Pain and pain management during induced abortions: A web‐based exploratory study of recollections from previous patients

Foregrounding pain in self-managed early medication abortion: a qualitative study

OBJECTIVE

To explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.

METHODS

From late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software.

RESULTS

Focused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising 'period-like pain'. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to 'period pain' can be misleading and a source of additional uncertainty at a potentially already challenging time.

CONCLUSIONS

For some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of 'period-like pain' do not clarify expectations and should be avoided.

“Out of This World”: Norwegian Women’s Experiences of Medical Abortion Pain

Introduction

Medical abortion has rapidly become the dominant abortion method in western countries. Pain is a known adverse effect; however, few studies have explored women's subjective experience of medical abortion pain.

Purpose

To explore Norwegian women's experiences of pain when performing a medical abortion at home.

Material and Methods

We recruited 24 women through an advertisement on Facebook and conducted semi-structured, face-to-face interviews. The interviews were transcribed verbatim and the data were analyzed using a phenomenological hermeneutical method.

Results

Our findings consisted of two main themes: 1) Being in pain or becoming pain, and 2) Being caught off guard and struggling to cope. Participants described undergoing severe pain, comparable to giving birth, during the medical abortion. Unprepared for the type and intensity of the pain, they felt anxious and insecure. Pain is physical, but it also has important psychological, social, and existential dimensions. Our culture (in)forms our thoughts and feelings about our pain, affecting our ability to endure suffering. The participants' experiences of abortion pain prompt timely questions concerning gendered socio-cultural and existential meanings connected to pain, specifically in relation to female reproductive functions.

Conclusion

Women need realistic information about the type and intensity of abortion pain, as well as evidence-based pain medication. Psychological factors may affect the experience of abortion pain and should therefore be taken into account in abortion care.

Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study

BACKGROUND

Most nurses and midwives are not prepared to provide bereavement care. The conflict between the need for high-quality care of bereaved parents and the lack of confidence in providing perinatal bereavement care among nursing staff is becoming increasingly prominent in China.

OBJECTIVE

To describe the current situation and identify influencing factors of perinatal bereavement care confidence (PBCC) among nurses and midwives in China.

METHODS

This descriptive and cross-sectional survey was conducted in 2021. A convenience sample was created by recruiting 571 nurses and midwives in 11 hospitals in Zhejiang Province. Collected the data of PBCC, secondary traumatic stress (STS) and emotional exhaustion (EE) in this study.

RESULTS

The average score of the PBCC was 67.83 ± 10.78. Average levels of STS were (23.32 ± 7.39) and EE (17.87 ± 8.62). PBCC was found to be most often associated with self-awareness, organisational support and training in perinatal bereavement care.

CONCLUSIONS

Managers should take measures to improve PBCC and optimise perinatal bereavement care practice from the perspective of enhancing self-awareness of nursing staff, strengthening organisational support and providing training in perinatal bereavement care. The mental health of nursing professionals in the context of perinatal bereavement care needs to be emphasised. Nursing managers should make clear policies and establish a communication platform for nursing staff. Professional training should be conducted in the future.

Effectiveness of the implementation of a perinatal bereavement care training programme on nurses and midwives: protocol for a mixed-method study

INTRODUCTION

The psychological outcomes for many parents who experience perinatal loss depend on nursing staff's ability to provide effective bereavement support. However, most nurses and midwives lack the ability to provide bereavement care and suffer from heavy emotional burden. The study aims to investigate the effectiveness of the perinatal bereavement care training programme on nurses and midwives to increase their perinatal bereavement care confidence (PBCC) and to reduce secondary traumatic stress and emotional exhaustion.

METHODS AND ANALYSIS

This study will follow a mixed methodology consisting of two stages. The first stage will adopt a pre/post repeated quasi-experimental design without a control group. The second stage will use a qualitative interview study. This study will be conducted in a tertiary maternity hospital in China in 2022-2023. Ethical approval was obtained from the institutional review board in January of 2020. Outcome measures will be assessed using the Chinese version of the PBCC, STS and the EE subscale of Chinese Burn-out Inventory at baseline, postintervention and at the 3-month follow-up. Participants will be interviewed to understand their perceptions of the training programme.

ETHICS AND DISSEMINATION

This research protocol was approved by the Ethics Committee of the Women's Hospital School of Medicine, Zhejiang University (IRB no. 20210091). The results will be disseminated through peer-reviewed journals and academic conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100049730.

No one needs to know! Medical abortion: Secrecy, shame, and emotional distancing

In 2021, 10,841 abortions were carried out in Norway, of which 95.3% were medical abortions. In this phenomenological study, we explore women's experiences connected to performing a medical abortion at home. We conducted 22 interviews and analyzed the data using Giorgi's descriptive phenomenological method. Our analysis revealed four crucial constituents: The logical and sensible choice-doubt beneath the surface; Secrecy and the dubious comfort of hidden shame; Emotional distancing as a coping strategy; and Moving on-and revisiting the meaning of the abortion. We discuss and reflect on these findings drawing on insights from existential phenomenology and contemporary research.

Exploring interactions between women who have experienced pregnancy loss and obstetric nursing staff: a descriptive qualitative study in China

BACKGROUND

Contradictory interactions between bereaved women who have experienced pregnancy loss and obstetric nursing staff are becoming increasingly prominent. The aim of the present study was to gain an understanding of how women who have experienced pregnancy loss and obstetric nursing staff perceive their interactions, what influencing factors impacted their experiences.

METHODS

A qualitative, exploratory study was conducted in a delivery room and six maternity wards of a tertiary hospital. Semi-structured interviews were performed with six nurses, 13 midwives and seven women who experienced pregnancy loss to collect rich information about how they make sense of their interactions. Thematic analysis was adopted to analyse the data.

RESULTS

Five overarching themes were identified: (1) interaction characteristics, (2) interactive contradiction, (3) influencing factors of the interaction, (4) training needs and (5) suggestions for benign interactions.

CONCLUSIONS

Healthcare providers should be instructed in adopting a respectful and sympathetic attitude in communication, strengthening information support and offering patient-centred care for benign interactions. Ignoring women's needs and using disrespectful words should be avoided. Training for preparing nurses and midwives in perinatal bereavement care and addressing heavy emotional burden is necessary. Additional efforts are needed to improve medical services and to facilitate benign interactions in induced abortion care.

Nonpharmacological pain management interventions in medical and surgical abortion: A scoping review

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.

Psychometric properties of the Chinese version of the Perinatal Bereavement Care Confidence Scale (C-PBCCS) in nursing practice

BACKGROUND

The Perinatal Bereavement Care Confidence Scale (PBCCS) was designed to evaluate midwives' and nurses' confidence and its psychosocial factors to provide bereavement care in Ireland. However, it is unknown whether this scale is valid and reliable for use with midwives and nurses in China. The aim of this study was to translate the English version into Chinese (C-PBCCS) and determine its validity and reliability in a population of Chinese midwives and nurses.

METHODS

In this cross-sectional observational study, after translating the English version of the PBCCS into Chinese and ensuring the linguistic adequacy and clarity of the language, we evaluated the validity and reliability of the C-PBCCS with Chinese midwives and nurses (n = 608). Participants were recruited using convenience sampling from 10 maternity hospitals in Zhejiang and Jiangsu Provinces. Exploratory factor analysis (EFA) was conducted to determine the construct validity (n = 304). Another sample of 304 midwives and nurses was used for confirmatory factor analysis (CFA) to verify the quality of the factor structures. Cronbach's alpha coefficient and Guttman split-half coefficient were adopted for the evaluation of internal consistency. The STROBE was followed in reporting the results.

RESULTS

The 43-item PBCCS was reduced to 40 items. Bereavement support knowledge (13 items, three factors), Bereavement support skills (eight items, two factors), Self-awareness (eight items, two factors), and Organizational support (11 items, two factors). The CFA suggested that the four scales in the C-PBCCS had acceptable fit indices. The Cronbach's alpha ranged from 0.835-0.901. The Guttman split-half coefficient was between 0.868-0.933.

CONCLUSION

The C-PBCCS was found to be a psychometrically sound measurement tool to evaluate Chinese-speaking midwives' and nurses' confidence and the psychosocial factors that affect their confidence in providing perinatal bereavement care.

"No one should be alone in living this process": trajectories, experiences and user's perceptions about quality of abortion care in a telehealth service in Chile

Self-managed abortion is a common self-care practice that enables pregnant people to exercise their rights to health, bodily autonomy and to benefit from the advances of science even when living in contexts that do not guarantee these rights. In this interpretative qualitative study, we aimed to understand women’s abortion trajectories, experiences with self-managed abortion and assessments of the quality of care provided by Women Help Women (WHW, an international activist non-profit organisation working on abortion access). Grounded in feminist epistemology and health inequalities approaches, we conducted eleven semi-structured interviews in Santiago, Chile. We found that illegality, stigma and expectations surrounding motherhood and abortion determined women’s experiences. Participants perceived the WHW service as good, trustworthy, fast and affordable, and valued confidentiality and privacy; the quantity and quality of information; having direct, personalised and timely communication with service staff; being treated with respect; and feeling safe, cared for and supported in their decisions. Most participants considered self-managed abortion appropriate and acceptable given their circumstances. Fear was the dominant feeling in women’s narratives. Some participants mentioned missing instant communication, in-person support and professional care. We conclude that support, information and company are key to improving abortion seekers’ experiences and enabling their decisions, particularly in legally restrictive settings. Centring care in pregnant people’s needs and autonomy is fundamental to ensure safe, appropriate and accessible self-care interventions in reproductive health. Social and legal changes, such as public funding for abortion, destigmatisation and decriminalisation, are needed to realise people’s right to higher standards of healthcare.

The experiences of nurses and midwives who provide surgical abortion care: A qualitative systematic review

AIM

To synthesize qualitative evidence on nurses' and midwives' experiences in the provision of surgical abortion care. We address three specific questions: (a) what are the experiences of nurses and midwives in surgical abortion care? (b) what are their responses and coping strategies? (c) what are the deficiencies in surgical abortion care?

DESIGN

Qualitative studies were synthesized using Thomas and Harden's qualitative thematic synthesis method.

DATA SOURCES

Electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science were searched. Grey literature using ProQuest was searched. The databases were searched from inception to 5 August 2020.

REVIEW METHODS

The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation and Research type) search tool was used in the literature search. Data synthesis was conducted using the three-stage thematic synthesis method described by Thomas and Harden.

RESULTS

966 studies were identified in the initial search and 18 studies were included. Four analytical themes were generated: 'Providing abortion care requires high emotional labour'; 'Professionalism of abortion care providers'; 'Initiatives in professional development' and 'Improving directions for high-quality abortion care'.

CONCLUSION

Nurses and midwives indicated that they require support to enhance psychological health and improve professional skills. Hospital managers should organize regular debriefing or structured group workshops for exchange of practical experiences and strengthening emotional support. More research is required to establish comprehensive training related to abortion care for nurses and midwives. The findings demonstrate that optimization of abortion services should start from hospital management models, pain management and bereavement care.

IMPACT

Understanding the experiences of nurses and midwives in abortion provision will inform future clinical practice in surgical abortion care, which would be helpful in improving the professionalism and confidence of abortion providers. Our findings have implications for the training, development of policies and standards for surgical abortion care for nurses and midwives.

Patient Experience with Postpartum Pain Management in the Face of the Opioid Crisis

INTRODUCTION

Professional societies have urged providers to reduce opioid use for pain management. Accordingly, the objective of this study was to assess patient experiences related to postpartum pain management in an effort to better understand potential paths to achieve such a reduction.

METHODS

This is a planned secondary analysis of a prospective observational study of opioid use following birth. In the primary study, women who received opioids as inpatients were queried about their pain management, including questions about pain experience, pain satisfaction, perceived areas for practice improvement, and the opportunity to leave additional comments. Participants who were prescribed opioids upon discharge completed postdischarge surveys with a similar opportunity for qualitative input. Data were analyzed using the constant comparative method to identify themes and subthemes.

RESULTS

Of the 493 women enrolled in the primary analysis, 125 provided qualitative data. Three overarching themes regarding pain management were identified: positive experiences (n = 22), negative experiences (n = 19), and beliefs and preferences on opioid use and pain management (n = 28). Women with positive experiences reported satisfaction with timely pain medication administration and appreciation of open dialogue with their care team. In contrast, several negative experiences centered on tardy administration of pain medications, resulting in increased pain. Patients also perceived judgment, accusation, and excessive lecturing by staff when requesting opioid medications. Finally, participants expressed the necessity for opioids for postpartum pain management, as well as their desires for limiting opioid use, improved options for multimodal pain management, and increased communication with providers about pain regimens.

DISCUSSION

Understanding women's perspectives and experiences regarding postpartum pain control is essential to improving care. Amid growing research on the role of maternity care providers in addressing the opioid crisis, women's voices are rarely solicited. These findings stress the importance of open and frequent dialogue between patients and providers and a need for multimodal pain management options.

Women's experiences with information before medication abortion at home, support during the process and follow-up procedures - A qualitative study

OBJECTIVE

To explore women's experiences of having a medication abortion at home in regard to their perceptions of the information provided before the abortion, support throughout the process and follow-up procedures.

STUDY DESIGN

A qualitative study based on interviews with 23 women between October 2019 and January 2020. Systematic text condensation was used for data analysis.

RESULTS

Three themes were identified from the analysis. The first theme covers how the women found the information given before the abortion to be inadequate and how this affected their feelings of safety. In the second theme, the participants described how they experienced lack of acknowledgement from health care professionals, and how this affected their feeling of support. The third theme covers how the women perceived access to health care professionals during the home abortion, and how this affected their feeling of well-being.

CONCLUSIONS

In general, the women stated that the information provided was inadequate, especially in regard to bleeding and pain. The women also found support during and after the abortion to be insufficient and would have preferred more help and information throughout the process. This suggests that health care professionals should improve their procedures for providing information, support and care.