The role of CNMs in abortion care - page 3

by cthomson

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Hello I am wondering if there is any programs that educate/train midwives in abortion care. There are currently six states which allow NPs to perform procedures. I am wondering if abortion care is included within the midwifery... Read More


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    Does that mean that CNM students would generally receive didactic and clinical education in medical abortions? If so, that's really good to know.

    If CNMs are already being trained on the job to do surgical abortions it would be interesting if there were degree programs that integrated this into their curriculum. The Abortion Access Project (http://www.abortionaccess.org/advanc...ice-clinicians) says this under their FAQs for Advanced Practice Clinicians:

    "How can I be trained?

    While currently there are no national training centers for APCs, local opportunities exist depending on your state and interest. AAP works with individual APCs on a case by case basis, providing tailored support and training where possible, and may be able to connect you with a training opportunity in your area. If you are a clinician within the Planned Parenthood network, there are often opportunities for training available through your affiliate. AAP also works with state-level partners to create sustainable training opportunities for APCs with other clinical affiliations.

    What resources would be helpful to me?

    AAP offers specific resources for physician's assistants, nurse practitioners and certified nurse-midwives. For more information about abortion care in your profession, please log in, free of charge, to our network member site. Also, please check out our APC Toolkit (http://www.apctoolkit.org/) for APCs who would like to advance their existing practice, as well as for those who are experienced in abortion care."

    Section V of the APC Toolkit referenced, BECOMING CLINICALLY COMPETENT AND DOCUMENTING COMPETENCY IN ABORTION CARE (http://www.apctoolkit.org/section5a.html) mentions some of the ways in which abortion care provided by APCs in being integrated into select educational programs, including at UCSF.
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    The surgical evacuation of the uterus is within our practice in every state provided it is to MANAGE AMISCARRIAGE. Oregon, Washington, new Mexico and several other jurisdictions allow us to do surgical abortions. NAF has the ceu didactic and will help you arrange clinical time to get your technique down. I strongly suggest that all CNMs who are able to cope with the concept learn the technique for the sake of managing miscarriages and, if it suits your practice ethics, providing first trimester abortions to selected patients. NAF = National Abortion Federation.

    Baba Yaga, formerly of Portland Feminist Women's Health.
  3. 0
    I am a Nurse-midwifery student at UCSF and we do not have opportunities to learn aspiration (aka surgical) abortions. We have learned in class how to do medical abortions. It is not possible for us to learn aspiration abortions as students because California law does not yet permit Advanced Practice Nurses nor Physicians Assistants to do aspiration abortions. The only non-physician providers who can do aspiration abortions in California right now are those who are enrolled in the ANSIRH study and those participants are providers who already have their license. I do not know whether OHSU or other Nurse-midwifery programs offer training in aspiration abortions.
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    Thanks for the info, Heather.

    Out of curiosity, is this a subject that gets much discussion among your classmates? Does there seem to be interest in including more training on abortion provision and widening CNM/NPs' scope of practice to include aspiration abortions?
  5. 0
    To LookingAhead:

    In response to your question, yes reproductive choices (including abortion) get a fair amount of discussion in our program and among my classmates. We have also discussed the issue in some of our classes of having CNMs, NPs, and PAs be first trimester abortion providers. If it were possible in California, I'm sure there are many of us Master's nursing students who would like to learn how to do aspiration abortions. As it is now, only those CNMs, NPs, and PAs who are enrolled in the ANSIRH study can be trained and perform aspiration abortions. So, if legislature wasn't holding us back, yes there would be a lot of interest on behalf of the students to learn aspiration abortions while in school.

    What we are allowed to do right now as Nurse-midwifery students is learn how to do laminaria insertions to dilate the cervix. That is as much as we can do besides medical abortions.

    Yes, lots and lots of interest in expanding the scope of practice for CNMs, NPs, and PAs to do aspiration abortions.
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    I'm in the school of nursing at OHSU and I have been told that at OHSU, if someone were to stay on for the DNP portion of study (currently offered, not required), the student is required to pick an area in which to focus for their additional study; examples suggested to me were ultrasound, long-term management of abnormal paps, C-section first assist, providing surgical abortion, etc. Selecting your study field would be contingent upon having a preceptor that would be willing to work with you during your DNP terms.

    So, to answer your question, I think you *could learn surgical abortion at that program, because CNMs can legally provide surgical abortions in OR and it could be the additional scope of practice you hoped to gain competency in during your DNP year. However, aspiration abortion is not included in the Master's level CNM program at OHSU.
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    I wrote a paper about this last semester. WHO feels that mid level providers are fully capable of performing early term abortions, both medical and aspiration. As there is a shortage of these providers, I feel that APN scope of practice should include this. Would I want to perform them? Maybe not. But it is certainly something that an APN can do.
    mz_marit likes this.
  8. 2
    I would like to be an abortion provider after finishing women's health NP school in one of the few states where there are no physician only laws - I'm happy to field questions for anyone interested in doing this, as I've researched it quite a bit. - ALSO presently no schools offer this as part of training, but ANSIRH's work is great and keep abreast as to what's happening legislatively in California regarding mid levels doing abortion care.

    Carrying a pregnancy to term is far more dangerous/complicated than doing a first trimester abortion. This is totally within scope of practice and I'm excited to see more people interested in it. With few MDs doing abortion care, we need more engaged, excited NPs/CNMs providing!
  9. 1
    Good for you mz-marit! We need open minded clinicians like yourself. Abortion is an important service, though people do not like to talk about it. I applaud you for stating your desire and I hope that you get to do exactly as you plan. Thank you for stepping up.
    mz_marit likes this.


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