Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

A Woman Centred Service in Termination of Pregnancy: A Grounded Theory Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

A Woman Centred Service in Termination of Pregnancy: A Grounded Theory Study

Article excerpt

INTRODUCTION

Abortion is a contentious issue and those involved in caring for women undergoing the procedure confront complex issues on a daily basis. In the UK within certain legal parameters, a woman can receive a first trimester abortion in one of two ways, medical or surgical. A surgical abortion usually involves the woman admitted to hospital as a day case and undergoing a relatively minor procedure involving suction aspiration of the products of conception. This usually occurs under a general anaesthetic. A medical abortion comprises two stages. Firstly, taking the tablet mifepristone and secondly, returning to hospital one to three days later for misoprostol (RCOG 2004).The abortion usually occurs about six hours later with the products of conception passed vaginally. There are advantages and disadvantages with both methods, although they are classed as equally safe and relatively minor procedures.

There has been an increase in medical abortions relative to surgical abortions in the UK. The number of abortions in the UK being performed with the use of medication, commonly administered by nurses, has risen steadily since 1991 when mifepristone was first licensed for use in the UK and has more than doubled in the last five years (Department of Health 2008). Medical abortions accounted for 30% of the total, compared with 24% in 2005. The total number of abortions in England and Wales in 2006 was 193,700, compared with 186,400 in 2005, a rise of 3.9%.The National Health Service funded 87% of abortions (Department of Health 2007).

The move towards more medical abortions has meant nurses are becoming more directly involved in the procedure. A recent House of Commons Scientific and Technology Committee (2007) recommended nurses take a more prominent role in both medical and surgical abortions which would further increase their involvement and responsibilities in this procedure.

Little research has been undertaken to examine how nurses or midwives perceive their role or how the increasing numbers of medical abortions in the UK has affected the nurses and midwives involved. A Swedish qualitative study (Alex & Hammarstrom 2004) analysed women's experiences of induced abortion from a feminist perspective and found that despite positive attitudes towards abortion generally, the women held negative attitudes towards their own abortion. Alex and Hammarstom (2004) advise that nurses and midwives need to be aware of the women's complex experiences with abortions in order to be able to support and empower women. In order to be able to assist the women, it is important that nurses/midwives are cognisant of the effect of their own intense involvement in such complex experiences.

Intense involvement by nurses and midwives with their patients has been termed emotional labour and has been the subject of research and commentary (Bolton 2000; Hemmerling et al. 2005; McCreight 2005; McQueen 1997; Phillips 1996; Smith 1992). In a qualitative study by Bolton (2000) examining nurses on a gynaecological ward, emotional labour was classed as a gift given freely to the patient. McCreight (2005), in her study of perinatal grief through unintentional loss, emphasised the challenges of nurses simultaneously managing their own emotions alongside those of the women.

A US exploratory study (Joffe 1999) comprising interviews with 25 long term surgical abortion providers asked about the transition to medical abortions. Joffe (1999) found that most viewed it as an acceptable innovation without the complications of haemorrhage they had feared. In Australia the move towards more medical terminations has been more haphazard (Calcutt 2007; RANZCOG 2005).

Despite the satisfactory safety record of medical abortion (Say et al. 2002), a woman undergoing the procedure requires the nurse or midwife to be with her to supervise and, therefore, experience it along with the woman (Huntington 2002). It is unclear how increased involvement will affect the dynamics of the nurse/midwife-patient relationship or the nurse/midwife's involvement in the long term. …

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