Care For Women Research Articles

Silent Tears of Midwives: ‘I Want Every Mother Who Gives Birth to Have Her Baby Alive’—A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania

Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being. To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings. Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted. Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns. Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.

‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial assessment programme

Objectiveto explore how contextual conditions influence midwives’ relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. Designa realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. Settingnine community-based and hospital-based midwife clinics in the North Region of Denmark. Interventiona dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. Participants and data15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. Findingscontextual conditions at multiple levels which supported midwives’ relational competencies, autonomy and the power of peer reflection—and thus facilitation of a woman-centred approach and trust—were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. Conclusionmidwives’ ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships — which is essential for disclosure — was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.

Development and pilot test of a smartphone app for midwifery care in Tanzania: A comparative cross-sectional study.

To address Tanzania's high maternal mortality ratio, it is crucial to increase women's access to healthcare. To improve access, the quality of antenatal care needs to be improved. Therefore, we conducted a pilot study of a smartphone app for midwives and examined its potential effects on the learning outcomes of midwives and birth preparedness of pregnant women in Tanzania. This mixed-methods, pilot study provided an educational app for midwives in the intervention group, obtained data about the continuous use of the app, measured midwives' learning outcomes, directed focus group discussions on the usability of the app, and conducted surveys among pregnant women about birth preparedness in the intervention and control groups to evaluate if midwives provided proper information to them. The control group received regular antenatal care and answered the same survey. Participants were 23 midwives who participated in the testing and provided learning outcome data. Twenty-one participated in focus group discussions. Results showed that 87.5% of midwives continued to study with the app two months post-intervention. A mini-quiz conducted after using the app showed a significant increase in mean scores (6.9 and 8.4 points, respectively) and a non-significant increase on the questionnaire on women-centered care (98.6 and 102.2 points, respectively). In the focus group discussions, all midwives expressed satisfaction with the app for several reasons, including comprehensive content, feelings of confidence, and reciprocal communication. There were 207 pregnant women included in the analysis. The intervention group had significantly higher knowledge scores and home-based value scores than did controls. The total scores and other subscales did not show statistical significance for group differences. The results indicate the potential impact of the midwifery education app when it is implemented on a larger scale, especially considering that the results show a potential effect on midwives' learning outcomes.

Doctor Versus Midwifery-led Care: A Commentary on a Task-shift, not Only Complex but Difficult to Accept

Task-shifting from doctors to midwives/nurse-midwives is not a novel human resources strategy but an evidence-based return to the origins of women's care in pregnancy, birth, and the postpartum period. Many countries still rely on medical-led care models to care for women at low risk of complications despite solid evidence that midwifery models result in better outcomes for women and babies. This commentary reflects on how historically women have been cared for by midwives and how a patriarchal and medicalized culture interfered negatively in a physiological life event.

Trends in clomiphene citrate and gonadotropins use in women with infertility between 2010 and 2017: A population-based study in France.

To describe temporal trends and assess factors associated with changes in the prescription of clomiphene citrate and gonadotropins between 2010 and 2017 in women with infertility aged 18-50 from metropolitan France. 6321 prevalent women from a representative sample of the national medico-administrative database were identified. We performed a Cochran-Armitage trend test and calculated the rate ratios. A Poisson regression was used to derive the incidence rate ratios, for each treatment class. The prevalence rate and incidence rate of clomiphene citrate use significantly decreased by 20% (RR 0.80: 95% CI 0.71-0.90) and 23% (RR 0.77: 95% CI 0.66-0.89), respectively. Its initiation was higher in all age groups compared to the reference (18-24 years), with a downward gradient. It was also higher when the density of gynaecologists was higher and in disadvantaged areas. The prevalence rate and incidence rate of gonadotropin use increased by 11% (RR 1.11: 95% CI 1.01-1.22) and 33% (RR 1.33: 95% CI 1.14-1.55) respectively. Gonadotropin initiation was highest in the 31-35 age group, but it was also higher in the 25-30 and 36-40 age groups at a similar level (reference 18-24 years). Its initiation was higher when the density of gynaecologists was higher, but not associated with social deprivation. Our results showed an increase in gonadotropin use for infertility treatment in France during the 2010-2017 period and a decrease in clomiphene citrate use. Further work should be undertaken to analyse the use of these drugs in relation to women's care pathways.

Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana

BackgroundHypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women’s experiences are indispensable measures to reduce maternal and perinatal adverse outcomes.ObjectiveTo explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges.MethodsA multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks’ gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach.ResultsFifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider–client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women’s experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP.ConclusionWomen with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women’s experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.

Primiparous women’s expectations and experiences of early labour: A qualitative study

ObjectivesTo gain a deeper understanding of primiparous women’s preparation for early labour as well as their expectations and experiences of symptoms of onset of labour. MethodsA qualitative study using focus group discussion was conducted with n = 18 first-time mothers within the first six months of giving birth. Discussions were transcribed verbatim and coded and summarised into themes by two researchers using qualitative content analysis. ResultsThe statements of the participants revealed four themes: ‘Preparing for the unpredictable’, ‘Expectations and reality’, ‘Perception and wellbeing’ and ‘Experiencing the beginning of birth’. Many women could not distinguish the preparation for early labour from that for the whole birth. Relaxation techniques to prepare for early labour were found to be very helpful. For some women, it was a big challenge that expectations often did not correspond to the experienced reality. Pregnant women faced many different physical and emotional symptoms of onset of labour with striking variability. Emotions ranged from positively excited to having fears. Not being able to sleep for hours was a huge problem for the labour process of some women. While early labour at home was experienced positively, early labour in hospital was sometimes difficult, because women had the feeling of being in the second rank. ConclusionThe study clearly identified the individual character of experiencing onset of labour and early labour. The variety of experiences highlighted the need for individualised, woman-centred early labour care. Further research should investigate new paths for assessing, advising, and caring for women during early labour.

Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women

ObjectiveTo examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations.DesignSystematic review.Eligibility criteriaOriginal studies of tool development and validation related to health engagement, with abstract available in...

Maternity care provision for women living with female genital mutilation/cutting: A qualitative study from a high asylum-seeking dispersal context in the UK.

To explore the perspectives of midwives and obstetrician/gynaecologists providing maternity care to women living with female genital mutilation/cutting (FGM/C) in a high asylum-seeker dispersal area in the North West of England. We carried out a qualitative study in four hospitals providing maternal health services within the North West of England, with the highest population of asylum-seeking individuals (many from high-prevalence FGM/C countries) in the UK. Participants included 13 practicing midwives and an obstetrician/gynaecologist. In-depth interviews were conducted with study participants. Data collection and analysis were carried out concurrently until theoretical saturation was reached. Data were analysed thematically to generate three key overarching themes. There is a disconnect between Home Office dispersal policy and healthcare policy. Participants indicated that there was inconsistent identification or disclosure of FGM/C, constraining appropriate follow-up and care prior to labour and childbirth. All participants noted existing safeguarding policies and protocols, which were seen by most as being important to protect female dependants, but potentially detrimental to the patient-provider relationship and to the woman's care. Unique challenges around accessing and maintaining continuity of care for asylum-seeking women due to dispersal schemes were indicated. All participants highlighted a lack of specialised training for FGM/C to support provision of clinically appropriate and culturally sensitive care. There is a clear need for harmony between health and social policy as well as specialised training that centres holistic wellbeing for the woman living with FGM/C, particularly where there are increased numbers of asylum-seeking women from high-prevalence FGM/C countries.

Midwifery care and social media

Rachelle Chee, Tanya Capper and Olav Muurlink discuss navigating the challenges of providing women-centred care in the social media age

Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis

BackgroundWoman-centred maternity care is respectful and responsive to women’s needs, values, and preferences. Women’s views and expectations regarding the quality of health services during pregnancy and childbirth vary across settings. Despite the need for context-relevant evidence, to our knowledge, no reviews focus on what women in sub-Saharan African Low and Low Middle-Income Countries (LLMICs) regard as quality intrapartum care that can inform quality guidelines in countries.MethodsWe undertook a qualitative meta-synthesis using a framework synthesis to identify the experiences and expectations of women in sub-Saharan African LLMICs with quality intrapartum care. Following a priori protocol, we searched eight databases for primary articles using keywords. We used Covidence to collate citations, remove duplicates, and screen articles using a priori set inclusion and exclusion criteria. Two authors independently screened first the title and abstracts, and the full texts of the papers. Using a data extraction excel sheet, we extracted first-order and second-order constructs relevant to review objectives. The WHO framework for a positive childbirth experience underpinned data analysis.ResultsOf the 7197 identified citations, 30 articles were included in this review. Women’s needs during the intrapartum period resonate with what women want globally, however, priorities regarding the components of quality care for women and the urgency to intervene differed in this context given the socio-cultural norms and available resources. Women received sub-quality intrapartum care and global standards for woman-centred care were often compromised. They were mistreated verbally and physically. Women experienced poor communication with their care providers and non-consensual care and were rarely involved in decisions concerning their care. Women were denied the companion of choice due to cultural and structural factors.ConclusionTo improve care seeking and satisfaction with health services, woman-centred care is necessary for a positive childbirth experience. Women must be meaningfully engaged in the design of health services, accountability frameworks, and evaluation of maternal services. Research is needed to set minimum indicators for woman-centred outcomes for low-resource settings along with actionable strategies to enhance the quality of maternity care based on women’s needs and preferences.

The Management of Obese Women in Pregnancy & Neonatal Outcome in Malta

Background: Over the past few years, the rise of obesity in pregnancy has been associated with a rise in pregnancy complications. The aim of this audit was to analyze the current management of obese women in pregnancy at Mater Dei Hospital (MDH). The Royal College of Obstetricians and Gynaecologists (RCOG) green-top guideline: Care of Women with Obesity in Pregnancy which was published in 2018 was used as a standard for this audit. Method: Data was collected from inpatient medical notes of obese mothers who presented at MDH between July 2020 and October 2020. There was no patient contact during data collection and all data was kept anonymous. Results: 53 mothers were recorded as obese between July and October 2020. The average maternal age was 31 years and the average maternal weight was 94kgs at antenatal booking visit. 47% of obese mothers were classified as Class 1 obese. Only 38% of obese mothers had an oral glucose test performed, and 70% of these mothers had a positive test.54.7% delivered via a caesarean section. 12% of neonates required NPICU admission. Conclusion: Pregnancy in women with obesity is an important public health problem with short- and long-term implications for maternal and child health. This audit demonstrates that the management of obese women in pregnancy currently in use at MDH does not follow all the RCOG recommendations. We suggest the need for local guidelines together with the use of patient information leaflets to help improve the care of women with obesity in pregnancy.

Evaluation of Birth Companions perinatal support in prisons during the COVID-19 pandemic

ABSTRACT Women in prison who are pregnant or recently had a baby are a highly vulnerable population due to complex histories, increased risks of poorer outcomes, and mother-infant separation. During the COVID-19 pandemic, these women faced additional challenges due to infection risks and enforced social isolation. In England in March 2020, the Ministry of Justice and Her Majesty’s Prisons and Probation Service prioritised the early release of pregnant women and mothers living with their babies in Mother and Baby units (referred to as compassionate release on ROTL – Release On Temporary Licence). Birth Companions, a UK-based charity that works with pregnant and post-natal women in prison, were commissioned to extend its reach to help coordinate care and post-release support to women released under ROTL, and those released as ‘business as usual’ in all English women’s prisons during the pandemic. Here we report insights from an evaluation of this work. Interviews were undertaken with nineteen participants (six women, eight Birth Companions, and five health/social care professionals) and thematic analysis was undertaken. Two themes and associated sub-themes emerged. ‘Facilitating support’ outlines how women benefitted from the support via engendering trust, promoting coping strategies, and facilitating positive change. ‘Challenges in support provision’ describes key barriers that Birth Companions faced in accessing and supporting women due to communication barriers and difficulties in coordinating wider support. This study highlights a unique, service model that enabled woman-centred care, despite limitations. Prisons need to revisit existing policies and guidelines to ensure that equitable care is provided during future crises.

TRANSFORMING FROM DOULA TO MIDWIFE

The roles of doulas and midwives converge in some areas, yet their divergences are vast. Transitioning from doula to midwife has given me an insider’s view, enabling me to reflect on the advantages and challenges of these vocations and the benefits of merging these skills. Providing continuity and woman-centred care in an emotionally-safe environment is a skill both doulas and midwives can develop. However, the variations in responsibilities and regulations can create discord, interfering with a woman’s experience, autonomy in decision-making and empowerment. When women’s voices are heard and philosophies align, doulas’ and midwives’ skills in supporting physiological birth are protective against over-medicalisation and iatrogenic trauma.

Health profile of pregnant women with asymptomatic bacteriuria

Background Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. UTIs in pregnancy are associated with maternal as well as fetal morbidity. The aim of the current study was to assess the health profile of pregnant women with asymptomatic bacteriuria (ASB). Design A descriptive research design was adopted to obtain the stated aim. Sample A purposive sample of pregnant women with UTIs without symptoms throughout 1 year but the sample not less than 100 pregnant women was recruited. Setting The study was performed at woman's care clinic at Al Kasr Al Ainy University Hospital. Tools Two tools were utilized: (a) urine analysis record and (b) structured interviewing questionnaire schedule. Results The study findings showed that the mean age of the pregnant women with ASB was 29.00±5.48 years old. Overall, 26% of them could not read and write, and 96% of them were housewives. Regarding place of residence, 82% of the selected sample was from rural areas. Half of the selected sample was multigravida, whereas 55% of them were multipara. Overall, 61% of them had a history of abortion. Furthermore, 86% of the selected sample used new latrine toilet, and 61% had a previous history regarding infection. In addition, 63% of the selected sample used contraceptive methods, and 58% of them had previous normal vaginal delivery. Concerning trimester, 73% were in the third trimester. Conclusion The current study's findings revealed that age, cannot read and write, rural areas, housewives, usage of new latrine toilet, multigravida, multipara, history of abortion, normal vaginal delivery, usage of contraceptive methods, history of previous infection, and third trimester were represented the health profile of the pregnant women with ASB that might increase the incidence of a symptomatic bacteriuria infection. Recommendation Pregnant women should be made aware regarding personal hygiene through classes on motherhood.

Outcomes of births attended by private midwives in the Gauteng Province of South Africa: A retrospective cohort study

Midwives are important role players in providing women-centred care for low-risk pregnant women.South African women use either public or private health care services during pregnancy and birth. As the public sector is overburdened, women do not receive a high level of continuity of care there. The private sector is mainly obstetrician-led and intervention-driven. Private midwife-led care is available in South Africa, but is limited to the major cities. No evidence could be found about the outcomes of private midwife-led care in South Africa.The objective reported in this paper was to compare the outcomes of and interventions during births attended by private midwives in Gauteng with the latest Cochrane review on midwife-led care.A retrospective cohort design was used to audit the birth registers of private midwives in Gauteng, focusing on outcomes and interventions as in the most recent Cochrane review on midwife-led care.The maternal and neonatal outcomes of Gauteng midwives' patients were reassuring. Compared to women in the Cochrane review, significantly more Gauteng women had an intact perineum (53.4% vs 29%), fewer had interventions such as induction of labour (9.6% vs 19.3%), but more had caesarean sections (19.3% vs 13.3%). Overall foetal loss (0.3% vs 2.7%) and NICU admissions (4.3% vs 7.1%) occurred significantly less frequently in the Gauteng sample.The study's findings indicated that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of outcomes and intervention rates.

Pregnant women's experiences of well-being in high-risk pregnancy: A qualitative study.

Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP. This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program. Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships. The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.

A kind reminder-A qualitative process evaluation of women's perspectives on receiving a reminder of type 2 diabetes follow-up screening after gestational diabetes.

Women with previous gestational diabetesmellitus(GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening. A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis. The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings. The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.

Learning through relationships: The transformative learning experience of midwifery continuity of care for students: A qualitative study

BackgroundMidwifery curricula in Australia incorporate ‘Continuity of care experiences’ (CoCE) as an educational strategy based on an assumption that midwifery students will learn skills and knowledge about woman-centred care that they may not learn in the typical fragmented care system. However, exactly what skills and knowledge they are expected to ‘learn’ and how these can be assessed have never been specifically identified. AimTo explore midwifery students’ continuity of care learning experiences within pre-registration midwifery education. MethodsFocus groups were conducted with first, second and third year Bachelor of Midwifery students (n = 12), who were undertaking CoCE in rural and regional tertiary hospitals in NSW, Australia. FindingsThe overarching theme, ‘Learning through relationships’, was made up of three interrelated themes: Meeting women and making connections, Being known, and Understanding holistic care. DiscussionThe findings from this study contribute to understanding the educational effects of CoCE. The CoCE relationship provided safety and freedom to learn which was seen as foundational for midwifery students’ vision of their future practice and can be seen as a self-determined transformational approach to learning. ConclusionThis study adds insight into midwifery students’ experience of CoCE, and demonstrates that transformative learning occurs through developing a relationship with both the woman and the midwife. For midwifery to develop as a profession and maintain its focus on woman-centredness, it is important that this aspect of midwifery education remains embedded within midwifery program philosophies and learning outcomes.

How much will it hurt? Factors associated with pain experience in women undergoing medication abortion during the first trimester

ObjectivesFew studies have investigated the features associated with pain levels during abortion. We aimed to investigate the risk factors for experiencing pain during medication abortion, focusing on women's psychological distress and anxiety levels. Study designWe carried out this observational study at two centers in Bologna, Italy. We included women aged 18 years or more with a viable intrauterine pregnancy of up to 63 days of amenorrhea, who chose medication abortion. Women received 600 mg of Mifepristone orally and after 48 hours 400 mcg of buccal misoprostol, repeated after 3 hours according to local and regional medication abortion guidelines, as well as prophylactic analgesia. We evaluated the clinical characteristics which may represent risk factors for severe pain (Visual Analogue Scale ≥ 70) through a multivariate model. ResultsTwo hundred forty-two patients were included in our analysis; 92 (38.0%) reported severe pain during medication abortion. Women with higher baseline anxiety levels (General Health Questionnaire 12 score ≥ 6 and General Anxiety Disorder 7 score ≥ 10) had a higher probability of experiencing pain with a Visual Analogue Scale ≥70 (OR = 3.33, 95% CI 1.43–7.76), as well as those who reported dysmenorrhea in the past year (OR = 6.30, 95% CI 2.66–14.91). Previous vaginal deliveries were inversely correlated with pain intensity (OR 0.26, 95% CI 0.14 – 0.50). ConclusionsIncreased baseline anxiety levels, dysmenorrhea and no previous vaginal deliveries are associated with severe pain in women undergoing medication abortion. ImplicationsThe identification of women at risk for severe pain based on clinical and historical factors as well as the definition of an adequate analgesic regimen may help to improve women's care and pain management during medication abortion.