A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care

Objective To investigate whether women having medical or surgical terminati ons of pregnancy differ in their emotional distress before or after the pro cedure. To evaluate whether choice of procedure occurs, the factors influen cing 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 su rgical first trimester termination of pregnancy. Methods Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional fun ctioning 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 terminat ion. There were no differences in emotional responses related to type of pr ocedure or gestation. One-quarter remained highly anxious at four weeks. Me dical and surgical groups did not differ in emotional status prior to termi nation. Those having the medical procedure rated it as marginally more stre ssful and experienced more post-termination physical problems and disruptio n to life. Seeing the fetus was associated with more intrusive events (nigh tmares, flashbacks, unwanted thoughts related to the experience). One-quart er of the medical and 67% of the surgical group reported having no choice i n type of procedure. Only 53% of the medical group would choose the same pr ocedure 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 cons idered very important but was unrelated to emotional distress or satisfacti on with care.