Regina-Maria Renner


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    Providers’ perspective on pain in abortion care, including cultural aspects

    Regina-Maria Renner University of British Columbia, Vancouver, BC, Canada -

    The majority of women report pain associated with abortion; either during or after the procedure. A variety of pain management options are available but no option is perfect. A paracervical block with or without oral analgesics has been shown to decrease pain but typically not enough to be pain-free whereas general anaesthesia provides a pain-free experience for the procedure, but women still report pain postoperatively. Conscious sedation provides an option in between the two. Access to these pain management options varies internationally, and is influenced by the interplay of safety concerns, woman's choice and available resources. Providers' perspectives of women's pain experience and pain management also vary internationally and are shaped by their respective clinical and in some cases, personal experience. In many European countries the majority of abortions are provided under general anaesthesia, while in North America the majority of procedures are done under local anaesthesia. In Canada, for example, IV sedation is more common. Cultural norms affect patient's reaction to pain and coping mechanisms coping with pain, not only in the context of abortion provision. All these aspects influence providers' perspective on women's pain and the acceptance of women's pain. Providers accustomed to an asleep patient may not be used to seeing patients in pain and "talking a woman through the procedure". Providers used to an awake patient oftentimes are more comfortable with a patient experiencing some pain and have practice in supporting her. Additionally, studies have shown that providers' perception of women's pain does not always correlate with the women's self-reported pain.