How race impacts sedation during abortion care

Contemporary OB/GYN®:

Hi, I'm Celeste Krewson with Contemporary OB/GYN and I'm here with Dr. Lauren Pace to discuss factors associated with pain and sedation during abortion. Do you want to introduce yourself?

Lauren Pace, MD:

Sure, I'm Dr. Lauren Pace. I am a current ob-gyn resident. I did my medical school training at the University of Maryland, which is where the study was conducted. And I am currently in my residency at UAB, University of Alabama Birmingham.

Contemporary OB/GYN:

So can you tell me about the study and your findings?

Pace:

Sure. So, this study sought to look at how race, age, and demographics as well as psychosocial factors, including things like the reason for abortion, impact a patient's pain, scoring, and the administration of sedation and analgesia during the procedure. In the study, we found that there was no difference in the medication dose by age, but we did find that the youngest age group, which was patients less than 19 years old, actually had the lowest reported pain. We also found that in spite of not having a difference in pain scoring by race, White patients actually received higher doses of midazolam for sedation on average, Patients who terminated for genetic anomalies also on average received higher doses of both fentanyl and midazolam even though they had no difference in pain scoring from patients who cited social or economic reasons for termination.

Contemporary OB/GYN:

And why do you think these factors were found in the study?

Pace:

Um, I think that there's a lot that goes into the perception of pain, especially during a procedure that has such an intense social and emotional impact, like a procedural abortion. I think that a patient walks into the door with kind of a lot of factors that are already playing into their experience. And the way that those things come out sometimes in terms of their physical perception of pain during the procedure, is something that we don't always pay enough attention to.

Contemporary OB/GYN:

And what do you think can be done to reduce these disparities in sedation?

Pace:

So, I think clinics probably need to start with adopting uniform policies for assessing pain and assessing sedation status, if that hasn't already been done. I also think that we need to give consideration to protocolizing administration of medications based off of somewhat of objective factors, whether that's vital signs, or other things that we can point to. And I know that the objective analysis of a patient's pain is kind of a million-dollar question in a number of different fields. But I think, in these procedures, we just need to do a little bit of a better job of having sort of a systematic way to both assess and address it.

Contemporary OB/GYN:

And going forward, what sort of impact do you think this study will have?

Pace:

Well, I hope that the study helps abortion providers to recognize that there are so many different factors that play into a patient's experience of pain during an abortion, and they may not even necessarily be upfront with their provider about all of the factors that are coming into play. So, I'm hoping that this will help providers to be just a little bit more thoughtful about that fact. And to continue to sort of look inward, recognizing that we all have implicit biases, whether we want them to be there or not, this is just a universal. And these implicit biases may be contributing to patient care in ways that we're not consciously aware of. So, the more we can proactively think about these biases, the more we can try to mitigate them.

Contemporary OB/GYN:

Those are great points. We're just about ready to wrap up. But is there anything you want to add first?

Pace:

I just kind of wanted to acknowledge that in the post-Dobbs era, we need to continue to recognize how important it is to provide high-quality and equitable abortion care to all comers. Because I think by trying to provide optimal care in the places where we're still able to that's going to be one of the only ways to continue to prove that this is a safe and important procedure, no matter who you are or where you are.