Study: Abortions Are Safe When Performed By Nurse Practitioners, Physician Assistants, Certified Nurse Midwives (2023)

First trimester abortions are just as safe when performed by trained nurse practitioners, physician assistants and certified nurse midwives as when conducted by physicians, according to a new six-year study led by UCSF.

The study posted online Thursday in the American Journal of Public Health in advance of the print edition.

The publication comes a week before the 40th anniversary of the Roe vs. Wade, the landmark Supreme Court decision that made abortion legal in the United States.

Currently in the United States, a patchwork of state regulations determines who can provide abortions, with several states specifically prohibiting non-physician clinicians from performing the procedure.

(Video) LB 716 Hearing - Expand Qualified Abortion Providers

Study: Abortions Are Safe When Performed By Nurse Practitioners, Physician Assistants, Certified Nurse Midwives (1)

Study: Abortions Are Safe When Performed By Nurse Practitioners, Physician Assistants, Certified Nurse Midwives (2)

The new study was designed to evaluate the safety of early aspiration abortions when performed by nurse practitioners, physician assistants and certified nurse midwives trained in the procedure. The study was conducted under a legal waiver from the Health Workforce Pilot Projects Program, a division of the California Office of Statewide Health Planning and Development. California law requires a legal clarification about who can perform aspiration abortions.

The researchers report in their study that the results show the pool of abortion providers could be safely expanded beyond physicians to include other trained health care professionals. They found that:

(Video) Nurse Practitioners in CA may soon perform abortions without a doctor's supervision

  • Nurse practitioners, certified nurse midwives and physician assistants can provide early abortion care that is clinically as safe as physicians;
  • Outpatient abortion is very safe, whether it is provided by physicians or by nurse practitioners, certified nurse midwives or physician assistants.

Nationally, 92 percent of abortions take place in the first trimester but studies find that black, uninsured and low-income women continue to have less access to this care, according to the researchers.

Study: Abortions Are Safe When Performed By Nurse Practitioners, Physician Assistants, Certified Nurse Midwives (3)Tracy Weitz, PhD, MPA

In California, 13 percent of women using state Medicaid insurance obtain abortions after the first trimester. Because the average cost of a second trimester abortion is substantially higher than a first trimester procedure and abortion complications increase as the pregnancy advances, shifting the population distribution of abortions to earlier gestations may result in safer, less costly care, according to the research team.

“Increasing the types of health care professionals who can provide early aspiration abortion care is one way to reduce this health care disparity,’’ said lead author Tracy Weitz, PhD, MPA, a UCSF associate professor and director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. “Policy makers can now feel confident that expanding access to care in this way is evidence-based and will promote women’s health.’’

(Video) Early medical abortion of pregnancy: for GPs, nurses and pharmacists (webinar 28 June 2022)

Currently, non-physicians are allowed to perform aspiration abortions in four states: Montana, Oregon, New Hampshire and Vermont. In other states, non-physician clinicians are permitted to perform medication but not aspiration abortions. In recent years, in an effort to limit abortion availability, several states have put laws on the books to prohibit non-physician clinicians from performing abortions.

In the study, 40 nurse practitioners, certified nurse midwives and physician assistants from four Planned Parenthood affiliates and from Kaiser Permanente of Northern California were trained to perform aspiration abortions. They were compared to a group of nearly 100 physicians, who had a mean of 14 years of experience providing abortions.

Altogether, 5,675 abortions were performed in the study by nurse practitioners, certified nurse midwives and physician assistants, compared to 5,812 abortions by physicians. The abortions were performed between August 2007 and August 2011 at 22 clinical facilities in California.

Study: Abortions Are Safe When Performed By Nurse Practitioners, Physician Assistants, Certified Nurse Midwives (4)Diana Taylor, PhD, RNP

(Video) CASN Lunch and Learn - The Evolving Landscape of Nurse Practitioner Scope of Practice

The researchers found that both groups of abortion providers had few complications – less than 2 percent, including incomplete abortions, minor infection and pain. Statistically, according to the researchers, the complication rates were not different between the two groups of providers.

“The value of this study extends beyond the question of who can safely perform aspiration abortion services in California because it provides an example of how research can be used to answer relevant health care policy issues,’’ said study co-author Diana Taylor, PhD, RNP, professor emeritus in the UCSF School of Nursing. “As the U.S. demand for cost-effective health care increases, workforce development has become a key component of health care reform. All qualified health professionals should perform clinical care to the fullest extent of their education and competency.’’

The study was funded by grants from private foundations including the John Merck Foundation, the Educational Foundation of America, the David & Lucile Packard Foundation and the Susan Thompson Buffet Foundation.

More information can be found about the research at the website of Advancing New Standards in Reproductive Health.

(Video) Accelerating Access to Abortion Care Through Policy-partnered Research | Dr. Sarah Munro


Can physician assistants perform abortions? ›

Nurse practitioners, certified nurse-midwives and physicians' assistants who complete specified training are now able to perform abortions in California. Gov. Jerry Brown signed the measure into law Wednesday.

What type of NP can perform abortions? ›

When California enacted AB 890 in 2020, lawmakers created a pathway for nurse practitioners (NPs) to treat patients independently (without physician supervision). Legislation (SB 1375) now pending in Sacramento would permit independent nurse practitioners to perform aspiration abortions without physician supervision.

Can nurses assist with abortions? ›

Registered nurses (RNs) provide abortion care in hospitals and clinics and support abortion care through sexual health education and family planning care in sexual health clinics, schools and family practice.

What is the role of nurses and midwives in the provision of abortion care? ›

Nurses and midwives provide technical and psychosocial care to women who seek abortions. Governments and regulatory bodies could safely extend their scope of practice to increase women's access to safe abortions.

Can nurse practitioners perform abortions in PA? ›

The plain language of the Reproductive Privacy Act permits health care professionals to perform abortions under the supervision of a licensed physician, and there is nothing in the Reproductive Privacy Act that requires this supervision to be in person.

Who is qualified to perform an abortion? ›

The majority of states require that a licensed physician be the provider performing an abortion procedure. However, a few states allow other advanced practice clinicians to perform abortions.

Can nurse practitioners perform abortions in California? ›

In 2013, California passed a law allowing nurse practitioners, certified nurse midwives and physician assistants to perform abortions during the first trimester of pregnancy — but only if they completed special training and were under the supervision of a doctor.

What NP Cannot do? ›

They then go through additional education and training to become licensed to do more throughout the treatment process. Essentially, a nurse practitioner can do everything a doctor can do, although they are not able to perform surgical procedures.

What procedures can an NP perform? ›

The NP is authorized to perform any and all standardized procedures, without direct or immediate supervision of a physician, except where otherwise mentioned in this document. V. Evaluation: Per Medical Staff rules, regulations and bylaws.

Are midwives allowed to perform abortions? ›

The ICM notes that authorised and well-educated midwives can provide competent and safe abortion-related services, and many governments have modified their laws and policies to empower midwives to provide comprehensive abortion services.

What are the nursing management of abortion? ›

Nursing Interventions
  • If bleeding is profuse, place the woman flat in bed on her side and monitor uterine contractions and fetal heart rate through an external monitor.
  • Also measure intake and output to establish renal function and assess the woman's vital signs to establish maternal response to blood loss.

What is nursing care plan for abortion? ›

For abortion or elective termination, the nursing plan of care for clients includes assessing biopsychosocial status, giving appropriate instruction/information, promoting coping strategies and emotional support, and preventing postprocedural complications.

What are the roles of midwife in relation to abortion? ›

Nurses and midwives provide technical and psychosocial care to women who seek abortions. Governments and regulatory bodies could safely extend their scope of practice to increase women's access to safe abortions.

Which of the following are the specific responsibilities of the certified nurse midwives? ›

What does a certified nurse midwife do?
  • Primary care for expecting mothers and women.
  • Diagnosing and treating patients.
  • Providing references to specialists.
  • Collaborative work with physicians.
  • STD testing and treatment on expecting parents.
  • Education and preparation for new parents.
  • Handling labor and delivery.
Apr 23, 2020

What are the roles and responsibilities of a nurse midwife? ›

Nurse midwives provide care to women from adolescence through menopausal years. For pregnant women, they provide care during prenatal visits, attend the birth, and provide care after the baby is born. Nurse midwives have similar roles to OB/GYNs but focus on natural techniques for childbirth and reproductive care.

Can nurse practitioners perform abortions in Washington state? ›

In Washington State, physicians (medical doctors) and Advanced Registered Nurse Practitioners (ARNPs) can perform in-clinic abortion procedures and prescribe pills for a medication abortion in the first trimester of pregnancy (weeks 1-13).

Can a nurse practitioner practice without a doctor in PA? ›

In Pennsylvania, an NP cannot practice without physician supervision, and the state limits the range of medicines they can prescribe.

Can nurse practitioners prescribe in PA? ›

NPs are recognized as primary care providers in Pennsylvania. In Pennsylvania, an NP may prescribe drugs, devices and Schedule II-V controlled substances as outlined in a written collaboration agreement with a physician.

What percentage of doctors support abortion? ›

Unfortunately, only 14 percent of practicing OBGYNs provide abortion care. As a profession, our words and actions don't match. I think there's a multitude of reasons for that. One is the stigma associated with providing abortion care in some parts of the country.

Is abortion taught in medical schools? ›

It is one of the most common procedures in the U.S., even more common than appendectomies, and The American College of Obstetricians and Gynecologists (ACOG) recommends all medical schools teach abortion, though students can opt out and in-person experience isn't required.

How many doctors perform abortions in the US? ›

But the authors of a research letter published in JAMA Internal Medicine have come up with a number: Roughly 3550 clinicians provide procedural and medication abortions, while 22,001 manage pregnancy loss with the same procedures and medications.

Can PAs in California perform abortions? ›

As another example, California passed legislation in 2013 that allows APRNs, PAs, and certified nurse midwives who complete specified training to perform first trimester abortions under a physician's supervision.

Can midwives perform abortions in California? ›

Who may perform an abortion in California? Doctors, licensed nurses/midwives, nurse practitioners, and physician assistants with proper training can perform abortions in California.

Can a nurse practitioner prescribe medication without a doctor in California? ›

California's Nurse Practitioner Prescribing Laws

Nurse practitioners in California may order, administer, dispense and prescribe medications including schedule II-V controlled substances. Yes, NP's in this great state are allowed to prescribe the good stuff– within a collaborative practice agreement.

Can NP have tattoos? ›

The simple answer is yes. A tattoo is unlikely to disqualify you from working as a nurse, though there are some important considerations to keep in mind.

Why are physicians against nurse practitioners? ›

During legislative debate, the California Medical Association said nurse practitioners have less training than physicians, so allowing them to practice independently could lessen the quality of care and even pose a risk to patients.

What can a doctor do that a PA Cannot? ›

An MD can work independently, while a PA must always work under the supervision of a doctor. PAs can't perform surgeries, but they can assist an MD during the procedure. However, an MD and a PA both can: Develop patient treatment plans.

What is the difference between a certified nurse practitioner and a physician's assistant? ›

Physician assistants train using the medical model, similar to physicians, which means they focus on the testing, diagnosis, and treatment of the disease that the patient has. Nurse practitioners train on the nursing model, which means they focus on the testing, diagnosis, and treatment of the patient with the disease.

Can a PA perform surgery? ›

A PA may perform surgical procedures requiring other forms of anesthesia if authorized by the practice agreement and only when the supervising physician is “immediately available” as defined by Title 16 of the California Code of Regulations section 1399.541.

Is a nurse practitioner a real doctor? ›

There can be a lot of confusion about the scope of practice for different health care providers. When you see a nurse practitioner prescribing your medication, diagnosing you, and doing procedures, you may wonder, "is a nurse practitioner a doctor?” The short answer is no.

What can midwives not do? ›

Midwives cannot:
  • Administer anesthesia or use advanced medical equipment.
  • Administer epidurals (though anesthesiologists can administer one if you're delivering in a hospital)
  • Perform surgery, including C-sections.
  • Use vaccum- or forceps-assisted deliveries.

Can nurses perform abortions in Michigan? ›

Also, Michigan restricts APRNs, including midwives, from performing first trimester surgical abortions, even though it is included in the International Confederation of Midwives competencies and is safer than other procedures midwives perform. Medication abortion prescribing is restricted to physicians.

Can you have a midwife while pregnant? ›

You can book an appointment with your GP or directly with your midwife as soon as you find out you're pregnant. Your GP surgery or a children's centre can put you in touch with your nearest midwifery service. You can find your nearest children's centre through your local council.

What are the different types of abortions in nursing? ›

Abortion is the medical term for a pregnancy loss before 20 weeks of gestational age. The types of spontaneous abortion include threatened, inevitable, incomplete, complete, septic, and missed abortion[1].

What is septic abortion health education? ›

Septic abortion describes any type of abortion (intentional termination or miscarriage), due to an upper genital tract bacterial infection including the inflammation of the endometrium during or after 20 weeks of gestation.

What are the 5 elements of post abortion care? ›

  • Emergency treatment.
  • Family planning counseling and service delivery, and where financial and human resources exist, evaluation and treatment of sexually transmitted infections (STIs) as well as HIV counseling and/or referral for testing.
  • Community empowerment through community awareness and mobilization.
Sep 28, 2016

What is the medical management of post abortion care? ›

Post-abortion care has been identified as a very important component of secondary prevention. It should involve provision of contraception, counseling about STI prevention and use of barrier methods, prophylactic antibiotics, and counseling about adverse complications from the procedure.

What are three 3 nursing actions that should be included in the plan of care for the client who has dysphagia? ›

More interventions:
  • Avoidance of certain foods or fluids.
  • Upright position during eating.
  • Allowance of time to eat slowly and chew thoroughly.
  • Provision of high-calorie meals.
  • Use of fluids to help facilitate passage of solid foods.
  • Monitoring of the patient for weight loss or dehydration.
Mar 19, 2022

What is the risk for spontaneous abortion nursing diagnosis? ›

Risk factors for having a spontaneous abortion include advanced maternal age, previous pregnancy loss, maternal chronic disease, infections, and structural uterine abnormalities.

Can a nurse refuse to assist with an abortion? ›

Nurses should have the right to refuse to take part in an abortion based on moral objection. However, once the pregnancy is terminated, the nurse should no longer be able to refuse care. Doing so is no different than refusing to take care of a patient who was drinking and driving.

Why use a midwife instead of a doctor? ›

Many women choose a midwife over a doctor because they want additional emotional support before, during and after delivery. A midwife will get to know you, your family and your preferences over the course of your pregnancy.

What is the role of a midwife in prevention of gender based violence? ›

Midwives as reproductive health practitioners are in a strategic position to mitigate intergenerational violence by identifying and making the appropriate referrals for pregnant women who are victims of gender-based violence (GBV) (Taket et al., 2003).

What is the difference between a certified nurse midwife and a certified midwife? ›

A CNM is a registered nurse who graduates from a nurse-midwifery program, while a certified midwife is not a registered nurse. Instead, CMs have a healthcare-related degree or educational background and they graduate from a midwifery program.

What is the difference between midwife and nurse practitioner? ›

Certified nurse-midwives supervise births, which women's health NPs do not have the licensure to do. Women's health nurse practitioners can act as primary care providers, unlike certified nurse-midwives, and provide care for women throughout their lifespan, not just during pregnancy.

Is using a certified nurse midwife a good idea? ›

A safe option for low-risk pregnancies

According to studies, CNMs provide more access to prenatal care, lower cesarean birth rates, and babies with higher birth weights.

Is a midwife the same as a nurse? ›

Certified professional midwives (CPMs) are non-nurse midwives who have training and clinical experience in childbirth, including childbirth outside of the hospital, and have passed a national exam.

Is a midwife higher than a nurse? ›

In addition to training as a nurse, the nurse-midwife has completed a higher education program (either a master's or doctoral degree with a focus in midwifery) and performed hundreds to thousands of additional clinical hours both managing primary care patients and attending births during their training.

Is a midwife a qualified nurse? ›

The qualifications you'll need

To become a midwife you'll need a degree in midwifery, which takes three years to complete. If you're already a registered adult nurse, you can undertake a shorter course instead, which takes 18 months.

What can't physician assistants do? ›

While physician assistants can do many things, they cannot perform all the duties of a medical doctor. For example, physician assistants can assist in surgery, but we cannot perform surgery.

What are things doctors can do that PAs Cannot? ›

Some of the differences between PA and MD depend on where you're practicing (state/province/country), but, on the whole, PAs do not perform surgery (they can assist), they do not take on the most complex or acute medical cases, and they may or may not be able to prescribe medications (again, depending on location).

Can a PA work in fertility? ›

PAs work closely with patients and doctors in the reproductive endocrinology setting, performing routine procedures, establishing relationships with patients and providing a lot of their ongoing care.

Can a PA give birth? ›

There are some PAs who do well women care but not pregnancy and there are some who do office care of pregnant women. Other PAs work on Labor and Delivery where they participate in deliveries and may assist on cesarean sections or other surgeries.

What can a PA do that a nurse practitioner Cannot? ›

Scope of medical treatment

A physician assistant can diagnose and treat a wide array of medical concerns, prescribe medicine, and may even perform surgery. A nurse practitioner can help diagnose and treat patients with routine and complex medical conditions, sometimes working alongside physicians to do so.

What can a doctor do that a nurse practitioner Cannot? ›

A primary difference between physicians and NPs is the fact that all doctors can prescribe medication to patients as a part of their duties. Nurse practitioners also prescribe medicine, but in some states they must be directly overseen by a doctor or physician in order to do so.

Why see a PA instead of a doctor? ›

While doctors and physician assistants perform many of the same duties, PAs have a greater focus on patient care. They don't need to worry about budgets and bureaucracy, so a greater percentage of their time is taken up by the work that drew them to medicine in the first place.

What can PAs do that nurses cant? ›

PA job duties

While registered nurses assist patients from a nursing approach, PAs assume a role more or less similar to that of physicians. This gives physician assistants a more direct role in administering tests, performing examinations, and prescribing medication.

Do you address a PA as doctor? ›

A physician's assistant is not a doctor. If you want to address a physician's assistant in a formal manner, you use the honorific of "PA" before the physician's assistant's name. A physician's assistant is not a doctor, but a healthcare professional who performs a number of different tasks in the medical field.

Are physician assistants called doctors? ›

A physician's assistant is not a doctor. If you want to address a physician's assistant in a formal manner, you use the honorific of "PA" before the physician assistant's name. A physician assistant is not a doctor but is a healthcare professional who performs a number of different tasks in the medical field.

How much do IVF nurses make in PA? ›

How much does a Fertility Nurse make in Pennsylvania? As of Feb 19, 2023, the average annual pay for a Fertility Nurse in Pennsylvania is $64,932 a year. Just in case you need a simple salary calculator, that works out to be approximately $31.22 an hour. This is the equivalent of $1,248/week or $5,411/month.

Can physician assistants deliver babies in Pennsylvania? ›

Yes, PA's can deliver.

Is IVF legal in Pennsylvania? ›

Assisted Reproductive Technologies in Pennsylvania

Pennsylvania recognizes ART, including in vitro fertilization (IVF), sperm and egg donation and surrogacy, as legal means for individuals to create and grow their families.

Can two moms be on a birth certificate PA? ›

Request to Modify Parentage on a Birth Record

Please note that a maximum of two parents may be listed on a child's birth record in Pennsylvania. This form may not be used to modify a birth record due to adoption.

Can physician assistants perform C sections? ›

They also assist during surgeries, such as cesarean sections, hysterectomies, and post-partum tubal ligations. Physician assistants working with gynecology-oncology surgeons assist in procedures and surgeries such as: Radical hysterectomies.

How much does it cost to deliver a baby in PA? ›

The Average Cost of Having a Baby in Each State
StateTotal CostChildbirth Cost
Rhode Island$23,864$6,334
South Carolina$16,112$7,759
South Dakota$17,066$7,895
46 more rows


1. Orientation on Implementation of Nurse Practitioner in Midwifery Programme
(Indian Nursing Council)
2. Report Webinar: The Safety and Quality of Abortion Care in the United States
(NASEM Health and Medicine Division)
3. Webinar: Policy Agenda for Promoting Health and Wellbeing Across the Lifespan
(Center for Community Resilience)
4. Board of Registered Nursing Meeting - May 19 2022
(California Department of Consumer Affairs)
5. HGO Committee Session, 2/1/2022 #1
6. Service Delivery Patterns After Introduction of Telemedicine Provision of Medical Abortion
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