The impact of doulas in the surgical management of early pregnancy failure and abortion care
Awarded 2014
Complex Family Planning Fellowship Research
Susan Wilson, MD
University of Pennsylvania

Background: The diagnosis of a failed pregnancy or undesired pregnancy is often emotionally challenging. Management of such clinical situations in the US is often by surgical uterine evacuation which itself is associated with physical and emotional stress. Studies have shown that patients with a support network tolerate and recovery better from medical procedures than those without, including women receiving abortion care. As a means of providing emotional support and physical comfort for all pregnant women, doulas have emerged in recent years in the world of clinical abortion care as “full spectrum doulas.” While the positive impact of doulas in labor and delivery is well studied and accepted, little research exists on the impact of doulas in miscarriage and abortion management.
Purpose: To evaluate the impact of doulas on patients’ physical and psychological distress levels during surgical management of first trimester undesired or failed pregnancy under local anesthesia.
Methodology: Women were randomized to receive doula support or routine care during office manual vacuum aspiration. The primary outcome was pain score measured on a 100mm visual analog scale. Secondary outcomes included satisfaction, validated psychometric scores and women’s sense of personal empowerment post-procedurally. Data were collected prior to, immediately following, and 1 month following their procedure.
Important Findings: A total of 70 women were randomized. While there was no statistically significant difference in reported pain between the doula and control groups (70.7 ± 24.5mm vs. 59.7 ± 32.5mm, p=0.11, respectively), women who received doula support experienced a statistically significant decrease in anxiety post procedure after controlling for baseline anxiety (OR -11.6, 95% CI -22.9 to -0.2, p=0.04). Relief was the most common emotion reported by 60% of women in both groups, regardless of procedure indication. There was no significant difference between groups regarding satisfaction with the procedure experience (86.2±23.4 vs. 93.4±13.5, p=0.12), sense of empowerment (0.11±0.31 vs. 0.12±0.30, p=0.93), or perceived ability to cope following the procedure (36.3±28.1 vs. 42.0±27.1, p=0.39). Of women who received doula support, 97% reported that this benefitted their experience and would recommend a doula to other women having such a procedure.
Conclusions: Doula support during office manual vacuum aspiration for undesired or failed pregnancies is well received and may address unmet psychosocial needs of women undergoing this procedure.