Re-examining the role of nurses and midwives in abortion
What is current role of nurses and midwives in abortion procedures?
Is there a pro-abortion bias in the medical profession?
The debate has continued for years over whether access to abortion can be made easier by allowing midwives and nurses to carry out early abortions. At their recent annual meeting, the British Medical Association voted against allowing other medical personnel to carry out abortions, stating that the procedure entails risks which make a doctor’s presence necessary.
Leading arguments for this position, Dr David Pring said, “The operation is timely, is technically very difficult, especially in young women and sadly these make up a significant number of our clientele.”
The BMA’s decision is significant as it will be included in their recommendation to parliament for the Scientific Inquiry into the 1967 Abortion Act. Under present laws, only a registered medical practitioner can legally carry out abortions. It would be illegal for a nurse or midwife to do so without being part of a team of doctors or surgeons.
The pro-choice rally has stressed over the last few years that early abortions are safe and that nurses and midwives are perfectly capable of dispensing drugs for an early medical abortion.
Citing the fact that 89 per cent of abortions in Britain are carried out at under-13 weeks, Abortion Rights director Anne Quesney said: “Allowing nurses to perform this very straightforward and common procedure would have a positive impact on service provision, women’s access to abortion and NHS waiting times.”
An article by Vincent Argent and Lin Pavey published in the Journal of Family Planning & Reproductive Health Care suggested the possibility of a nurse or a midwife performing surgical abortions without a doctor present. Surgical abortions involve using a vacuum pump or hand-held syringe to remove the contents of the womb.
Ann Furedi, Chief Executive of the British Pregnancy Advisory Service said the article reflected the fact that the role of nurses was already expanding and that patients supported this.
“In South Africa and some states in the USA, nurses can lead in this type of ‘surgical’ procedure,” she said.
“The technical skill involved is broadly similar to that used in fitting a woman with an IUD (the ‘coil’). It is a gentle suction method, taking place via a soft catheter. BPAS’ early ‘medical’ abortion service (the pill and pessary method) has been nurse-led for nearly ten years.
“To comply with the law, our doctors prescribe the appropriate medicine, but women using this method tell us that they appreciate having their treatment from a nurse.”
Regarding the Argent and Pavey article, the NMC stated that although midwives and nurses are now trained to do a number of surgical procedures that were previously performed by doctors, the law makes no provisions for them to carry out abortions independently.
According to Dr Himansu Basu, nurses already have a fairly significant role in abortion procedures.
“Nurses and midwives are carrying out a lot of work doctors used to carry out particularly where the work is of a repetitive nature. We’re talking not only about actual technique of carrying out abortion but also the counselling beforehand, support afterward, a lot of these can be carried out and are carried out by nurses.”
Although nurses do play a large role, Dr Basu feels that they should remain part of a larger team which includes experienced doctors as opposed to working in isolation.
“Even with that, now precedence of nurses carrying out procedures as I said particularly of a repetitive nature where they have competence… what I’d like to suggest that this is part of a set-up where doctors of more senior competence are readily available.
“In other words I’m making a distinction between nurses who are isolated from being part of a team and nurses and midwives who are very much part of a team. In the second model that I have just described it’s perfectly possible to say it’s reasonable for nurses can carry out termination of pregnancy, particularly early terminations.”
Doctors say that abortion is still a complicated procedure, despite arguments that early abortions are very safe. Side effects associated with abortion include haemorrhage, infection, pain, and nausea.
Dr David Pring stated at the BMA annual meeting that frequently only the more experienced surgeons are able to quickly pick up on signs indicating possible serious complications during the procedure.
There is some concern that adding abortion to the list of duties of nurses will further burden an already strained profession. In June, an article on the BBC website declared that the “Birth surge ‘stretches midwives’”. Reporting that live births in the UK in 2006 reached a 26-year high, the BBC said maternity units were strained and home-births were at an all-time low because there simply weren’t enough midwives.
These difficulties were confirmed by the general secretary of the Royal College of Midwives, who said over 80% of heads of midwifery said they did not have the number of staff needed to cope with the workload.
Helen Pearson, a registered nurse in Southampton, agrees that nurses are being strained by their workload and cited problems with the NHS for the shortage of staff.
Speaking of the situation in her workplace, Brighton midwife Veronica Langford said: “It’s totally impossible to see with the number of midwives there are at the moment and the workload that we do have, to think for a minute that we would also be involved with abortion.”
Another concern is that the medical profession is increasingly adopting a pro-abortion stance, and this might affect professionals who are against abortion. Currently the conscientious objection clause affords protection to anyone who objects to performing any procedure in the workplace.
Veronica Langford is a pro-life midwife. She says so far she hasn’t been pressured into doing anything she doesn’t feel comfortable with, but there is always someone else to take up the task.
She added: “I certainly think that the medical profession generally is more pro-choice and that my view is not well-represented. Certainly in a way I think if you have a pro-life view it’s something that you are almost encouraged to keep to yourself, that your views and your beliefs don’t come into it.”
Helen Pearson questions why people would enter profession knowing that they object to duties that would be required of them.
“You could argue that a nurse that works in that field of nursing knows the type of nursing they’ll be doing, and so to some degree, regardless of what they think, it’s their job and they should carry it out,” she said.
“Why would you work in that field of nursing if you didn’t agree with terminations? That’s your job.”
Veronica Langford doesn’t see abortions as a necessary part of her profession.
“I see my role very much as, in a professional way, to safeguard women throughout pregnancy, throughout the birth and throughout the post-natal period,” she said.
“I definitely feel that carrying out an abortion procedure is totally at odds with the role as midwife. It’s quite frightening to think that one day you might be bringing a baby into the world and trying to safeguard it, and then another day you might be expected to end a pregnancy.”
At the end of the day, Helen Pearson feels that says that healthcare professionals should act in the best interests of their patients.
“I think it’s important to consider you’re treating the patient and you’re there to act in the best needs, and if that is the best need for them to terminate their pregnancy then a nurse has to do, that’s their job.”