Objective: To investigate whether women having medical or surgical terminations of pregnancy differ in their emotional distress before or after the procedure. To evaluate whether choice of procedure occurs, the factors influencing type of procedure and the effect of choice on emotional responses and satisfaction with care.
Design: A prospective comparative study.
Setting: A termination of pregnancy unit in a University Teaching Hospital.
Participants: Two hundred and seventy-five women attending for medical or surgical first trimester termination of pregnancy.
Methods: Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional functioning was reassessed together with satisfaction with care.
Results: Women having a surgical termination waited longer for the procedure and were at more advanced gestation than those having the medical termination. There were no differences in emotional responses related to type of procedure or gestation. One-quarter remained highly anxious at four weeks. Medical and surgical groups did not differ in emotional status prior to termination. Those having the medical procedure rated it as marginally more stressful and experienced more post-termination physical problems and disruption to life. Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience). One-quarter of the medical and 67% of the surgical group reported having no choice in type of procedure. Only 53% of the medical group would choose the same procedure again compared with 77% of the surgical group.
Conclusions: Termination method did not influence emotional adjustment. Many women were not offered genuine choice of procedure. Having choice was considered very important but was unrelated to emotional distress or satisfaction with care.
PIP: A prospective, comparative study conducted at a UK teaching hospital investigated whether medical and surgical abortion patients differ, before and after pregnancy termination, in their degree of emotional distress and the extent to which having choice of method affects psychological outcome. 132 women having a medical procedure and 143 scheduled to undergo surgical abortion were enrolled and interviewed before and 4 weeks after the procedure. 58% of women in the medical abortion group and 31% in the surgical group felt they had been given a choice between the two procedures. However, since access to medical abortion was restricted to those with pregnancies under 9 weeks of gestation, choice in this situation may have been based on expediency rather than true preference. There were no significant differences between the two groups either at baseline or at follow-up in levels of anxiety, depression, or general negative affect. One-quarter of women in both groups remained anxious at 4 weeks postabortion. Women undergoing medical abortion reported higher levels of severe pain, bleeding, and disruption of daily activities; moreover, women who saw the fetus were most susceptible to psychological distress, including nightmares, flashbacks, and unwanted thoughts related to the procedure. Women in the surgical group who received general rather than local anesthesia were most likely to report postabortion distress. In the event of a future unwanted pregnancy, 92% of women in the surgical group and 53% in the medical group would select the same process. Exercising choice was not associated with any significant differences in postabortion emotional state or satisfaction. The option of suction termination under local anesthetic offers a combination of desirable factors, including a single appointment, shorter waiting times, no sight of the fetus, less pain, and avoidance of the side effects of general anesthesia.