Importance of abortion training to United States Obstetrics and Gynecology residency applicants in 2023.

OBJECTIVE: Nearly half of obstetrics and gynecology (OB/GYN) residency programs in the United States lost access to local training in abortion care following the 2022 Dobbs v Jackson Supreme Court decision. We aimed to determine whether OB/GYN residency candidates who desire abortion training apply to programs in states where abortion is restricted/banned. STUDY DESIGN: In 2023, we conducted an anonymous electronic survey of residency interviewees at three large academic OB/GYN programs about the importance of various program characteristics in their selection process. We chose to represent both very restrictive and protective environments for abortion care. We stratified respondents by importance of abortion training in applying to programs (essential or very important [high preference group] vs moderately, slightly, or not important [low preference group]). RESULTS: We analyzed 175 completed surveys (response rate 56%). Of 175 respondents, most (n = 115, 66%) stated that access to abortion training was essential (33%) or very important (33%) when applying to programs. Both high preference group (82%) and low preference group respondents (98%) applied in states where abortion is banned or restricted. Respondents applied in banned/restricted states due to geography, concern about applying to too few programs, and expectation that the program would provide out-of-state training nonetheless. CONCLUSION: The majority of survey respondents who reported that access to abortion training during residency is essential or very important applied to programs where abortion training is not locally available. Most of these applicants expected programs in restricted states to provide training regardless. IMPLICATIONS: Residency programs should be aware of the importance of abortion training to applicants, as well as abortion training expectations, and work to develop opportunities and strengthen training networks in abortion care to meet candidates' needs and ensure adequate learning opportunities exist for all.

Effects of aromatherapy on patient satisfaction with procedural abortion at less than 10 weeks' gestation: A randomized controlled trial.

OBJECTIVES: This study aimed to compare satisfaction with procedural abortion prior to 10 weeks' gestation in patients randomized to lavender essential oil aromatherapy vs placebo (jojoba oil). STUDY DESIGN: This randomized trial compared lavender aromatherapy vs placebo in patients undergoing procedural abortion <10 weeks' gestation. Participants self-administered and inhaled oil during their procedures. Our primary outcome was composite mean score on the Iowa Satisfaction with Anesthesia Scale. Participants completed the State-Trait Anxiety Inventory, a visual analog scale reporting maximum procedural pain, and reported postprocedure aromatherapy acceptability. RESULTS: We analyzed 112 participants randomized to aromatherapy (n = 57) vs placebo (n = 55). Baseline characteristics were similar between groups. We found no difference in overall satisfaction (mean Iowa Satisfaction with Anesthesia Scale scores aromatherapy: 0.72 ± 0.96 vs placebo: 0.46 ± 0.98, p = 0.17) or maximum procedural pain (median visual analog scale score aromatherapy: 65 [range: 4-95] vs placebo: 63 [range: 7-97], p = 0.91). Independent predictors of satisfaction included the use of oral sedation (B: 0.36; 95% CI: 0.04-0.69), state anxiety (B: -0.45; 95% CI: -0.79 to -0.10), and maximum procedural pain (B: -0.17; 95% CI: -0.25 to -0.09). The aromatherapy participants were significantly more likely to have found inhaling scented oil helpful during their procedure (71.9% vs 45.5%; p = 0.005) and would recommend it to a friend who needed a procedural abortion (86.0% vs 56.4%; p = 0.0005) compared to those in the placebo group. Additionally, patients in the aromatherapy group were significantly more likely to agree with the statement, "If I need another procedural abortion, I would want to inhale scented oil during my procedure" (87.7% vs 70.9%; p = 0.03). CONCLUSIONS: The adjunctive use of lavender aromatherapy during first-trimester procedural abortion does not improve satisfaction with anesthesia but is highly valued by patients. IMPLICATIONS: Oral opioids as an adjunct to standard analgesics during procedural abortion (ibuprofen and paracervical block) do not decrease pain, and nonopioid options are lacking. Given current limited anesthesia options, aromatherapy could serve as an affordable and acceptable nonopioid adjunct to current standard of care during procedural abortion. GOV IDENTIFIER: NCT04969900.

Medication Abortion.

This JAMA Patient Page describes medication abortion and its risks and effectiveness.