Microsoft Word PS Midwives as Abortion Providers FINAL 19 Mar 18.docx

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1 compre Midwives as Abortion Providers Certified nurse - midwives (CNMs) and certified midwives (CMs) provide care for individuals across Many midwives currently the lifespan, including sexual and reproductive health care. abortion services, including options counseling, ultrasound, safe and effective provide and post - abortion care. comprehensive abortion care American College of Nurse - , The Midwives (ACNM) affirms the following: manual vacuum aspiration Midwives may perform abortion as part of an expanded • (MVA) 1,2 accordance with state regulations and credentialing . scope of practice in • abortion has low risk of post - procedure complications , su ch as Manual vacuum aspiration e ven lower than MVA infection or hemorrhage. The risk profile of medication abortion is 3 Both options pose much lower risks than childbirth. abortion . medication abortion abortion and Manual vacuum aspiration may be safely provided by • 4,5 advanc e practice clinicians (APC s ) , including midwives . trained • have the right to decide what is best for their health, bodies, lives, and Individuals 1 ACNM opposes legislative, policy, or administrative efforts at the federal, state, families. as wel l as any efforts to render it less accessible. and local levels to restrict or ban abortion ACNM supports policy efforts that work to expand clinician scope of practice laws to • abortion providers , which will increase access to comprehensive include APCs as . reproductive health services Background 6 of all pregnancies are unintended, In the United States, and 42% of these end in aborti on. 45% 7 1 in 4 women will have obtained at least one abortion . By the age of 45, Although patients seeking abortion religi ous , ethni c, and racial backgrounds, in 2014, nearly have a variety of 8 75% were low - income. This statistic highlights the fact that access to abortion is an important part of addressing health disparities in th e U nited States . limit abortion access. significantly In addition to economic barriers, geographic disparities increasing restrictions and legal barriers, 90% of US countie s now lack abortion Because of 9 s , and 39% of individuals of reproductive age live in these counties. clinic More abortion

2 providers are needed, rticularly in the low - resourced, underserved communities that midwives pa . frequently serve e medication and MVA some provid states. Sixteen states do not require Midwives abortions in 10 abortion , a physician to provide medication and a number of states do not require a physician 11 MVA abortion. to perform Of all abortions, 89% are performed within the first 12 weeks of 12 a timeframe within which MVA can be performed safely . M edication abortion is pregnancy, approved by the US Food and Drug Administration (FDA) to 10 weeks gestation . F ollowing 13 competency outlined in the APC Toolkit, - midwives can based training, such as the training concept is MVA abortions . This safely provide medication and supported by the US FDA, which moved away from physician - centric language in labeling for Mifeprex (mifepristone) , 1 of medications used to provide abortions : “Mifeprex must be ordered, prescribed 2 and dispensed by or under the supervision of a healthcare provider who prescribes and who 14 meets certain qualifications. ” Nineteen states require the clinician to be physically present to 10 dispense mifeprist one, and 18 of these states also require the clinician be a physician. Ethical Considerations he ACNM Code of Ethics is imbued with the ethical principles of autonomy, , T beneficence maleficence, justice, veracity, and fidelity as the and serve s - framework for safe and ethical non 15 The Core Competencies for Basic Midwifery Practice promote “advocacy midwifery practice. - for informed choice, shared decision making, and the right to self determination” as integral to 16 care . the art and science of midwifery Ethical duties of the midwife include provision of the education on following services based on unbiased, factual information: services , reproductive for the advocacy informed decisions regarding fertility , and the provision of individual’s 15 se rvices or referral for those services . who Midwives abortion provide abortion and/or abortion care support the individual’s autonomy about through shared decision making 17 Providing abortion and/or abortion care contributes to reducing health pregnancy intentions. for individuals in rural or underserved areas. care disparities and promotes access, especially The decision to terminate an un planned or unwanted pregnancy can be difficult, often 18 influenced by multiple factors includi ng finances, health, or a need to focus on other children. While midwives are ethical ly obligated to provide non - directional counseling and shared 1 decisio , s ome may morally oppose pregnancy termination. n making about pregnancy options ACNM recogniz es the ethical dilemma that may result from this conflict : M idwives have the right as individuals to live and practice with moral integrity in accordance with ethical, moral, or religious beliefs. However, in emergency situations in which referral is not an option, midwives have an ethical, moral, and legal obligation to provide appropriate, quality care regardless of personal bias and beliefs. Midwives who have ethical, moral, or religious limitations to scope of practice have an obligation to notify potential employers and

3 19 clients of those limitations and to ensure that mechanisms are in place for referral. R provide a referral for these efusal to provide abortion servic es or to quickly and appropriately 20 delay in care or moral distress on the part of th e patient. For midwives and services may create other APCs who feel a moral and ethical duty to provide abortions and/or the care surrounding 21 abortions, the ability to provide these services is an important part of a fufilling practice. This conscientious provision of care is supported by ACNM. Advance Practice Clinicians as Abortion Providers as abortion support of APC s , including midwives ACNM joins the following organizations in , providers: • The International Confederation of Midwives includes abortion - related care, including medication and MVA abortion to 1 2 weeks gestation , as an essential competency for basic 2 2 midwifery practice. The A merican College of O bstetricians and G ynecologists supports increasing the types of • 4,2 3 training programs for APCs . abortion providers to include APCs and expanding abortion • T he American Pub lic Health Association support s the provision of abortion by advanced practice nurses and physician assistants : “Surgeons perform surgery. Aspiration abortion is not surgery. Primary care providers, including NPs, CNMs, and PAs, provide a wide range of procedures, including intrauterine device (IUD) insertion, e ndometrial biopsy, 2 4 ” management of early pregnancy loss, and abortion. A in ac cordance with the ACNM bortion care is an essential element of reproductive health care dividual view that “everyone has the right to make reproductive health choices that meet their in 1 Midwives ” , and their services will help needs. who choose to do so are ideal abortion providers abortion in the U nited S tates , especially for underserved populations. to improve access to REFERENCES American College of Nurse - Midwives. ACNM p osition statement: a ccess to 1. roductive health care services . comprehensive sexual and rep http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000 - 7/Access - to Comprehensive 00008 - Sexual - and - Reproductive - Health - Care - Services - FINAL - - 12 - 17.pdf . P ublished October 2016. Accessed February 1, 2018. 04 American College of Nurse - Midwives. ACNM p osition statement: e xpansion of 2. midwifery practice and skills beyond ba sic core competencies . http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000 ublished June 2015. Accessed - of - Mi dwifery - 000066/Expansion - June - 2015.pdf . P Practice February 1, 2018.

4 3. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and . Obstet Gynecol - 21 9. childbirth in the United States . 2012;119(2 Pt 1):215 American College of Obste tricians and Gynecologists. ACOG committee opinion number 4. https://ww w.acog.org/ - /media/Committee - 612: abortion training and education. - - - Health Opinions/Committee Care - for - Underserved - on . Published November 2014. Women/co612.pdf?dmc=1&ts=20170626T0455425989 Accessed February 1, 2018. nurse 5. Weitz TA, Taylor D, Desai S, et al. Safety of aspiration abortion performed by d physician assistants under a C alifornia legal practitioners, certified nurse midwives, an Am J Public Health . 2013;103(3):454 - 461. doi: 10.2105/AJPH.2012.301159. waiver. 6. Finer LB, Zoln a MR. Declines in unintended pregnancy in the United S tates, 2008 – 2011 . N Engl J Med . 2016;374:843 852. - incidence of abortion: RK, Jerman J. Population group abortion rates and lifetime 7. Jones United S – 2014. Am J Public Health. 2017;107(12):1904 - 1909. doi: tates, 2008 10.2105/AJPH.2017.304042. 8. Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014 and - changes since 2008 https://www.guttmacher.org/report/characteristics - us - abortion . patients - 2014 . Published May 2016. Accessed February 1, 2018. 9. Jones tates, RK, Jerman J. Abortion incidence a nd service availability in the United S 2014. Perspect Sex Reprod Health. - 27. doi: 10.1363/psrh.12015. 2017;49(1):17 Guttmacher Institute. https://www.guttmacher.org/state - 10. Medication abortion. abortion February 1, 2018. - policy/explore/medication . Accessed An overview of abortion laws. https://www.guttmacher.org/state - 11. Guttmacher Institute. - abortion - laws . policy/explore/overview 2018. Accessed February 1, 12. Guttmacher Institute. Induced abortion in the United S tates. - - abortion - https://www.guttmacher.org/fact - states sheet/induced . Updated January united 2018. Accessed February 1, 2018. 13. Taylor D, Safriet B, Dempsey G, Kruse B , Jackson C. Providing abortion care: a professional toolkit for nurse - midwives, nurse practitioners and physician assistants. - . Published 2 009. Accessed http://apctoolkit.org/wp content/themes/apctoolkit/index.html February 1, 2018. 14. U.S. Food and Drug Administration. Mifeprex (mifepristone) information. https://www.fda.gov/Drugs/Drug Safety/PostmarketDrugSafetyInformationforPatientsand Providers/ucm111323.htm . Updated January 23, 2018. Accessed February 1, 2018. 15. American College of Nurse - Midwives. Code of ethi cs with explanatory statements . http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000 June - of - Ethics - w - Explanatory - Sta tements - 000293/Code - 2015.pdf . Approved June 2015. Accessed February 2, 2018. 16. American College of Nurse . Midwives. Core competencie s for basic midwifery practice - http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000

5 000050/Core%20Comptencies%20Dec%202012.pdf . Approved December 2012. Accessed February 2, 2018. American College of Nurse - Midwives. ACNM p osition statement: s cision 17. hared de . making in midwifery care http://www.midwife.org/ACNM/files/ACNMLibraryDa ta/UPLOADFILENAME/000000 - Decision - Making - in - Midwifery - Care 000305/Shared 10 - 13 - 17.pdf Approved December - 2016. Accessed February 2, 2018. 18. Biggs, M. A., Gould, H., & Foster, D. G. (2013). Understanding why women seek BMC Women’s Health , 13 (1), 29. http://doi.org/10.1186/1472 abortions in the US. 6874 - - 13 - 29 19. American College of Nurse - Midwives. ACNM p osition statement: c onscientious refusal a nd the profession of midwifery . http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000 000301/ConscientiousObjectionPositionSta . Approved March tementFINAL2016.pdf 2016. Accessed February 2, 2018. 20. ACOG c ommittee opinion American College of Obstetricians and Gynecologists. number 385: t he limits of conscientious refusal in reproductive medicine. https://www.acog.org/Clinical - Guidance - and - Publications/Committee - of Opinions/Committee on - Ethics/The - Limits - - - Conscientiou s - Refusal - in - - Reproductive Medicine . Published November 2007. Accessed February 2, 2018. 21. . Recognizing conscience in abortion provision. N Engl J Med . Harris L H 98 - 3. doi: 10.1056/NEJMp1206253. 2012;367(11):981 International Confederation of Midwives. Interna tional Confederation of Midwives 22. evised 2013 . . R essential competencies for basic midwifery practice 2010 https://internationalmidwives.org/assets/uploads/documents/CoreDocuments /ICM%20Es sential%20Competencies%20for%20Basic%20Midwifery%20Practice%202010,%20revi . Accessed February 2, 2018. sed%202013.pdf ACOG c ommittee opinion number American College of Obstetricians and Gynecologists. 23. i ncreasing access to abortion . Obstet Gy necol. 2014;124(5):1060 - 106 5. doi: 613: 10.1097/01.AOG.0000456326.88857.31. 24. American Public Health Association. Provision of abortion care by advanced practice n urses and physician assistants . https://www.apha.org/policies - and - advocacy/public - of health - statements/policy - database/2014/07/28/16/00/provision - policy - abortion - care - - by - advanced - practice - nurses - and - physician - assistants . Published November 1, 2011. Accessed Fe bruary 2, 2018. Note. Midwifery as used throughout this document refers to the education and practice of certified nurse - midwives (CNMs) and certified midwives (CMs) who have been certified by the American Midwifery Certification Board (AMCB) . Source: Gender Equity Taskforce & Clinical Documents Section. Approved by the ACNM Board of Directors: March 2018

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