Pain relief for osmotic cervical dilator placement: A survey of providers
Awarded 2011
Complex Family Planning Fellowship Research
Kathleen Morrell, MD, MPH
Columbia University

We conducted a cross-sectional web-based survey of US abortion providers who insert dilators prior to second-trimester dilation and evacuation procedures.  Providers were contacted via electronic mail through relevant professional organizations and in person at national conferences during 2011.  Respondents (n=271) were mostly female (74%), and OBGyn physicians (76%), with a median age of 40 years, and median practice duration of seven years. A majority of providers use paracervical block or non-steroidal anti-inflammatory drugs (NSAIDs); 45% use both as their preferred method of pain relief. Forty-four providers (16%) reported no use of analgesia or anesthesia with dilator placement.  Providers not using medications are older (median age 51 vs. 39 years; p = 0.002) and have been placing dilators for more years (median 10 vs. 7 years; p=0.008) than providers who use some form of pain relief.  Current or former Family Planning Fellows were more likely to use pain relief than those not fellowship-trained (91% vs. 73%; p<0.001).  All Family Medicine physicians (n=13), Physician Assistants (PAs, n=3), and Certified Nurse Midwives (CNMs, n=3) use some form of pain relief for dilator placement.  Fellowship-trained providers are more likely than other providers to use both an NSAID and paracervical block for their preferred method of pain relief (57% vs. 30%; p=0.006).  Female providers are more likely than male providers to use this combination (50% vs. 28%; p=0.02).  Family Planning Fellowship-trained providers, Family Medicine physicians, PAs, CNMs, and younger providers who responded to this survey are more likely to use some form of pain relief for dilator placement.  Female and fellowship-trained providers more often use an NSAID plus paracervical block.  Further research is needed to evaluate different methods in order to establish best practices and improve patient experiences.