experiences when receiving miscarriage care, signaling a gap in the quality of miscarriage care. We explore the literature on individuals' experiences with miscarriage care across a variety of dimensions and assess how these experiences align with practice recommendations. STUDY DESIGN We conducted a scoping review of peer-reviewed studies in PubMed published in English through April 30, 2022, and focused on individuals' experiences with miscarriage care in healthcare settings and on practice recommendations for providing care in a variety of countries. The search returned 1812 studies; after screening, 41 studies were included in the analysis. RESULTS Included studies reported on individuals' experiences with miscarriage care settings and accessibility, information provision, emotional support, decision-making and follow-up. Overall, individuals are often dissatisfied with their miscarriage care experiences. Practice recommendations are generally responsive to these issues. CONCLUSIONS Individuals experiencing miscarriage are best served by care that is patient-centered, involves shared decision-making, and addresses individuals' informational and emotional needs. However, the prevalence of individuals' negative experiences with miscarriage care points to the need to address key gaps in and improve the implementation of practice recommendations. IMPLICATIONS Future research should focus on documenting the miscarriage experiences of and developing relevant practice recommendations for communities that face the greatest barriers to care, generating evidence on the dimensions that constitute high-quality miscarriage care from patients' perspectives and assessing the barriers and facilitators to effectively implementing existing practice recommendations.
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Affiliation(s)
| | | | | | - Daniel Grossman
- Ibis Reproductive Health, Cambridge, MA, USA; Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA, USA
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Heggie C, Tong L, Heran A, Bhambhani I, McKibbon S, Paynter M. The role of doulas and community birth workers in abortion and contraception care: An international scoping review. Contraception 2024; 136:110482. [PMID: 38734230 DOI: 10.1016/j.contraception.2024.110482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Equitable and safe access to abortion and contraception is essential to protecting reproductive autonomy. Despite this, barriers to access remain. Nonclinical support people, may be able to facilitate access to abortion and contraception services and care, but evidence on the scope and efficacy of doulas in abortion and contraception care is lacking. The aim of this scoping review was to synthesize what is known about the role of doulas in abortion and contraception care. STUDY DESIGN We followed the Joanna Briggs Institute methodology for scoping reviews. A clinical librarian performed an initial search of all relevant databases. Three reviewers independently screened the titles and abstracts for assessment against the inclusion and exclusion criteria. The populations of interest included doulas, and/or untrained birth attendants and birth companions, and patients who use doula services. The concept of interest was the doula and the context was access to abortion or contraception. RESULTS Our review identified relevant studies conducted in different countries, published between 1976 and 2023. Studies broadly focused on three key themes: doulas performing procedural abortions, doulas supporting abortion care, and doulas supporting contraception. Outcomes of interest included client outcomes, barriers to access, doula training, and attitudes. CONCLUSIONS Doulas have the potential to improve client satisfaction and mitigate barriers to accessing abortion and contraception services. Further research is needed to identify the training needs of doulas, the potential for their integration into interdisciplinary care teams, and the role in supporting medication abortion.
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Affiliation(s)
- Clare Heggie
- University of New Brunswick Department of Interdisciplinary Studies, Fredericton, New Brunswick, Canada.
| | - Lin Tong
- University of New Brunswick Faculty of Nursing, Fredericton, New Brunswick, Canada
| | - Aishwarya Heran
- Department of Physiology, McGill University Faculty of Science, Montreal, Quebec, Canada
| | - Ishika Bhambhani
- University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shelley McKibbon
- Dalhousie University WK Kellogg Health Sciences Library, Halifax, Nova Scotia, Canada
| | - Martha Paynter
- University of New Brunswick Faculty of Nursing, Fredericton, New Brunswick, Canada
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Alvarado G, Schultz D, Malika N, Reed N. United States Doula Programs and Their Outcomes: A Scoping Review to Inform State-Level Policies. Womens Health Issues 2024; 34:350-360. [PMID: 38724343 DOI: 10.1016/j.whi.2024.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The field of maternal health has advanced significantly over the past decades. However, the United States continues to have poor outcomes in comparison with other industrialized nations. With emerging evidence on the promise of doula care, states are including doula care under their Medicaid programs. METHODS We conducted a scoping review across four academic databases and gray literature published between January 1, 2012, and March 10, 2022, to describe the landscape of literature on U.S. doula programs and their outcomes in order to inform state policy makers considering laws or programs related to doula care. FINDINGS Of 740 records identified, 100 met inclusion criteria. Outcomes fell into four areas: birthing people's outcomes, infant outcomes, systems of care and implementation, and cross-cutting issues. Data on outcomes related to doula care in the literature were predominantly clinical, even though doulas are not clinical providers. Although some studies have found associations between doula care and improved clinical outcomes for birthing people and infants, the evidence is limited due to small sample sizes, study methodology, or conflicting conclusions. Doula outcomes are underexplored in the literature, with mainly qualitative data describing low levels of diversity and equity within the doula workforce and ineffective payment models. When cost-effectiveness estimates have been calculated, they largely rely on savings realized from averted cesarean births, preterm births, and neonatal intensive care unit admissions. CONCLUSIONS As state Medicaid programs expand to include doula care, policymakers should be aware of the limitations in the evidence as they plan for successful implementation, such as the narrow focus on certain clinical outcomes to quantify cost savings and conflicting conclusions on the impact of doula care. An important consideration is the impact of the reimbursement rate on the adoption of doula care, which is why it is important to engage doulas in compensation determinations, as well as the development of improved metrics to untangle the components that contribute to maternal health outcomes in the United States.
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Seymour JW, Ruggiero S, Ranker L, Thompson TA. Experiences with and unmet needs for medication abortion support: A qualitative study with US abortion support providers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:116-123. [PMID: 38666706 DOI: 10.1111/psrh.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Quality abortion care must be person-centered. Although academic literature has focused on full-spectrum and abortion doulas supporting instrumentation abortion (also referred to as procedural abortion) clients, clients undergoing medication abortion remain understudied and may have unique needs. We aimed to understand United States (US) abortion support providers' perceptions of medication abortion clients' support needs by exploring which needs they address, which needs remain unmet, and how remote support provision might help address client needs. METHODOLOGY Between April and October 2018, we conducted 60- to 90-min semi-structured, in-depth interviews by telephone with medication abortion support providers. The interviews focused on their experiences providing support to medication abortion clients in the US. We used a deductive thematic analysis approach. RESULTS We interviewed 16 abortion support providers affiliated with nine US-based organizations. Six participants provided in-person support to medication abortion clients, five provided remote support, and five provided both remote and in-person support. Both in-person and remote providers described offering support that addressed clients' informational, emotional, physical, spiritual, and logistical needs. Through participant narratives, we identified interwoven benefits and challenges to remote support care provision. Participants highlighted that most medication abortion clients did not have a support provider. DISCUSSION Participants revealed that abortion support providers, including remote support providers, can be a critical component of high-quality abortion care provision. More work is needed to ensure all abortion clients have access to support services as the abortion landscape in the US continues to evolve.
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Affiliation(s)
- Jane W Seymour
- Collaborative for Reproductive Equity, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Lynsie Ranker
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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Conroy C, Jain T, Mody SK. Interest in peer support persons among patients experiencing early pregnancy loss. BMC Pregnancy Childbirth 2023; 23:506. [PMID: 37434154 DOI: 10.1186/s12884-023-05816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Limited data exist regarding the type of support patients need when experiencing early pregnancy loss (EPL). The objective of this study is to explore how patients emotionally cope with EPL and to assess if there is interest in a peer EPL support program with a self-compassion component. METHODS We conducted semi-structured interviews with patients who experienced EPL in the past two years. We evaluated the kinds of support that patients felt were most helpful, interest in a possible peer EPL support person, and suggestions for the creation of such a program. Content analysis was utilized to analyze the data and identify themes. RESULTS Twenty-one individuals participated in the study. Approximately 52.3% (n = 11) of interviewees reported expectant management of their EPL, 23.8% (n = 5) reported medication management, and 23.8% (n = 5) reported undergoing dilation and curettage. We identified five themes: (1) therapy and in-person support groups are helpful when experiencing EPL, but are sometimes inaccessible; (2) social media support groups are initially advantageous for creating a sense of solidarity, but in the long term can be triggering; (3) support from a peer who has also experienced EPL is uniquely valuable; (4) developing self-compassion is important in emotionally coping with EPL; and (5) there is a demand for emotional and informational support following EPL. CONCLUSIONS Given the unique support participants identified receiving from a peer with shared lived experience, there is interest in a peer EPL support program with a self-compassion component for emotional and informational support following EPL.
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Affiliation(s)
- Carmen Conroy
- School of Medicine, University of California at San Diego, San Diego, CA, USA
| | - Tanya Jain
- School of Medicine, University of California at San Diego, San Diego, CA, USA
| | - Sheila K Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Diego, 9300 Campus Point Dr. MC 7433, La Jolla, 92037, San Diego, CA, USA.
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Toutain T, Philip CA, Bollon L, Cros M, Fraissenon A, Dupont C, Gaucher L, Haesebaert J, Nohuz E, Cortet M. Surgical management of a loss of pregnancy in the first trimester: Patient experience and influencing factors, a prospective observational study. J Gynecol Obstet Hum Reprod 2023; 52:102602. [PMID: 37187317 DOI: 10.1016/j.jogoh.2023.102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Describe the "patient experience" regarding care provided during the surgical management of a loss of pregnancy in the first trimester and identify the factors influencing this experience. MATERIAL AND METHODS It is an observational prospective study conducted in two type III, academic, maternity wards in Lyon, France, carrying out 8,500 deliveries per year. Adult female patients, having undergone a suction curettage for a loss of pregnancy in the first trimester from 24 December 2020 to 13 June 2021 were inculded. The "patient experience" was assessed using the 15 questions of the Picker Patient Experience (PPE-15) questionnaire, and research was conducted on factors influencing the patient experience. The main outcome was the percentage of patients reporting a problem in response to at least one of the PPE-15 questions. RESULTS 58 out of 79 patients (73% CI [62-83]) reported at least one problem with their care. The largest proportion of problems was raised in question about "Opportunity for family/loved ones to talk to the doctor" (76% CI [61-87]). The lowest proportion of problems was raised in question about "Treated with respect and dignity" (8% CI [3-16]). No factors influencing the patient experience were identified. DISCUSSION Almost three out of four patients reported a problem in the experience as a patient. The main areas of improvement reported by patients were the participation of their family/relatives and the emotional support provided by the healthcare team. TWEETABLE ABSTRACT Better communication with patient families and emotional support could improve patient experience during the surgical management of a loss of pregnancy in the first trimester.
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Affiliation(s)
- T Toutain
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France
| | - C-A Philip
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France
| | - L Bollon
- Faculty of Maieutic, Lyon, France
| | - M Cros
- Faculty of Maieutic, Lyon, France
| | - A Fraissenon
- Mother and Child Radiology Department, North University Hospital, Saint Etienne 42000, France; Paediatric Imaging Department, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - C Dupont
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; AURORE Perinatal Network, Lyon 69004, France
| | - L Gaucher
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Midwifery Department, Geneva, Switzerland; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - J Haesebaert
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - E Nohuz
- Department of Obstetrics and Gynaecology, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - M Cortet
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France.
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Leahy-Warren P, Nieuwenhuijze M. Measuring women's empowerment during the perinatal period in high income countries: A scoping review of instruments used. Heliyon 2023; 9:e14591. [PMID: 37064454 PMCID: PMC10102201 DOI: 10.1016/j.heliyon.2023.e14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
Empowerment is acknowledged as a process facilitating those who are less powerful to be engaged in their problem identification, decision making and actions to gain control over their life. This is an important goal for women during the perinatal period in their transition to motherhood. A concept analysis of women's empowerment during the perinatal period found that psychological and social dimensions play a role in women's perinatal empowerment and identified several defining attributes. The aim of this study was to identify robust validated instruments that measure all the attributes of women's empowerment during the perinatal period. We did a scoping review of scientific literature following the methodology of the JBI Reviewer's Manual. We searched the database MEDLINE, CINAHL, PsycINFO, PsycARTICLES and SocINDEX and selected papers meeting the inclusion criteria. Instruments measuring empowerment or related concepts were identified in the selected papers. Two authors independently cross referenced the items of each instrument against the defining attributes for empowerment. Our search resulted in 9771 unique hits of which 36 papers were finally included. Studies were from various countries with a wide variety of aims, demographics of cohorts and timepoints across the perinatal period. Twenty-one different instruments were used to measure empowerment, of which 11 were validated among women during the perinatal period. However, no identified instrument was developed specifically for women during the perinatal period or included all the dimensions of empowerment and the defining attributes. There is a need for a theoretically sound valid and reliable instrument measuring all the dimensions of empowerment of women during the perinatal period. Once developed this instrument needs testing with a broad range of women. Results from such a study will inform the development of appropriate interventions that have a coherent theoretical basis and are empirically informed to enhance women's empowerment during the perinatal period.
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Affiliation(s)
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Academie Verloskunde Maastricht, Zuyd University, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
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Lindsey A, Narasimhan S, Sayyad A, Turner D, Mosley EA. " I can be pro-abortion and pro-birth": Opportunities and challenges for full spectrum care among doulas in Georgia. Front Glob Womens Health 2023; 4:966208. [PMID: 36937040 PMCID: PMC10014539 DOI: 10.3389/fgwh.2023.966208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/02/2023] [Indexed: 03/05/2023] Open
Abstract
Background The work of full spectrum doulas (i.e., non-medically trained care workers offering support before, during, and after pregnancy including abortion)-is increasingly important as abortion access decreases across the U.S. Few studies have examined the work of community-based doulas in restrictive abortion settings or how they might further incorporate full spectrum care. As part of the community-engaged mixed methods Georgia Doula Study, this analysis examines the scope of work of community-based doulas regarding full spectrum and abortion services, doula opinions on full spectrum and abortion work, and potential barriers and facilitators for full spectrum doula care in metro-Atlanta, Georgia. Methods From October 2020 to February 2022, the team recruited 20 community-based doulas with 8 who provide full spectrum services including abortion. Surveys covered demographics, doula scope of work, family planning attitudes, and abortion stigma. Survey data were analyzed using descriptive and bivariate statistics. In-depth interviews further explored those topics. They were de-identified and thematically analyzed using a semi-deductive approach. Results The findings are organized around five themes: (1) doulas of all kinds center reproductive autonomy; (2) abortion doulas play important roles in reproductive autonomy; (3) doulas have mixed feelings about contraceptive counseling; (4) abortion doulas provide diverse services carrying numerous benefits in a stigmatized environment; and (5) abortion doulas experience challenges including stigma but they offer solutions. All but two doulas in this study were interested in learning how to incorporate contraception and abortion services in their current scope of work, and most participants supported the role of full spectrum doulas. Conclusion This analysis highlights the experiences of abortion and full spectrum doulas, reactions of the larger doula community to those services, and facilitators and barriers to full spectrum doula care in a restrictive abortion setting. There are urgent needs and opportunities for full spectrum doulas to offer life-protecting services to pregnant people across the U.S. and globally. Coordination efforts for U.S. abortion care post-Roe v. Wade must include community-based doulas, who are largely open to aiding abortion clients through education, connection to care, and emotional support.
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Affiliation(s)
- Alyssa Lindsey
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Subasri Narasimhan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
| | - Ayeesha Sayyad
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Daria Turner
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Elizabeth A. Mosley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- The Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States
- Department of Health Policy and Behavioral Sciences, Georgia State University, Atlanta, GA, United States
- Division of General Internal Medicine, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Ho AL, Hernandez A, Robb JM, Zeszutek S, Luong S, Okada E, Kumar K. Spontaneous Miscarriage Management Experience: A Systematic Review. Cureus 2022; 14:e24269. [PMID: 35602780 PMCID: PMC9118363 DOI: 10.7759/cureus.24269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
Background: The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place. Methods: Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist. Results: The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage. Conclusion: Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.
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Qian J, Sun S, Wang M, Yu X. Nonpharmacological pain management interventions in medical and surgical abortion: A scoping review. Int J Nurs Pract 2022; 29:e13056. [PMID: 35373419 DOI: 10.1111/ijn.13056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022]
Abstract
AIMS The study aimed to present a broad overview of the research conducted and to synthesize evidence of the utility of nonpharmacological interventions for pain management in medical and surgical abortions. BACKGROUND High-quality care for medical and surgical abortion requires pain to be managed effectively. However, women reported low satisfaction with pain management in abortion care. DESIGN A scoping review design was employed. DATA SOURCES No date limit was set. PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL, PsycINFO, ProQuest and Scopus were searched in April 2021. REVIEW METHODS Arksey and O'Malley's framework was used. The Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews was followed. RESULTS Fifteen studies were included. The results revealed that support interventions, music therapy, acupoint stimulation and hypnotic analgesia were nonpharmacological interventions used to decrease abortion pain. CONCLUSIONS Clinical nurses, nurse managers and policymakers should attach full importance to the pain management in abortion and may use the study findings to guide the pain management practice.
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Affiliation(s)
- Jialu Qian
- Zhejiang University School of Medicine Hangzhou China
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University Hangzhou China
| | - Shiwen Sun
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University Hangzhou China
| | - Man Wang
- Zhejiang University School of Medicine Hangzhou China
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University Hangzhou China
| | - Xiaoyan Yu
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University Hangzhou China
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Chung JPW, Law TSM, Mak JSM, Liu RCY, Sahota DS, Li TC. Hyoscine butylbromide in pain reduction associated with ultrasound-guided manual vacuum aspiration: a randomized placebo-controlled trial. Reprod Biomed Online 2021; 44:295-303. [PMID: 34949538 DOI: 10.1016/j.rbmo.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION What is the effect of adding an anti-spasmodic drug to an existing ultrasound-guided manual vacuum aspiration (USG-MVA) protocol to alleviate immediate post-procedure abdominal cramping pain in women treated for early pregnancy loss? DESIGN Double-blind, placebo-controlled, randomized controlled trial conducted between February 2018 and January 2020. Participants were assigned to receive a 1-ml intravenous injection containing 20-mg hyoscine butylbromide (HBB) (n=55) or saline (n =56) as a control immediately before USG-MVA. Primary outcome was reduced abdominal pain after adding a 20-mg dose of HBB to the current pain control regimen. Secondary outcomes were vaginal pain, complications and side-effects, women's pre- and post-procedure psychological state, physiological stress (saliva alpha-amylase) and procedure pain control satisfaction. Two-way mixed ANOVA was used to evaluate the main effects and interactions. RESULTS VAS abdominal pain scores in the HBB group were 16% lower immediately after and 21% lower 2 h after surgery (not statistically significant). Two-way ANOVA indicated that time (F[1108] = 83.41, P < 0.001) was the only significant main effect for reduced abdominal pain after the procedure and vaginal pain score (F[1108] = 180.1, P < 0.0001) but not drug received. No adverse events were reported. No significant difference was found for psychological state, physiological stress and procedure pain control satisfaction between the two groups. CONCLUSIONS Anti-spasmodic drugs can help to reduce abdominal cramping pain associated with USG-MVA; HBB produced an insignificant decrease in abdominal pain score. Further studies with longer acting or larger doses of anti-spasmodic drugs are warranted.
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Affiliation(s)
- Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China.
| | - Tracy Sze Man Law
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China
| | - Jennifer Sze Man Mak
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China
| | - Rebecca Chui Yiu Liu
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China
| | - Tin Chiu Li
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories Hong Kong SAR, China
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Campbell E, Connor N, Heaney S, Bloomer F. Training abortion doulas in Northern Ireland: lessons from a COVID-19 context. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e17. [PMID: 34642208 DOI: 10.1136/bmjsrh-2021-201098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Suzie Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Coleraine, UK
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Altshuler AL, Ojanen-Goldsmith A, Blumenthal PD, Freedman LR. "Going through it together": Being accompanied by loved ones during birth and abortion. Soc Sci Med 2021; 284:114234. [PMID: 34303291 DOI: 10.1016/j.socscimed.2021.114234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022]
Abstract
We sought to understand the meaning people who have given birth and have had an abortion ascribe to being accompanied by partners, family members and friends during these reproductive experiences. Incorporating this knowledge into clinical practice may contribute to improving the quality of these services, especially in abortion care, in which loved ones are often excluded. The study took place in Northern California in 2014. We conducted semi-structured, intensive interviews with twenty cis-women about their birth and abortion experiences and analyzed their narratives with respect to accompaniment using grounded theory. The roles of loved ones were complementary yet distinct to those of medical personnel. They were also multifaceted. Participants needed familiar individuals to bear witness, share the emotional experience and provide protection from perceived or possible harm associated with medical care. In some cases, more often in the context of abortion than childbirth, participants shielded their loved ones from emotional burdens of the reproductive process. Some pregnant people of color faced gendered racism, which also influenced their accompaniment needs. Male partners played a distinct role of upholding dominant social ideals related to pregnancy. As is commonplace in birth-related care, abortion services could be formally structured to include partners, family members and friends when desired by pregnant people to improve their experiences. Such integration should be balanced with considerations for privacy, safety and institutional resources. Working toward this goal may reduce structural abortion stigma and help alleviate pregnant people's burdens associated with reproduction.
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Affiliation(s)
- Anna L Altshuler
- Obstetrician-Gynecologist, California Pacific Medical Center Research Institute, 475 Brannan St #220, San Francisco, CA, 94107, USA.
| | - Alison Ojanen-Goldsmith
- Full Spectrum Doula and Researcher, University of Washington Division of Family Planning, I-ACCESS, Planned Parenthood North Central States, USA.
| | - Paul D Blumenthal
- Professor of Obstetrics & Gynecology, Stanford University Medical Center, 300 Pasteur Dr. HG332, Stanford, CA, 94305, USA.
| | - Lori R Freedman
- Associate Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
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Filippi V, Dennis M, Calvert C, Tunçalp Ö, Ganatra B, Kim CR, Ronsmans C. Abortion metrics: a scoping review of abortion measures and indicators. BMJ Glob Health 2021; 6:bmjgh-2020-003813. [PMID: 33514592 PMCID: PMC7849886 DOI: 10.1136/bmjgh-2020-003813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022] Open
Abstract
Consensus is lacking on the most appropriate indicators to document progress in safe abortion at programmatic and country level. We conducted a scoping review to provide an extensive summary of abortion indicators used over 10 years (2008–2018) to inform the debate on how progress in the provision and access to abortion care can be best captured. Documents were identified in PubMed and Popline and supplemented by materials identified on major non-governmental organisation websites. We screened 1999 abstracts and seven additional relevant documents. Ultimately, we extracted information on 792 indicators from 142 documents. Using a conceptual framework developed inductively, we grouped indicators into seven domains (social and policy context, abortion access and availability, abortion prevalence and incidence, abortion care, abortion outcomes, abortion impact and characteristics of women) and 40 subdomains. Indicators of access and availability and of the provision of abortion care were the most common. Indicators of outcomes were fewer and focused on physical health, with few measures of psychological well-being and no measures of quality of life or functioning. Similarly, there were few indicators attempting to measure the context, including beliefs and social attitudes at the population level. Most indicators used special studies either in facilities or at population level. The list of indicators (in online supplemental appendix) is an extensive resource for the design of monitoring and evaluation plans of abortion programmes. The large number indicators, many specific to one source only and with similar concepts measured in a multitude of ways, suggest the need for standardisation.
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Affiliation(s)
- Veronique Filippi
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Mardieh Dennis
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Clara Calvert
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Bela Ganatra
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Caron Rahn Kim
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Carine Ronsmans
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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15
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Wang N, Allen J, Gamble J, Creedy DK. Nonpharmacological interventions to improve the psychological well-being of women accessing abortion services and their satisfaction with care: A systematic review. Nurs Health Sci 2020; 22:854-867. [PMID: 32986315 DOI: 10.1111/nhs.12779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
How women perceive and experience abortion impacts their subsequent psychological well-being. This systematic review evaluated nonpharmacological interventions designed to support women undergoing abortion services and improve their psychological well-being and satisfaction with care. Searches were conducted in MEDLINE, CINAHL, the Cochrane Library, PsycINFO, Sociological Abstracts, Social Services Abstracts, and PTSD Pubs. All searches were limited to peer-reviewed articles published in English from January 2010 to February 2020. Two reviewers independently assessed study eligibility. Ten studies were included, involving four types of interventions: music therapy; social support; information support; and mandated waiting and counseling requirements on abortion access. Outcome measures were divided into four categories comprised of cognitive domains, emotional and psychological well-being, clinical symptoms, and satisfaction with care. However, there is limited evidence on intervention effects. Most studies report null or mixed intervention effects. Even though some positive effects on women's cognitive outcomes and satisfaction with care were seen, findings across studies were inconclusive. Findings also show that methodological limitations such as lack of theoretical basis, inadequate reporting and no power sample size calculation were apparent across studies. There is limited evidence about nonpharmacological interventions designed to improve women's satisfaction with abortion services or psychological outcomes subsequent to accessing abortion services. Well-designed interventions that meet the needs of service-users should be developed and rigorously tested.
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Affiliation(s)
- Na Wang
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Gold Coast, Queensland, Australia
| | - Jyai Allen
- School of Nursing and Midwifery, Griffith University - Logan Campus, Meadowbrook, Queensland, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University - Logan Campus, Meadowbrook, Queensland, Australia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University - Logan Campus, Meadowbrook, Queensland, Australia
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Chin J, Kaneshiro B, Elia J, Raidoo S, Savala M, Soon R. Buffered lidocaine for paracervical blocks in first-trimester abortions: a randomized controlled trial. Contracept X 2020; 2:100044. [PMID: 33196038 PMCID: PMC7644856 DOI: 10.1016/j.conx.2020.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective was to evaluate if buffered lidocaine decreases injection pain as compared to plain lidocaine for paracervical blocks during first-trimester outpatient surgical abortions. Study design We conducted a randomized, double-blind, placebo-controlled trial among women undergoing outpatient uterine aspiration of a first-trimester pregnancy or an early pregnancy loss. Subjects received a paracervical block with either lidocaine 1% 20 mL or lidocaine 1% 18 mL plus sodium bicarbonate 8.4% 2 mL. The primary outcome was pain from injection of the paracervical block measured on a 100-mm visual analog scale (VAS). Secondary outcomes included pain after cervical dilation, uterine aspiration and overall satisfaction with pain control. Scores were compared using the Mann–Whitney U test. We aimed to detect a 15-mm difference in pain from injection of the paracervical block. Results From May 2017 to October 2018, 48 women received plain lidocaine and 50 women received buffered lidocaine. Groups were similar in demographics. We found no clinically or statistically meaningful difference in pain when evaluating median VAS scores for paracervical block injection between the buffered and plain lidocaine [30.0 (interquartile range (IQR) 15.3–64.5); 44.5 (IQR 18.3–65), respectively, p = .32]. We found no difference in secondary outcomes between buffered and plain lidocaine. Conclusion Buffered lidocaine for paracervical blocks in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine. Implications statement Buffering the paracervical block in first-trimester outpatient surgical abortions does not decrease injection pain as compared to plain lidocaine, nor does it increase patient satisfaction. Eliminating sodium bicarbonate allows for a more cost-effective and readily available solution for paracervical blocks.
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Affiliation(s)
- Jennifer Chin
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Bliss Kaneshiro
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Jennifer Elia
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Shandhini Raidoo
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Michael Savala
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
| | - Reni Soon
- University of Hawaii, Department of Obstetrics, Gynecology, and Women's Health, 1319 Punahou St., Suite 824, Honolulu, HI 96826, USA
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17
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The patient perspective: perceptions of the quality of the abortion experience. Curr Opin Obstet Gynecol 2019; 30:407-413. [PMID: 30299320 DOI: 10.1097/gco.0000000000000492] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Abortion services are essential in sexual and reproductive health and should be held to the same standards as other health services. Patient (or person)-centeredness is a key dimension of healthcare quality that incorporates the perspectives of patients in care provision. The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care. RECENT FINDINGS Considering person-centeredness in abortion care using dimensions of dignity, autonomy, privacy, communication, social support, supportive care and health facility environment allows for critical evaluation of data describing women's experiences with abortion and postabortion services. Review of the available literature shed light on the impact of social stigma, health policy and abortion restrictions on women's abortion experiences. SUMMARY Considering multiple domains and varied settings, current data suggest abortion services worldwide generally fail to provide person-centered care. Institutions and providers may be limited in their ability to provide patient-centered abortion care because of deeply embedded social stigma, institutional regulations and legal restrictions.
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Fukuzawa RK, Kondo KT. A holistic view from birth to the end of life: end-of-life doulas and new developments in end-of-life care in the West. Int J Palliat Nurs 2019; 23:612-619. [PMID: 29272199 DOI: 10.12968/ijpn.2017.23.12.612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The relatively newly-developed profession of birth doulas, who accompany perinatal women and their families during the birth process, has been in existence since the 1990s. End-of-life (EoL) doulas are another emerging profession in developed Western countries. Doulas provide non-medical support for both childbearing women and people at the EoL, as well as their families. Although birth and death would appear to be opposites, they share common characteristics and challenges, such as tending to be treated in medicalised care settings, and that they both concern vulnerable parties. Doulas, with a holistic view encompassing birth and death, may be able to contribute to the improvement of the healthcare system in modern societies.
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Wint K, Elias TI, Mendez G, Mendez DD, Gary-Webb TL. Experiences of Community Doulas Working with Low-Income, African American Mothers. Health Equity 2019; 3:109-116. [PMID: 31289769 PMCID: PMC6608698 DOI: 10.1089/heq.2018.0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The aim of this study was to learn from doulas the components of their services that might best serve low-income, African American (AA) women and to show the significance of doulas in helping these women have healthy, positive, birth experiences. Methods: Ten doulas were recruited from a local community doula program and through word-of-mouth referrals from participants and completed in-depth interviews. Interviews were transcribed verbatim and analyzed using Atlas.ti software to identify emerging themes. Thematic saturation was achieved in interviews. Results: Several themes emerged from the interviews including: (1) The influence of similarities of race, culture, and lived experience on doula care; (2) How doulas often provide birthing persons with support and resources beyond birth; and (3) How doulas recognize the institutional biases that exist in the health care system and try to mediate their effect on birthing persons. Conclusions: These themes highlight how doulas can support birthing persons to mitigate the negative effects of social determinants of health, specifically racism and classism, and highlight potential avenues for doulas to consider when working with birthing persons who have low income and are AA.
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Affiliation(s)
- Kristina Wint
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Gabriella Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Dara D Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany L Gary-Webb
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
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20
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Smith PP, Dhillon-Smith RK, O'Toole E, Cooper N, Coomarasamy A, Clark TJ. Outcomes in prevention and management of miscarriage trials: a systematic review. BJOG 2019; 126:176-189. [PMID: 30461160 DOI: 10.1111/1471-0528.15528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes. OBJECTIVE To review systematically, outcomes reported in existing miscarriage trials. SEARCH STRATEGY MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) reporting prevention or management of miscarriage. Miscarriage was defined as a pregnancy loss in the first trimester. DATA COLLECTION AND ANALYSIS Data about the study characteristics, primary, and secondary outcomes were extracted. MAIN RESULTS We retrieved 1553 titles and abstracts, from which 208 RCTs were included. For prevention of miscarriage, the most commonly reported primary outcome was live birth and the top four reported outcomes were pregnancy loss/stillbirth (n = 112), gestation of birth (n = 68), birth dimensions (n = 65), and live birth (n = 49). For these four outcomes, 58 specific measures were used for evaluation. For management of miscarriage, the most commonly reported primary outcome was efficacy of treatment. The top four reported outcomes were bleeding (n = 186), efficacy of miscarriage treatment (n = 105), infection (n = 97), and quality of life (n = 90). For these outcomes, 130 specific measures were used for evaluation. CONCLUSIONS Our review found considerable variation in the reporting of primary and secondary outcomes along with the measures used to assess them. There is a need for standardised patient-centred clinical outcomes through the development of a core outcome set; the work from this systematic review will form the foundation of the core outcome set for miscarriage. TWEETABLE ABSTRACT There is disparity in the reporting of outcomes and the measures used to assess them in miscarriage trials.
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Affiliation(s)
- P P Smith
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - R K Dhillon-Smith
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - E O'Toole
- Women's Voices Involvement Panel, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nam Cooper
- Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - T J Clark
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Lanning RK, Oermann MH, Waldrop J, Brown LG, Thompson JA. Doulas in the Operating Room: An Innovative Approach to Supporting Skin-to-Skin Care During Cesarean Birth. J Midwifery Womens Health 2018; 64:112-117. [PMID: 30548422 DOI: 10.1111/jmwh.12930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Skin-to-skin care (SSC) immediately after birth is recommended for all women and their newborns. Barriers to SSC after cesarean birth lead to delays in initiation of this practice. The purpose of this quality improvement project was to implement an innovative approach with volunteer doulas to support initiation of SSC after cesarean for all clients. PROCESS Volunteer doulas in a well-established hospital-based program within an academic health center were trained to provide care during scheduled cesarean births in the operating and recovery rooms. Data on rate and time of SSC and client and nurse satisfaction were collected for a 12-week period. OUTCOMES Sixty-six women received doula-supported care in the operating room. All medically stable woman-newborn couplets with complete data (N = 58) initiated SSC in the operating room and were included in the data analysis. Forty-eight women completed a feedback survey after birth. Scores indicated that clients agreed or strongly agreed that the doula was an important part of the birth experience. Feedback from labor and delivery nurses indicated highly positive attitudes about the importance of SSC and the presence of volunteer doulas. All nurses surveyed who had participated in doula care (n = 20) agreed or strongly agreed that they were satisfied with the doulas and that the doulas were prepared for this role. DISCUSSION This project demonstrates that volunteer doulas can be prepared to provide supportive care to clients during and immediately after cesarean birth. Doulas can play an integral role in supporting the initiation of SSC after cesarean birth and are perceived as an important member of the maternity health care team by clients and nurses.
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Chor J, Lyman P, Ruth J, Patel A, Gilliam M. Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences. J Midwifery Womens Health 2018; 63:53-57. [PMID: 29369513 DOI: 10.1111/jmwh.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. METHODS We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. RESULTS Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. DISCUSSION Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic.
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