The role of CNMs in abortion care

klone, MSN, RN · Nov 18, 2010

I'm not sure, but I don't think it's within a CNM scope of practice to perform surgical abortion.

Chemical abortion may be different, though.

LoveANurse09 · Nov 20, 2010

I was wondering about this too as I see many job openings for WHNP/CNMs at Planned Parenthood.

klone, MSN, RN · Nov 20, 2010

I was wondering about this too as I see many job openings for WHNP/CNMs at Planned Parenthood.

They do well-woman care and prescribe birth control. They don't perform abortions.

LoveANurse09 · Nov 21, 2010

They do well-woman care and prescribe birth control. They don't perform abortions.

Good to know..thanks!

cthomson · Nov 23, 2010

Actually, i currently work at Planned Parenthood of the Columbia Willamette. CNMs do perform surgical and medical abortions. It depends on the state

klone, MSN, RN · Nov 23, 2010

Actually, i currently work at Planned Parenthood of the Columbia Willamette. CNMs do perform surgical and medical abortions. It depends on the state

Interesting! Thanks for sharing that; I guess it does depend on the state's scope. I didn't realize any states allowed APNs to perform surgical abortion.

LookingAhead · Nov 24, 2010

You may be interested in research that is being done at UCSF on this topic: ANSIRH: Research and other workHealth Workforce Pilot Project.

BabyLady, BSN, RN · Nov 26, 2010

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 curriculum of any school.
I am posting for strictly educational and healthcare inquiries into the field. Please refrain from responding if you have any sort of moral judgment on this particular topic.

I am posting from a medica standpoint.

An abortion is a surgical procedure that if not done correctly, or knowing what to do in case of a major complication, can lead to infection, complications leading to a hysterectomy or even death.

I do not believe that NP's should perform this service, under ANY circumstance.

That role needs to be reserved for a physician...who is able to handle a complication, should it arise.

LookingAhead · Nov 27, 2010

BabyLady -

Actually, abortions are not necessarily surgical procedures at all. Many early abortions (which is the focus of ANSIRH, linked to in my previous post) are "medical abortions", completed with the administration of abortifacient drugs such as mifepristone and misoprostol.

Even if an aspiration technique were called for, for example, advanced practice nurses/CNMs are often trained to perform minor surgical procedures such as episiotomies, suturing, and skin biopsies, all of which have their own risks of complications that APRNs/CNMs are also trained to avoid, and manage or transfer to the care of a physician.

In any case, I don't think the OP was asking for the opinions of individual posters on whether or not CNMs should be allow to perform abortions, but rather was seeking advice on programs that offer this training.

BabyLady, BSN, RN · Nov 27, 2010

BabyLady -
Actually, abortions are not necessarily surgical procedures at all. Many early abortions (which is the focus of ANSIRH, linked to in my previous post) are "medical abortions", completed with the administration of abortifacient drugs such as mifepristone and misoprostol.
Even if an aspiration technique were called for, for example, advanced practice nurses/CNMs are often trained to perform minor surgical procedures such as episiotomies, suturing, and skin biopsies, all of which have their own risks of complications that APRNs/CNMs are also trained to avoid, and manage or transfer to the care of a physician.
In any case, I don't think the OP was asking for the opinions of individual posters on whether or not CNMs should be allow to perform abortions, but rather was seeking advice on programs that offer this training.

I think the OP was trying to avoid an abortion debate, which I 100% agree with.

The "surgical" procedures that you are referring to that CNM's already perform are missing one key element: A placenta.

I fully, 100% support advance practice nursing, but just because you can be trained to perform certain tasks, doesn't mean you should.

Case in point...I saw an interview of a surgeon once that said, "I can pull anyone off the street and teach them to do an appendectomy in probaby 2 to 3 hours. It is not a hard organ to find, nor difficult to retrieve. However, it would take me 10 years to teach you what to do if something goes wrong."

LookingAhead · Nov 27, 2010

I understand what you're saying - and appreciate that complications are the issue - but fortunately any CNM who would be performing such a procedure *would* have years of training; they would have a BSN, plus a MSN - plus, most probably, additional training since very few MSN programs include training on the provision of abortions. That is to say nothing of the fact that more and more CNMs will probably have doctorates as the DNP moves forward (not to get into a debate about that issue here :)).

CNMs regularly face the prospect of serious and sudden complications when helping women give birth, including maternal hemorrhage, retained placenta, cord prolapse, shoulder dystocia, neonates that need resuscitating, etc...again, fortunately CNMs are trained to manage complications, and transfer to a physician when necessary. I don't see why CNMs performing certain kinds of abortions would be any different.