Nurses, mid­wives seek clar­ity on abor­tion

The Saratogian (Saratoga, NY) - - FRONT PAGE - By Marina Vil­leneuve As­so­ci­ated Press

AL­BANY, N.Y. >> There is still some some un­cer­tainty about how nurse prac­ti­tion­ers and mid­wives are af­fected by a law that was sup­posed to ex­pand the num­ber of New York health care providers who can per­form abor­tions.

In Jan­uary, the state Leg­is­la­ture cod­i­fied a “fun­da­men­tal right” to have an abor­tion at a time when some states have re­stricted ac­cess. The law le­gal­ized abor­tion af­ter 24 weeks of preg­nancy if a woman’s health is at risk or if the fe­tus is not vi­able.

The law says a health care provider act­ing within “his or her law­ful scope of prac­tice” may per­form an abor­tion, but it doesn’t spec­ify which prac­ti­tion­ers can pro­vide which types of abor­tion ser­vices.

That lack of de­tail has prompted the state’s ed­u­ca­tion de­part­ment, which li­censes health care pro­fes­sion­als, to reach out to Gov. Andrew Cuomo and the Leg­is­la­ture to un­der­stand how the law ap­plies to mid­wives and nurse prac­ti­tion­ers.

Ex­ist­ing rules don’t ex­actly say “whether abor­tion ser­vices are even within the scope of prac­tice for mid­wives,” the de­part­ment said in an email re­spond­ing to ques­tions from The As­so­ci­ated Press.

Nurse-mid­wife Eu­ge­nia Mon­tesinos, who works in New York City and is one of the state’s roughly 1,200 li­censed mid­wives, said mid­wives

of­ten work in hos­pi­tals and can al­ready ad­min­is­ter med­i­ca­tion that brings about abor­tion in New York. She said the state should make it clear that mid­wives are “in­de­pen­dent pro­fes­sion­als” who can pro­vide abor­tions in the first trimester with ad­e­quate train­ing.

“Even though we mostly do preg­nan­cies, we should also par­tic­i­pate when a women does want to go through that,” she said.

WHAT DOES THE LAW SAY?

The New York De­part­ment of Health has pre­vi­ously said physi­cian as­sis­tants can pro­vide abor­tion care un­der a physi­cian’s su­per­vi­sion, and the New York State Board for Nurs­ing has rec­og­nized nurse prac­ti­tion­ers can per­form abor­tion pro­ce­dures that don’t in­clude surgery. Mid­wives, mean­while, can pre­scribe and ad­min­is­ter drugs in New York.

One of the law’s lead spon­sors, Sen. Liz Krueger, a New York City Demo­crat, said be­fore it passed that it would en­sure that physi­cian as­sis­tants, nurse prac­ti­tion­ers and mid­wives can pro­vide abor­tion care if their li­cense al­lows it and they have the train­ing.

“The goal of the legislatio­n was to get out of the way and let the med­i­cal pro­fes­sion­als de­ter­mine who is qual­i­fied to pro­vide any par­tic­u­lar kind of abor­tion care,” Krueger told the AP in an email Fri­day.

Ex­ist­ing rules are less clear about whether nurse prac­ti­tion­ers and mid­wives can per­form cer­tain abor­tion pro­ce­dures with­out the over­sight of a physi­cian. Preg­nan­cies can be aborted by tak­ing med­i­ca­tion, through the use of suc­tion, or through a pro­ce­dure called di­la­tion and evac­u­a­tion that in­volves both suc­tion and the use of med­i­cal tools.

Health care prac­ti­tion­ers can face penal­ties for pro­fes­sional mis­con­duct if they per­form a ser­vice that’s be­yond the scope of their pro­fes­sion.

WHAT DO SUP­PORT­ERS, CRIT­ICS THINK?

Groups that sup­port ex­panded ac­cess to abor­tion — in­clud­ing the New York Civil Lib­er­ties Union and the state’s mid­wifery as­so­ci­a­tion — are push­ing New York to clearly lay out which non-doc­tors can pro­vide cer­tain kinds of abor­tions.

“Part of im­prov­ing ac­cess

is en­sur­ing that the providers who are qual­i­fied to pro­vide care can ac­tu­ally pro­vide care,” said Katharine Bodde, se­nior pol­icy coun­sel at the New York Civil Lib­er­ties Union.

Stephen Fer­rara, ex­ec­u­tive di­rec­tor of the statewide nurse prac­ti­tioner as­so­ci­a­tion, said many nurse prac­ti­tion­ers in New York have long pro­vided abor­tion med­i­ca­tion. But he said the lack of clar­ity on whether nurse prac­ti­tion­ers can now pro­vide abor­tions in­volv­ing suc­tion means New York’s new law hasn’t changed any­thing when it comes to who can pro­vide abor­tions.

“It cer­tainly can po­ten­tially de­lay women ac­cess­ing abor­tion ser­vices be­cause nurse prac­ti­tion­ers and mid­wives are not ex­plic­itly per­mit­ted to do so,” he said. He said it’s open to in­ter­pre­ta­tion whether such suc­tion pro­ce­dures count as surgery.

As some states and courts strike down physi­cian-only abor­tion laws, it can be up to pro­fes­sional li­cens­ing boards to fill in the de­tails about who ex­actly can pro­vide abor­tion care, ac­cord­ing to Elis­a­beth Smith, an at­tor­ney for the Cen­ter for Re­pro­duc­tion Rights.

“What has hap­pened is that state gov­ern­ments have re­moved physi­cianonly re­quire­ments, and not re­placed them,” Smith said. “Which cre­ates an area in which it would be pos­si­ble to pro­vide, but there aren’t af­fir­ma­tive pro­tec­tions, so it’s dif­fi­cult to trace if it’s hap­pen­ing.”

Abor­tion op­po­nents, in­clud­ing the Arch­dio­cese of New York, have said that New York’s new law will harm women and chil­dren by al­low­ing state reg­u­la­tors to de­cide which non­doc­tors can per­form abor­tions in­volv­ing suc­tion.

WHY DO SUP­PORT­ERS

WANT TO EX­PAND WHO CAN PER­FORM ABOR­TIONS?

A re­cent wave of abor­tion re­stric­tions across the na­tion has led abor­tion rights groups in­clud­ing Planned Par­ent­hood and sev­eral med­i­cal as­so­ci­a­tions to call on states to al­low more trained health prac­ti­tion­ers to per­form abor­tions.

Those groups are now tar­get­ing “physi­cians-only” abor­tion laws passed decades ago by states want­ing to pro­hibit un­scrupu­lous abor­tion providers. Mid­wives in roughly a dozen states have filed law­suits to strike down those laws.

Na­tion­wide, 34 states al­low only physi­cians to per­form med­i­ca­tion abor­tions, ac­cord­ing to the Guttmacher In­sti­tute, which sup­ports ex­panded ac­cess to abor­tion rights.

A hand­ful of states al­low nurse prac­ti­tion­ers, physi­cian as­sis­tants and mid­wives who are also nurses to per­form both med­i­ca­tion and suc­tion abor­tions.

A 2013 Univer­sity of Cal­i­for­nia San Fran­cisco study found that those three types of providers can safely per­form abor­tions by med­i­ca­tion and vacuum just as safely as doc­tors.

Still, abor­tion op­po­nents ar­gue that al­low­ing peo­ple other than doc­tors to per­form the pro­ce­dures low­ers the stan­dard of care for women.

The Amer­i­can Med­i­cal As­so­ci­a­tion, which fought to ban abor­tion in the 1880s and later pushed to re­strict mid­wives and nurse prac­ti­tion­ers, reaf­firmed in 2010 its stance that only doc­tors should per­form abor­tions. The group didn’t re­spond to re­quests for com­ment.

“Abor­tion is a med­i­cal pro­ce­dure and should be per­formed only by a duly li­censed physi­cian and sur­geon in con­for­mance with stan­dards of good med­i­cal prac­tice and the med­i­cal prac­tice act of his state,” reads the group’s pol­icy.

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